Checklist template

Physiotherapy Clinic

A ready-to-use checklist with 86 items in 8 sections, covering Reception, Treatment Plinth & Area, Modalities & Tech Safety, Gym & Rehab Equipment, Clinical Hygiene & PPE, Service & Documentation and more. Use it as-is in InspectLoop, or adapt it to your own standards in minutes.

  • 8 Sections
  • 86 Items
  • 70 Yes / No checks
  • 8 Scored ratings
  • 1095 Points

Use this template How audits work

1. Reception 11 items

  1. Was the patient greeted by name within 30 seconds? Yes / No 10 pts
  2. Are computer screens angled away from guest view? Yes / No 20 pts
  3. Is the "Notice of Privacy Practices" clearly visible? Yes / No 15 pts
  4. Are phone calls regarding treatment kept private? Yes / No 15 pts
  5. Are intake forms presented on a clean digital tablet? Yes / No 5 pts
  6. Is the lobby music at a soft, professional volume? Yes / No 5 pts
  7. Are staff uniforms/scrubs clean and branded? Yes / No 10 pts
  8. Is the floor free of trip hazards (rugs/cords)? Yes / No 20 pts
  9. Are retail items (braces/rollers) neatly displayed? Yes / No 5 pts
  10. General clinic atmosphere: Rating
    • Professional/Calm 10 pts
    • Clinical/Cold 5 pts
    • Chaotic/Loud 0 pts
  11. Name of the Front Desk Coordinator: Short text

2. Treatment Plinth & Area 11 items

  1. Is the treatment table upholstery free of tears? Yes / No 15 pts
  2. Are tables wiped with disinfectant after every use? Yes / No 25 pts
  3. Is the room temp between 68°F–74°F (20°C–23°C)? Yes / No 10 pts
  4. Are "Face Cradle" covers changed for every patient? Yes / No 20 pts
  5. Are linens/towels fresh and stain-free? Yes / No 15 pts
  6. Is the floor free of ultrasound gel or massage oil? Yes / No 20 pts
  7. Are pillows covered with wipeable vinyl or fresh cases? Yes / No 10 pts
  8. Is a "Privacy Curtain" or door used for all sessions? Yes / No 15 pts
  9. Is the lighting adjustable or dimmed for comfort? Yes / No 5 pts
  10. Visual cleanliness of treatment zone: Rating
    • Sterile Appearance 15 pts
    • Minor Clutter 5 pts
    • Unsanitary 0 pts
  11. Current Treatment Room Temp (°F or °C): Number

3. Modalities & Tech Safety 11 items

  1. Are Ultrasound/TENS units tested for electrical safety? Yes / No 25 pts
  2. Is the "Hydrocollator" temp 160°F–165°F (71°C–74°C)? Yes / No 20 pts
  3. Are Hot Pack covers inspected for holes or wear? Yes / No 15 pts
  4. Are Cold Packs stored in a clean, dedicated freezer? Yes / No 10 pts
  5. Are electrical cords free of fraying or "daisy-chains"? Yes / No 20 pts
  6. Is the ultrasound head free of cracks or pits? Yes / No 15 pts
  7. Are lead wires for TENS organized and not tangled? Yes / No 10 pts
  8. Is the Emergency Stop on treadmills functional? Yes / No 25 pts
  9. Are laser therapy goggles available and intact? Yes / No 20 pts
  10. Equipment maintenance status: Rating
    • 100% Operational 15 pts
    • Minor Repair Needed 5 pts
    • Safety Out of Service 0 pts
  11. Serial number of the primary modality audited: Short text

4. Gym & Rehab Equipment 11 items

  1. Are exercise mats wiped down after each patient? Yes / No 20 pts
  2. Are Resistance Bands free of nicks or tears? Yes / No 15 pts
  3. Are weights/dumbbells stored in racks (not on floor)? Yes / No 10 pts
  4. Is the upholstery on gym machines sweat-free? Yes / No 15 pts
  5. Are Balance Pads/Balls clean and fully inflated? Yes / No 10 pts
  6. Is there 3 feet of clearance around gym equipment? Yes / No 15 pts
  7. Are Steps/Benches stable and non-slip? Yes / No 15 pts
  8. Is the gym floor free of hair, dust, and debris? Yes / No 10 pts
  9. Are Parallel Bars secure and height-adjusted? Yes / No 15 pts
  10. Organization of the gym floor: Rating
    • Highly Organized 10 pts
    • Slightly Cluttered 5 pts
    • Safety Hazard 0 pts
  11. List any gym equipment requiring repair: Comments

