Section 1 – Clinic & Audit Information

Please complete this section before commencing the audit. Verify all information with the clinic representative and ensure the details recorded accurately identify the premises being audited.

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Clinic Details

Clinic Name * Clinic Address * Building Photograph *Photograph Notes

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Audit Details

Audit Date * Auditor * Clinic Representative * Position * Registered Manager CQC Provider ID

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Clinic Profile

Clinic Type *Select clinic typeDental PracticeGP SurgeryPrivate Medical ClinicPhysiotherapy ClinicOpticiansPharmacyAesthetic ClinicVeterinary PracticeOtherIf Other Services ProvidedNumber of EmployeesTypical Daily Patients / Visitors

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Purpose of Audit

Reason for Audit *Select reasonRoutine Compliance AuditInitial Compliance AuditCQC PreparationFollowing IncidentInsurance RequirementManagement RequestOtherIf audit relates to a CQC inspection or request, provide details.Record any specific CQC actions, concerns, inspection themes or requested areas that should receive particular attention during this audit. Leave blank if not applicable.

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Overall Impression on Arrival

Before reviewing documentation, record your first impressions of the premises. Consider: • External condition • Cleanliness • Security • Ease of access • General housekeeping • Professional appearance • Any obvious hazards This section captures your unbiased first observations before speaking with staff or reviewing documents.

Section 2 – Health & Safety Management

This section reviews the clinic's management arrangements to determine whether suitable systems are in place to effectively manage health, safety and legal compliance.

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Health & Safety Policy

Status * Select statusCompliantMinor Non-ConformityMajor Non-ConformityObservationNot ApplicablePriority * Select priorityNoneLowMediumHighAuditor NotesReview the current Health & Safety Policy. Confirm: • Signed by senior management. • Dated and reviewed within the last 12 months. • Appropriate for the size and activities of the clinic. • Responsibilities clearly allocated. • Available to staff. Record any deficiencies, missing information or examples of good practice.

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Competent Health & Safety Advice

Status * Select statusCompliantMinor Non-ConformityMajor Non-ConformityObservationNot ApplicablePriority * Select priorityNoneLowMediumHighAuditor NotesDetermine who provides competent Health & Safety advice. Confirm: • Internal or external competent person identified. • Suitable qualifications or experience. • Evidence advice is available when required. Record details of the competent person and any deficiencies.

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Risk Assessment Management

Status * Select statusCompliantMinor Non-ConformityMajor Non-ConformityObservationNot ApplicablePriority * Select priorityNoneLowMediumHighAuditor NotesReview the clinic's risk assessment arrangements. Confirm: • Suitable assessments are available. • Assessments reflect current activities. • Reviewed regularly. • Significant findings implemented. • Staff aware of relevant controls. Do not review individual risk assessments here—only the overall management system.

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Staff Consultation & Communication

Status * Select statusCompliantMinor Non-ConformityMajor Non-ConformityObservationNot ApplicablePriority * Select priorityNoneLowMediumHighAuditor NotesDetermine how Health & Safety information is communicated. Consider: • Team meetings. • Safety briefings. • Staff notice boards. • Consultation arrangements. • Mechanisms for reporting concerns. Record examples seen during the audit.

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Monitoring & Continuous Improvement

Status * Select statusCompliantMinor Non-ConformityMajor Non-ConformityObservationNot ApplicablePriority * Select priorityNoneLowMediumHighAuditor NotesReview how the organisation monitors Health & Safety performance. Consider: • Internal inspections. • Previous audits. • Action tracking. • Management reviews. • KPI monitoring. • Continuous improvement processes. Record evidence demonstrating active management rather than reactive compliance.

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Overall Management System

Examples of Good PracticeRecord positive observations that demonstrate effective management arrangements.Key Management Improvements RequiredSummarise the most significant management issues identified within this section. Avoid repeating observations already recorded above.

Section 3 – Workplace Safety

This section assesses the general condition of the workplace to determine whether the premises provide a safe environment for employees, patients, contractors and visitors.

