PHYSICAL LOCATION INSPECTION-COASTAL

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PHYSICAL LOCATION INSPECTION-COASTAL

INSPECTION INFO

Date / Time of Inspection

Date

Time

CLINIC

CLINIC EMAIL *

PERSON DOING INPECTION *

First

Last

WC ON DUTY *

First

Last

DOCTOR ON DUTY 1 *

First

Last

DOCTOR ON DUTY 2 *

First

Last

FRONT AREA

LOBBY CLEANED REGULARLY

LOOKS GOOD
LOOKS NEGLECTED

FLOORS

LOOKS GOOD
LOOKS NEGLECTED

CHAIRS

LOOKS GOOD
LOOKS NEGLECTED

NO UNATHORIZED MATERIALS

NONE
PRESENT

FRONT AREA COMMENTS

SLIDESHOW

SLIDESHOW UPDATED

LOOKS GOOD
LOOKS NEGLECTED

SLIDESHOW COMMENTS

GLASS AND DOOR

FRONT GLASS

CLEAN
DIRTY

FRONT GLASS COMMENTS

DOOR

CORRECT NAMES
NEEDS WORK

DOOR COMMENTS

DOCTORS CREDENTIALS

CORRECT
NEEDS ATTENTION

CREDENTIALS DISPLAYED COMMENTS

DRESS CODE

CORRECT
NEEDS ATTENTION

DRESS CODE COMMENTS

FRONT DESK AREA

FRONT DESK

NEAT AND ORGANIZED
NEEDS WORK

FRONT DESK COMMENTS

DOCTORS AREA

CLEAN AND ORGANIZED
NEEDS WORK
SOMETHING IS BROKEN

COMMENTS: (copy)

FACEPAPER

STOCKED
NEEDS ATTENTION

COMMENTS:

SUPPLIES

CLEANING SUPPLIES

STOCKED
NEEDS ATTENTION

PAPER PRODUCTS

STOCKED
NEEDS ATTENTION

COMMENTS:

DOK SHOP SUPPLIES

DOK SHOP

STOCKED
NEEDS ATTENTION

COMMENTS:

NEW PATIENT FOLDERS

FOLDERS MADE

STOCKED
NEEDS ATTENTION

COMMENTS:

BATHROOM CLEANLINESS (copy)

BATHROOM

CLEAN
WELL STOCKED
DIRTY / UNSTOCKED
SOMETHINGS BROKEN

COMMENTS

CASH HANDLING

CASH

PETTY CASH COUNT MATCHES LOG
BUSINESS CASH COUNT MATCHES LOG
PETTY CASH IS OFF
BUSINESS CASH IS OFF

COMMENTS

INVENTORY

STOCK LEVELS MATCH LAST INVENTORY
WELL STOCKED
INVENTORY IS LOW
STOCK LEVELS DON’T JIVE WITH INVENTORY
THEFT SUSPECTED

COMMENTS

OTHER COMMENTS

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CLINIC