Please enable JavaScript in your browser to complete this form.INSPECTION INFODate / Time of InspectionDateTimeCLINIC CLINIC EMAIL *PERSON DOING INPECTION *FirstLastWC ON DUTY *FirstLastDOCTOR ON DUTY 1 *FirstLastDOCTOR ON DUTY 2FirstLastFRONT AREA LOBBY CLEANED REGULARLYLOOKS GOODLOOKS NEGLECTEDFLOORSLOOKS GOODLOOKS NEGLECTEDCHAIRSLOOKS GOODLOOKS NEGLECTEDNO UNATHORIZED MATERIALSNONEPRESENTFRONT AREA COMMENTS SLIDESHOWSLIDESHOW UPDATEDLOOKS GOODLOOKS NEGLECTEDSLIDESHOW COMMENTSGLASS AND DOORFRONT GLASSCLEANDIRTYFRONT GLASS COMMENTSDOORCORRECT NAMESNEEDS WORKDOOR COMMENTSDOCTORS CREDENTIALS DOCTORS CREDENTIALS CORRECTNEEDS ATTENTIONCREDENTIALS DISPLAYED COMMENTSDRESS CODEDRESS CODE CORRECTNEEDS ATTENTIONDRESS CODE COMMENTSFRONT DESK AREAFRONT DESKNEAT AND ORGANIZEDNEEDS WORKFRONT DESK COMMENTSDOCTORS AREADOCTORS AREACLEAN AND ORGANIZEDNEEDS WORKSOMETHING IS BROKENCOMMENTS: (copy)FACEPAPERFACEPAPER STOCKEDNEEDS ATTENTIONCOMMENTS:SUPPLIESCLEANING SUPPLIESSTOCKEDNEEDS ATTENTIONPAPER PRODUCTSSTOCKEDNEEDS ATTENTIONCOMMENTS: DOK SHOP SUPPLIESDOK SHOP STOCKEDNEEDS ATTENTIONCOMMENTS: NEW PATIENT FOLDERSFOLDERS MADESTOCKEDNEEDS ATTENTIONCOMMENTS: BATHROOM CLEANLINESS BATHROOM CLEANWELL STOCKEDDIRTY / UNSTOCKEDSOMETHINGS BROKENCOMMENTSCASH HANDLINGCASH PETTY CASH COUNT MATCHES LOGBUSINESS CASH COUNT MATCHES LOGPETTY CASH IS OFFBUSINESS CASH IS OFFCOMMENTSHANDOFF & NEW PATIENT COMMUNICATIONEXECUTION OF HANDOFF / PROPER NEW PATIENT COMMUNICATIONWELL DONENEEDS WORKNONE TO SEECOMMENTS PATIENT FLOW MANAGMENT AND INTERACTIONSPATIENT FLOW MANAGEMENT AND INTERACTIONS SATISFACTORYWELL MANAGEDNEEDS WORKCOMMENTS CONFLICT RESOLUTION (IF OBSERVED)CONFLICT RESOLUTIONWELL HANDLED ALL SITUATIONSNEEDS WORKNO CONFLICT WAS OBSERVEDINVENTORY INVENTORY STOCK LEVELS MATCH LAST INVENTORYSTOCK LEVELS DON’T JIVE WITH INVENTORYCOMMENTSOTHER COMMENTSOTHER COMMENTS Submit