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Access & External Areas

Status * Select statusCompliantMinor Non-ConformityMajor Non-ConformityObservationNot ApplicablePriority * Select priorityNoneLowMediumHighAuditor NotesInspect all approaches to the premises. Consider: • Safe pedestrian access. • Vehicle movements. • Lighting. • Surface condition. • Steps and handrails. • Disabled access. • Trip hazards. • External housekeeping. Record any defects that may present a risk to staff, patients or visitors.

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Internal Circulation Routes

Status * Select statusCompliantMinor Non-ConformityMajor Non-ConformityObservationNot ApplicablePriority * Select priorityNoneLowMediumHighAuditor NotesWalk all accessible circulation routes. Check: • Corridors unobstructed. • Floors in good condition. • Adequate lighting. • Changes in level identified. • No trailing cables. • Safe storage. • Good housekeeping. Record any hazards identified.

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Housekeeping Standards

Status * Select statusCompliantMinor Non-ConformityMajor Non-ConformityObservationNot ApplicablePriority * Select priorityNoneLowMediumHighAuditor NotesAssess general housekeeping throughout the premises. Consider: • Cleanliness. • Waste management. • Storage arrangements. • Stock control. • Spillages. • Clutter. • Trip hazards. Record both positive observations and deficiencies.

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Working Environment

Status * Select statusCompliantMinor Non-ConformityMajor Non-ConformityObservationNot ApplicablePriority * Select priorityNoneLowMediumHighAuditor NotesAssess the suitability of the working environment. Consider: • Lighting. • Ventilation. • Temperature. • Noise. • Workspace. • General comfort. • Evidence of poor maintenance. Record any issues affecting staff welfare or patient experience.

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Welfare Facilities

Status * Select statusCompliantMinor Non-ConformityMajor Non-ConformityObservationNot ApplicablePriority * Select priorityNoneLowMediumHighAuditor NotesInspect welfare facilities provided for staff. Consider: • Toilets. • Washing facilities. • Drinking water. • Rest facilities. • Kitchen areas. • Cleanliness. • Supplies. Confirm facilities are suitable for the number of employees.

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Security Arrangements

Status * Select statusCompliantMinor Non-ConformityMajor Non-ConformityObservationNot ApplicablePriority * Select priorityNoneLowMediumHighAuditor NotesReview security arrangements. Consider: • Controlled access. • Door security. • Visitor management. • CCTV (if provided). • Lone working. • Out-of-hours security. • Protection of staff and patients. Record any vulnerabilities identified.

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Accessibility

Status * Select statusCompliantMinor Non-ConformityMajor Non-ConformityObservationNot ApplicablePriority * Select priorityNoneLowMediumHighAuditor NotesAssess accessibility for patients and visitors. Consider: • Step-free access. • Accessible WC. • Door widths. • Signage. • Waiting areas. • Reception arrangements. • Reasonable adjustments. Record any barriers that may disadvantage service users.

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Summary of Workplace Safety

Examples of Good PracticeRecord examples of good housekeeping, maintenance, accessibility or workplace standards observed during the inspection.Key Improvements RequiredSummarise the most significant workplace issues identified. Do not repeat detailed observations already recorded above.

Section 4 – Infection Prevention & Control (IPC)

This section assesses the arrangements in place to prevent and control infection risks. The audit should consider policies, working practices, environmental cleanliness and compliance with recognised infection prevention guidance.

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Infection Prevention & Control Management

Status * Select statusCompliantMinor Non-ConformityMajor Non-ConformityObservationNot ApplicablePriority * Select priorityNoneLowMediumHighAuditor NotesReview the overall infection prevention arrangements. Confirm: • IPC policy available and current. • Named IPC Lead appointed. • Staff understand responsibilities. • Regular audits undertaken. • Action plans completed where required. Record the name of the IPC Lead within your notes together with any deficiencies identified.

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Environmental Cleanliness

Status * Select statusCompliantMinor Non-ConformityMajor Non-ConformityObservationNot ApplicablePriority * Select priorityNoneLowMediumHighAuditor NotesInspect all clinical and non-clinical areas. Consider: • Overall cleanliness. • Cleaning schedules. • Evidence of deep cleaning. • High-touch surfaces. • Waste bins. • Floors, walls and ceilings. • Washrooms. • Waiting areas. Record any areas requiring improved cleaning standards.

