Cleaning Management Audit Report Date audited:
12/10/2014
Location:
Sample General Dental Practice Sample surgery Your town Your Post Code
Client name:
Your practice
Auditor:
Yourself
Accompanied by:
Staff member
Additional info:
Rooms: 5 treatment rooms, decon room, waiting area, public toilets, staff kitchen, staff toilet
Section
% Compliance
Governance and Documentary Evidence of effective cleaning practices
61 %
Healthcare cleaning training
33%
Hand hygiene
71%
Use of Personal Protective Equipment for Cleaning
55%
Waste Management
82%
Spillage Management
90%
Treatment room 1
48%
Treatment room 2
72%
Treatment room 3
50%
Treatment room 4
48%
Treatment room 5
50%
Decontamination Room
77 %
Clean Instrument Store
92 %
Public WC
52%
Staff toilet & shower
36%
Staff kitchen
32%
General office
60%
Reception area
92 %
Domestic/Housekeeping Room
60%
Standard assessment of cleanliness of the environment
40 %
Total
61 %
Copyright IPC Management (Holdings) Ltd Š 2005–2014 Template: Primary Care with Minor Surgery (AT017)
Date Approved: 13/05/2014
ICAT Audit Tool Vrs 2.0 Page 1 of 3