5. Clinical Hygiene & PPE 11 items

  1. Are therapists washing hands in front of the patient? Yes / No 25 pts
  2. Is the hand sink stocked with soap and paper towels? Yes / No 20 pts
  3. Are staff wearing appropriate PPE (gloves/masks)? Yes / No 15 pts
  4. Are Sharps Containers (for dry needling) secure? Yes / No 20 pts
  5. Is the biohazard waste bin lid functional? Yes / No 20 pts
  6. Is the SDS binder (Safety Data Sheets) accessible? Yes / No 15 pts
  7. Are single-use needles (needling) disposed of? Yes / No 25 pts
  8. Is the First Aid kit accessible and fully stocked? Yes / No 20 pts
  9. Are cleaning chemicals stored in a locked cabinet? Yes / No 10 pts
  10. Overall clinical sanitation level: Rating
    • Medical Grade 15 pts
    • Acceptable 10 pts
    • High Risk 0 pts
  11. Date of last professional deep clean: Short text

6. Service & Documentation 11 items

  1. Did the PT discuss the "Plan of Care" with the patient? Yes / No 20 pts
  2. Was a "Home Exercise Program" (HEP) provided? Yes / No 15 pts
  3. Was a subjective "Pain Scale" check performed? Yes / No 10 pts
  4. Did the session start/end within 5 mins of schedule? Yes / No 10 pts
  5. Were "Subjective, Objective, Assessment, Plan" (SOAP) notes completed for the last session? Yes / No 25 pts
  6. Was the patient's identity verified (2 identifiers)? Yes / No 15 pts
  7. Was a follow-up appointment scheduled? Yes / No 10 pts
  8. Did the PT ask about adverse reactions to last visit? Yes / No 15 pts
  9. Was the patient thanked and encouraged? Yes / No 5 pts
  10. Provider professional engagement: Rating
    • High/Attentive 10 pts
    • Standard 5 pts
    • Disengaged 0 pts
  11. Name of the Physiotherapist being audited: Short text

7. Locker & Restrooms 10 items

  1. Are restrooms cleaned and signed off every hour? Yes / No 15 pts
  2. Are soap, paper towels, and toilet paper fully stocked? Yes / No 15 pts
  3. Is the floor dry and free of footprints? Yes / No 10 pts
  4. Are mirrors streak-free and the sink polished? Yes / No 5 pts
  5. Is the toilet flushing correctly with no leaks? Yes / No 10 pts
  6. Is the ventilation fan operational and quiet? Yes / No 5 pts
  7. Is the staff breakroom tidy and clean? Yes / No 5 pts
  8. Are staff personal items kept in designated lockers? Yes / No 5 pts
  9. Restroom air quality: Rating
    • Fresh/Neutral 5 pts
    • Neutral 2 pts
    • Odor Detected 0 pts
  10. Time of last restroom walkthrough: Short text

8. Facility & Safety 10 items

  1. Are all fire extinguishers charged and tagged? Yes / No 20 pts
  2. Are fire exits clear of gym gear or treatment tables? Yes / No 25 pts
  3. Are "Wet Floor" signs used when needed? Yes / No 15 pts
  4. Are all electrical panels unobstructed? Yes / No 15 pts
  5. Is the exterior signage fully illuminated? Yes / No 10 pts
  6. Is the dumpster area secure and lids closed? Yes / No 10 pts
  7. Are all ceiling bulbs operational (no flickering)? Yes / No 10 pts
  8. Is the "Evacuation Map" posted in the hallway? Yes / No 10 pts
  9. Overall safety readiness score: Rating
    • High Compliance 10 pts
    • Minor Violations 5 pts
    • Critical Risk 0 pts
  10. Final audit summary: 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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