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Hand Hygiene Facilities

Status * Select statusCompliantMinor Non-ConformityMajor Non-ConformityObservationNot ApplicablePriority * Select priorityNoneLowMediumHighAuditor NotesInspect hand hygiene arrangements. Confirm: • Clinical hand wash basins provided where required. • Liquid soap available. • Alcohol hand gel available. • Disposable towels provided. • Hand hygiene posters displayed where appropriate. Record any deficiencies or poor practice observed.

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Personal Protective Equipment (PPE)

Status * Select statusCompliantMinor Non-ConformityMajor Non-ConformityObservationNot ApplicablePriority * Select priorityNoneLowMediumHighAuditor NotesReview PPE arrangements. Consider: • Appropriate PPE available. • Correct storage. • Staff using PPE correctly. • Supplies maintained. • Eye protection available where required. Record any examples of incorrect use or shortages.

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Treatment Rooms & Clinical Areas

Status * Select statusCompliantMinor Non-ConformityMajor Non-ConformityObservationNot ApplicablePriority * Select priorityNoneLowMediumHighAuditor NotesInspect treatment and consultation rooms. Consider: • Cleanliness. • Surfaces in good condition. • Clinical waste management. • Hand washing facilities. • Equipment cleanliness. • Decontamination arrangements. • Stock storage. • Separation of clean and dirty equipment. Record any deficiencies.

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Decontamination of Equipment

Status * Select statusCompliantMinor Non-ConformityMajor Non-ConformityObservationNot ApplicablePriority * Select priorityNoneLowMediumHighAuditor NotesReview cleaning and decontamination procedures. Confirm: • Written procedures available. • Appropriate disinfectants used. • Reusable equipment effectively decontaminated. • Staff understand procedures. Record any deficiencies or inconsistencies.

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Clinical Waste Management

Status * Select statusCompliantMinor Non-ConformityMajor Non-ConformityObservationNot ApplicablePriority * Select priorityNoneLowMediumHighAuditor NotesInspect clinical waste arrangements. Consider: • Correct segregation. • Appropriate waste containers. • Storage arrangements. • Collection records. • Waste contractor documentation. • No overfilled containers. Record any non-compliances identified.

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Overall Infection Prevention & Control

Examples of Good PracticeRecord examples of effective infection prevention and control arrangements observed during the audit.Key Improvements RequiredSummarise the principal infection prevention issues identified. Avoid repeating detailed observations already recorded above.

Section 5 – Clinical Safety & Hazardous Substances

This section reviews the management of hazardous substances, medicines and sharps to ensure suitable controls are in place to protect staff, patients and visitors from foreseeable harm.

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COSHH Management

Status * Select statusCompliantMinor Non-ConformityMajor Non-ConformityObservationNot ApplicablePriority * Select priorityNoneLowMediumHighAuditor NotesReview the management of hazardous substances. Confirm: • COSHH register available. • Assessments are current. • Safety Data Sheets available. • Staff understand control measures. • Appropriate PPE identified. • Assessments reflect substances currently used. Record any missing documentation or poor practices.

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Chemical Storage

Status * Select statusCompliantMinor Non-ConformityMajor Non-ConformityObservationNot ApplicablePriority * Select priorityNoneLowMediumHighAuditor NotesInspect chemical storage areas. Consider: • Secure storage. • Correct labelling. • Compatible substances stored together. • Spill control measures. • Containers in good condition. • No decanted unidentified chemicals. Record any unsafe storage arrangements.

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Medicines Management

Status * Select statusCompliantMinor Non-ConformityMajor Non-ConformityObservationNot ApplicablePriority * Select priorityNoneLowMediumHighAuditor NotesReview medicine storage arrangements. Consider: • Secure storage. • Access restrictions. • Stock rotation. • Expiry date checks. • Medicines clearly identified. • Controlled drugs managed appropriately (where applicable). Record any issues affecting the safe storage or management of medicines.

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Medicine Refrigeration

Status * Select statusCompliantMinor Non-ConformityMajor Non-ConformityObservationNot ApplicablePriority * Select priorityNoneLowMediumHighCurrent Recorded TemperatureAuditor NotesInspect medicine refrigeration. Confirm: • Dedicated medicine fridge. • Temperature monitoring records. • Daily checks completed. • Temperature within acceptable limits. • Fridge clean and organised. • No food or drink stored. Record any deficiencies identified.

