Checklist template

Clinic manager site review

A ready-to-use checklist with 112 items in 6 sections, covering Patient experience, Staffing, Facility, Supplies, Compliance, Financial. Use it as-is in InspectLoop, or adapt it to your own standards in minutes.

  • 6 Sections
  • 112 Items
  • 84 Yes / No checks
  • 6 Scored ratings
  • 114 Points

Use this template How audits work

1. Patient experience 19 items

  1. A test call to the clinic's main number was answered within the time set by company policy Yes / No 1 pt
  2. The after-hours phone message states the opening hours Yes / No 1 pt
  3. The after-hours phone message tells callers what to do in an emergency Yes / No 1 pt
  4. Days until the third next available appointment for a new patient Number
  5. The third next available appointment is within the company target Yes / No 1 pt
  6. Appointment reminders were sent for tomorrow's schedule Yes / No 1 pt
  7. No-show rate last month (%) Number
  8. Average minutes past the appointment time before 5 sampled patients were roomed Number
  9. Patients are told when a provider is running later than the limit set by company policy Yes / No 1 pt
  10. Patient portal messages are answered within the time set by company policy Yes / No 1 pt
  11. Prescription refill requests are completed within the time set by company policy Yes / No 1 pt
  12. No test result older than the company limit is waiting to be communicated to the patient Yes / No 1 pt
  13. No referral older than the company limit is waiting to be processed Yes / No 1 pt
  14. Each patient complaint logged last month has a documented response Yes / No 1 pt
  15. Patient complaints received last month Number
  16. Patient satisfaction score for the last month Number
  17. Online reviews posted last month have received a reply per company policy Yes / No 1 pt
  18. A front desk employee asked could reach the interpreter service Yes / No 1 pt
  19. Patient experience observed at the front desk and in the corridors Rating
    • Courteous, timely and private 5 pts
    • Courteous but with delays 3 pts
    • Patients ignored or kept uninformed 1 pt

2. Staffing 18 items

  1. The employees on site today match the posted schedule Yes / No 1 pt
  2. Provider schedules are open for booking as far ahead as company policy requires Yes / No 1 pt
  3. Open positions at the clinic Number
  4. Each open position has an active job posting or candidate Yes / No 1 pt
  5. The license tracker shows no expired professional license among clinical employees Yes / No 1 pt
  6. Basic life support certification is current for every clinical employee Yes / No 1 pt
  7. Employees hired in the last 90 days have a completed orientation checklist Yes / No 1 pt
  8. Annual performance reviews due in the last 12 months have been completed Yes / No 1 pt
  9. Completion of mandatory annual training (%) Number
  10. Overtime hours in the last pay period Number
  11. Overtime in the last pay period was within budget Yes / No 1 pt
  12. Approved time off for the next 4 weeks has coverage arranged Yes / No 1 pt
  13. A staff meeting was held in the last month, with minutes kept Yes / No 1 pt
  14. Date of the last staff meeting Date
  15. Every employee seen is wearing a name badge Yes / No 1 pt
  16. Medical assistants perform only the tasks on the delegation list approved by the medical director Yes / No 1 pt
  17. Agency and temporary employees received a site orientation before their first shift Yes / No 1 pt
  18. Staffing of the clinic Rating
    • Fully staffed and trained 5 pts
    • Covered with overtime or temporary staff 3 pts
    • Shortages affecting patient care 1 pt

3. Facility 20 items

  1. The exterior sign is fully lit Yes / No 1 pt
  2. Walkways from the parking lot to the entrance are free of trip hazards Yes / No 1 pt
  3. Accessible parking spaces are marked and unobstructed Yes / No 1 pt
  4. The automatic door opener at the entrance works Yes / No 1 pt
  5. Counters in three exam rooms checked were clear of clutter and personal items Yes / No 1 pt
  6. Exam room furniture has no torn upholstery Yes / No 1 pt
  7. Floors, sinks and toilets in patient restrooms are free of visible soil Yes / No 1 pt
  8. Soap dispensers in patient restrooms are filled Yes / No 1 pt
  9. No stained or missing ceiling tiles were seen Yes / No 1 pt
  10. All light fixtures in patient areas are working Yes / No 1 pt
  11. Temperature in the main patient corridor (°F or °C) Number
  12. The cleaning contractor's checklist was signed for each of the last 7 nights Yes / No 1 pt
  13. Maintenance requests open longer than 14 days Number
  14. Fire extinguisher inspection tags are current Yes / No 1 pt
  15. Exit routes are clear all the way to the outside door Yes / No 1 pt
  16. The biohazard waste storage area is locked Yes / No 1 pt
  17. Biohazard waste pick-ups took place on schedule in the last month Yes / No 1 pt
  18. Pest control service reports for the last 3 months are on file Yes / No 1 pt
  19. No staff food is stored in clinical refrigerators Yes / No 1 pt
  20. Condition of the facility Rating
    • No soil or damage seen 5 pts
    • No soil seen, repairs outstanding 3 pts
    • Visible soil or damage in patient areas 1 pt

4. Supplies 17 items

  1. Par levels are posted in the clinical supply room Yes / No 1 pt
  2. 10 supply items sampled were all at or above par Yes / No 1 pt
  3. 10 supply items sampled in the supply room were all within their expiry date Yes / No 1 pt
  4. Exam room drawers were checked for expired supplies in the last month, per the log Yes / No 1 pt
  5. Older stock is placed in front of newer stock on the supply shelves Yes / No 1 pt
  6. Orders are placed by a named employee on the set ordering days Yes / No 1 pt
  7. Supplies are ordered from the company's approved vendor list Yes / No 1 pt
  8. Deliveries are checked against the packing slip before being put away Yes / No 1 pt
  9. The vaccine count matches the vaccine inventory record Yes / No 1 pt
  10. The vaccine refrigerator temperature log is complete for the last 7 days Yes / No 1 pt
  11. Vaccine refrigerator temperature (°F or °C) Number
  12. Sample medications are logged in and out Yes / No 1 pt
  13. Emergency kit medications were checked for expiry in the last month Yes / No 1 pt
  14. A full spare oxygen cylinder is on site Yes / No 1 pt
  15. A stockout log is kept in the clinical supply room Yes / No 1 pt
  16. Stockouts recorded last month Number
  17. Supply levels in the exam rooms and supply room checked Rating
    • At par with nothing expired 5 pts
    • Below par on a few items 3 pts
    • Stockouts or expired items found 1 pt

5. Compliance 18 items

  1. The clinic licenses and permits on display are within their expiry dates Yes / No 1 pt
  2. Employee notices required by local regulation are posted in the staff area Yes / No 1 pt
  3. The notice of privacy practices is available to patients at the front desk Yes / No 1 pt
  4. Unattended computer screens seen during the walk were locked Yes / No 1 pt
  5. No patient information was left on printers, fax machines or counters Yes / No 1 pt
  6. Shredding bins are locked Yes / No 1 pt
  7. Each privacy incident logged in the last 3 months has a completed follow-up Yes / No 1 pt
  8. Each patient safety incident logged in the last 3 months has a completed follow-up Yes / No 1 pt
  9. Incidents logged in the last 3 months Number
  10. Hand hygiene observations were done on the company schedule Yes / No 1 pt
  11. Sterilizer biological indicator results are on file for each week of the last month Yes / No 1 pt
  12. The controlled drug count log was signed by two people on each of 5 days sampled Yes / No 1 pt
  13. A medical emergency drill was held in the last 12 months Yes / No 1 pt
  14. Date of the last medical emergency drill Date
  15. The policy manual shows a review in the last 12 months Yes / No 1 pt
  16. 5 charts sampled from last week were completed and signed by the provider Yes / No 1 pt
  17. Findings from the last external inspection have been closed Yes / No 1 pt
  18. Compliance position of the clinic Rating
    • No open findings 5 pts
    • Minor findings with a plan 3 pts
    • Significant findings without a plan 1 pt

6. Financial 20 items

  1. Patient visits last month Number
  2. Patient visits last month compared with budget (%) Number
  3. Average days from visit to charge entry last month Number
  4. Charges are entered within the time set by company policy Yes / No 1 pt
  5. No visit older than the company limit remains unbilled Yes / No 1 pt
  6. Share of co-pays collected at the time of service last month (%) Number
  7. Time-of-service collections met the company target last month Yes / No 1 pt
  8. The manager signed the daily deposit reconciliation on each of 5 days sampled Yes / No 1 pt
  9. Claim denial rate last month (%) Number
  10. The top reasons for claim denials were reviewed with the front desk in the last month Yes / No 1 pt
  11. Payroll cost last month was within budget Yes / No 1 pt
  12. Supply expense last month was within budget Yes / No 1 pt
  13. Vendor invoices are approved by the clinic manager before payment Yes / No 1 pt
  14. Petty cash was counted in the last month and agreed with the record Yes / No 1 pt
  15. The monthly financial results were reviewed with the regional manager Yes / No 1 pt
  16. Each budget variance above the company threshold has a written action plan Yes / No 1 pt
  17. Corrective actions from the previous site review have been completed Yes / No 1 pt
  18. Name of the clinic manager Short text
  19. Overall rating of the clinic Rating
    • On target in all six areas reviewed 5 pts
    • Gaps in one or two areas, with a plan 3 pts
    • Gaps in several areas or no plan 1 pt
  20. Corrective actions required Comments

About this template

This checklist is part of the InspectLoop template library. Yes / No checks score 1 point when met; ratings score the points shown for each option. The overall score is the percentage of points earned, with N/A answers excluded. In InspectLoop you can add photos, assign corrective actions, require sign-off and compare results across sites.

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