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Sharps Management

Status * Select statusCompliantMinor Non-ConformityMajor Non-ConformityObservationNot ApplicablePriority * Select priorityNoneLowMediumHighAuditor NotesInspect sharps management arrangements. Consider: • Sharps containers correctly assembled. • Correct locations. • Not overfilled. • Temporary closure used when appropriate. • Safe disposal arrangements. • Staff aware of reporting procedures. Record any unsafe practices observed.

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Needlestick & Exposure Management

Status * Select statusCompliantMinor Non-ConformityMajor Non-ConformityObservationNot ApplicablePriority * Select priorityNoneLowMediumHighAuditor NotesReview arrangements for managing sharps injuries and exposure incidents. Confirm: • Procedure available. • Staff understand reporting process. • Occupational Health arrangements. • Hepatitis B vaccination programme where appropriate. • Incident records maintained. Record any deficiencies or improvements required.

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Overall Clinical Safety

Examples of Good PracticeRecord examples of good clinical safety arrangements observed during the inspection.Key Improvements RequiredSummarise the principal issues identified within this section. Avoid repeating individual observations already recorded.

Section 6 – Premises, Equipment & Statutory Compliance

This section assesses whether the premises, equipment and engineering controls are suitably maintained, inspected and managed to ensure ongoing compliance with statutory requirements and manufacturer recommendations.

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Medical & Clinical Equipment

Status * Select statusCompliantMinor Non-ConformityMajor Non-ConformityObservationNot ApplicablePriority * Select priorityNoneLowMediumHighAuditor NotesInspect a representative sample of clinical and portable equipment. Confirm: • Equipment appears safe and serviceable. • Asset register maintained. • Maintenance records available. • Calibration completed where required. • Defective equipment removed from use. • Users appear competent. Record any damaged, poorly maintained or overdue equipment.

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Electrical Safety

Status * Select statusCompliantMinor Non-ConformityMajor Non-ConformityObservationNot ApplicablePriority * Select priorityNoneLowMediumHighDate of Latest EICR (if applicable)Auditor NotesReview electrical safety management. Confirm: • Current Electrical Installation Condition Report (EICR). • Defects addressed. • Portable appliance inspection programme where appropriate. • Extension leads used appropriately. • No obvious electrical hazards. Record any deficiencies or unsafe electrical practices observed.

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Legionella & Water Hygiene

Status * Select statusCompliantMinor Non-ConformityMajor Non-ConformityObservationNot ApplicablePriority * Select priorityNoneLowMediumHighAuditor NotesReview water hygiene management. Confirm: • Legionella Risk Assessment available. • Responsible Person appointed. • Water temperature monitoring completed. • Sentinel outlets identified. • Flushing programme where required. • Little-used outlets managed. Record any missing records or deficiencies.

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Gas Safety (Where Applicable)

Status * Select statusCompliantMinor Non-ConformityMajor Non-ConformityObservationNot ApplicablePriority * Select priorityNoneLowMediumHighAuditor NotesWhere gas installations exist, confirm: • Current Gas Safety Certificate. • Appliances maintained. • Plant rooms secure. • Ventilation unobstructed. • Defects rectified. Select 'Not Applicable' where no gas installation exists.

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Premises Maintenance

Status * Select statusCompliantMinor Non-ConformityMajor Non-ConformityObservationNot ApplicablePriority * Select priorityNoneLowMediumHighAuditor NotesAssess the overall condition of the premises. Consider: • Planned preventative maintenance programme. • Building fabric. • Lighting. • Flooring. • Doors. • Ceilings. • Signs of water ingress. • General repair. Record any defects likely to affect safety, patient care or business continuity.

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Contractor Management

Status * Select statusCompliantMinor Non-ConformityMajor Non-ConformityObservationNot ApplicablePriority * Select priorityNoneLowMediumHighAuditor NotesReview arrangements for appointing and controlling contractors. Confirm: • Competence checks completed. • RAMS reviewed where appropriate. • Contractors supervised. • Induction arrangements. • Permit systems where required. • Records retained. Record any deficiencies identified.

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Asbestos Management (Where Applicable)

Status * Select statusCompliantMinor Non-ConformityMajor Non-ConformityObservationNot ApplicablePriority * Select priorityNoneLowMediumHighAuditor NotesWhere the building was constructed before 2000, confirm: • Asbestos Management Survey available. • Asbestos Register accessible. • Management Plan in place. • Contractors informed before work. • Materials remain in good condition. Select 'Not Applicable' where asbestos legislation does not apply.

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Overall Premises & Compliance

Examples of Good PracticeRecord examples of effective premises management, planned maintenance or statutory compliance.Key Improvements RequiredSummarise the most significant maintenance or statutory compliance issues identified within this section.

Section 7 – People, Training & Competence

This section assesses whether employees have received appropriate information, instruction, training and supervision to undertake their duties safely and competently. It also reviews arrangements for occupational health, wellbeing and manual handling where applicable.

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Staff Induction

Status * Select statusCompliantMinor Non-ConformityMajor Non-ConformityObservationNot ApplicablePriority * Select priorityNoneLowMediumHighAuditor NotesReview the induction process for new employees. Confirm: • Corporate induction completed. • Local induction completed. • Health & Safety responsibilities explained. • Emergency procedures discussed. • Competency records retained. Review a sample of recent employee records and record any deficiencies.

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Training & Competence

Status * Select statusCompliantMinor Non-ConformityMajor Non-ConformityObservationNot ApplicablePriority * Select priorityNoneLowMediumHighAuditor NotesReview the staff training matrix. Confirm training appropriate to each role. Consider: • Health & Safety • Infection Prevention & Control • COSHH • Manual Handling • Safeguarding • First Aid (where required) • Clinical competency • Refresher training Review a representative sample of records and identify any expired or missing training.

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Professional Registration & Clinical Competence

Status * Select statusCompliantMinor Non-ConformityMajor Non-ConformityObservationNot ApplicablePriority * Select priorityNoneLowMediumHighAuditor NotesWhere staff are professionally registered, verify registration remains current. Consider: • GMC • GDC • NMC • HCPC • GPhC • Other professional bodies Confirm evidence of continuing professional competence where appropriate.

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Manual Handling

Status * Select statusCompliantMinor Non-ConformityMajor Non-ConformityObservationNot ApplicablePriority * Select priorityNoneLowMediumHighAuditor NotesAssess manual handling arrangements. Consider: • Risk assessments completed. • Staff trained. • Suitable equipment provided. • Safe lifting practices observed. • Patient handling arrangements where applicable. Record any unsafe practices or missing controls.

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Health Surveillance & Staff Wellbeing

Status * Select statusCompliantMinor Non-ConformityMajor Non-ConformityObservationNot ApplicablePriority * Select priorityNoneLowMediumHighAuditor NotesReview arrangements to support employee health. Consider: • Occupational Health referrals. • Health surveillance where required. • Vaccination programmes. • Stress and wellbeing support. • Return to work procedures. • Reasonable workplace adjustments. Record any deficiencies or examples of good practice.

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First Aid Provision

Status * Select statusCompliantMinor Non-ConformityMajor Non-ConformityObservationNot ApplicablePriority * Select priorityNoneLowMediumHighAuditor NotesReview first aid arrangements. Confirm: • First aid needs assessment completed. • Appropriate number of trained first aiders. • First aid kits available and maintained. • Accident information displayed. • Emergency equipment inspected where applicable. Record any deficiencies identified.

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Overall People & Competence

Examples of Good PracticeRecord examples of effective staff development, supervision, competence management or employee engagement.Key Improvements RequiredSummarise the principal training, competence or workforce management issues identified during the audit.

Section 8 – Governance, Incident Management & Compliance

This section reviews the clinic's governance arrangements, incident management procedures and key compliance documentation to determine whether suitable systems are in place to support safe service delivery.

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Incident Reporting & Investigation

Status * Select statusCompliantMinor Non-ConformityMajor Non-ConformityObservationNot ApplicablePriority * Select priorityNoneLowMediumHighAuditor NotesReview the clinic's incident reporting arrangements. Confirm: • Incident reporting procedure available. • Accident book maintained. • Incidents investigated appropriately. • Learning shared with staff. • RIDDOR reports submitted where required. • Trends reviewed by management. Review a sample of recent incidents where possible and record any deficiencies identified.

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Safeguarding & Clinical Governance

Status * Select statusCompliantMinor Non-ConformityMajor Non-ConformityObservationNot ApplicablePriority * Select priorityNoneLowMediumHighAuditor NotesReview safeguarding and governance arrangements. Confirm: • Named Safeguarding Lead. • Appropriate safeguarding training completed. • Safeguarding policy current. • Confidentiality maintained. • Consent procedures followed. • Information governance arrangements appropriate. • Clinical escalation procedures understood. Record any concerns affecting patient safety or regulatory compliance.

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Fire Risk Assessment

Status * Select statusCompliantMinor Non-ConformityMajor Non-ConformityPriority * Select priorityNoneLowMediumHighDate of Current Fire Risk AssessmentAuditor NotesConfirm that a suitable and sufficient Fire Risk Assessment has been completed by a competent person. Verify: • Assessment is current. • Covers the current use of the premises. • Significant findings are suitable. • Recommendations have been completed or are actively managed. • Evidence of periodic review. This audit does NOT assess fire precautions in detail. If no suitable Fire Risk Assessment exists, record this as a Major Non-Conformity and explain why.

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Regulatory Compliance

Status * Select statusCompliantMinor Non-ConformityMajor Non-ConformityObservationPriority * Select priorityNoneLowMediumHighAuditor NotesReview overall regulatory compliance. Consider: • CQC registration requirements. • Previous inspection actions. • Improvement notices. • Regulatory correspondence. • Evidence of ongoing compliance management. Record any significant regulatory concerns or examples of proactive compliance management.

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Overall Governance

Examples of Good PracticeRecord examples of strong governance, leadership, compliance management or continual improvement observed during the audit.Key Improvements RequiredSummarise the principal governance or compliance issues identified within this section. Avoid repeating observations already recorded above.

Section 9 – Audit Summary & Action Plan

This section summarises the overall findings of the audit, highlights areas of good practice, identifies significant risks and records the agreed actions required to achieve compliance.

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Overall Compliance Rating

Overall Compliance *Select overall ratingExcellent (95–100%)Good (85–94%)Satisfactory (70–84%)Requires Improvement (50–69%)Unsatisfactory (<50%)Overall Risk Rating *Select overall riskLowMediumHighCritical

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Executive Summary

Provide a concise summary of the audit. Include: • Overall standard of health and safety management. • General condition of the premises. • Level of compliance observed. • Significant strengths. • Main areas requiring improvement. • Whether the clinic demonstrates an effective safety culture. This should read like the executive summary of a professional consultancy report.

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Key Strengths

Summarise the principal areas of good practice identified during the audit. Avoid repeating individual observations already recorded within previous sections. Focus on management commitment, staff engagement, compliance standards and examples of excellent practice.

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Significant Non-Conformities

Record only the most significant non-conformities. These should normally be Major findings or issues presenting significant legal, regulatory or patient safety concerns. Explain why each issue is significant.

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Immediate Actions Required

List any actions that should be completed immediately to reduce significant risk. Include any issues requiring urgent management attention before the next audit.

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Recommended Improvements

Provide practical recommendations to improve compliance over the coming months. Recommendations should be proportionate, achievable and prioritised according to risk.

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Recommended Specialist Assessments

Select all that applyNone RequiredFire Risk Assessment ReviewLegionella Risk AssessmentCOSHH ReviewDSE AssessmentAsbestos SurveyElectrical Inspection (EICR)Gas Safety InspectionManual Handling AssessmentOccupational Health ReviewOtherIf Other, specify

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Photographic Evidence

Upload Supporting EvidenceEvidence NotesBriefly describe the uploaded photographs or supporting evidence and explain which findings they relate to.

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Client Comments

Record any comments made by the client during the closing meeting, including agreed actions, clarifications or additional information.

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Auditor Declaration

I confirm that this audit has been completed to the best of my knowledge based upon the information available and observations made on the day of the inspection.Auditor Name *Date *

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