Checklist template

Dental gold, materials and drug security

A ready-to-use checklist with 119 items in 6 sections, covering Scrap metal, Materials, Drugs, Prescription pads, Access, Logs. Use it as-is in Bindy, or adapt it to your own standards in minutes.

  • 6 Sections
  • 119 Items
  • 98 Yes / No checks
  • 6 Scored ratings
  • 128 Points

Use this template How audits work

1. Scrap metal 20 items

  1. Removed crowns, bridges and inlays not kept by the patient go into the scrap metal container on the day they are removed Yes / No 1 pt
  2. The patient's choice to keep or leave a removed gold restoration is noted in the chart Yes / No 1 pt
  3. The practice uses a single scrap metal container, labeled as such Yes / No 1 pt
  4. The scrap metal container is locked Yes / No 1 pt
  5. Pieces enter the scrap metal container through a drop slot without opening it Yes / No 1 pt
  6. The scrap metal container is kept in a locked cabinet or room, not in an operatory Yes / No 1 pt
  7. The key to the scrap metal container is held by the dentist or the practice manager Yes / No 1 pt
  8. Each piece added is entered in the scrap log with the date, the chart number, a description and the employee's initials Yes / No 1 pt
  9. Scrap is sent only to the refiner approved by head office Yes / No 1 pt
  10. Scrap is shipped in the refiner's sealed, insured shipping kit Yes / No 1 pt
  11. The container is weighed before shipment and the weight is signed by two people Yes / No 1 pt
  12. Weight of the last scrap shipment (g or oz) Number
  13. Date of the last scrap shipment Date
  14. The refiner's assay report is on file for each of the last 3 shipments Yes / No 1 pt
  15. The weight received by the refiner matched the weight shipped, within the tolerance set by company policy Yes / No 1 pt
  16. Refiner payments are made by check or transfer to the practice's bank account Yes / No 1 pt
  17. Each refiner payment can be traced to a deposit in the practice's books Yes / No 1 pt
  18. Employees asked confirmed that scrap is never sold to visiting buyers for cash Yes / No 1 pt
  19. Pieces of scrap metal found outside the container in operatory drawers or on the laboratory bench Number
  20. Control of scrap metal Rating
    • Logged, locked and reconciled 5 pts
    • Locked but log or reconciliation incomplete 3 pts
    • Not controlled 1 pt

2. Materials 21 items

  1. Take-home whitening kits and gel syringes are kept in a locked cabinet or refrigerator Yes / No 1 pt
  2. Whitening kits on hand Number
  3. Whitening kits are signed out by the employee who hands them to the patient Yes / No 1 pt
  4. Each of 5 whitening kits recorded as dispensed is matched to a charge on a patient ledger Yes / No 1 pt
  5. Boxed power toothbrushes held for sale are locked up outside working hours Yes / No 1 pt
  6. Loupes and other personal equipment bought by the practice are recorded as issued to the named employee Yes / No 1 pt
  7. Items on the equipment register that could not be found during the visit Number
  8. Curing lights, apex locators, loupes and intraoral cameras are listed on the equipment register with serial numbers Yes / No 1 pt
  9. The intraoral scanner and its laptop are locked away or cable-locked outside working hours Yes / No 1 pt
  10. Supply usage by operatory or by provider is compared every month and unusual increases are followed up Yes / No 1 pt
  11. Implants, bone graft and milling blocks taken from stock are signed out against a named patient Yes / No 1 pt
  12. Diamond burs and endodontic files are issued from central stock, not ordered by operatory Yes / No 1 pt
  13. The storeroom key or code is held only by the employees named by the practice manager Yes / No 1 pt
  14. Deliveries are checked against the packing slip by a person other than the one who placed the order Yes / No 1 pt
  15. Delivered boxes are moved out of the reception area and the corridor within the hour Yes / No 1 pt
  16. Free goods and samples left by manufacturer representatives are recorded and added to stock Yes / No 1 pt
  17. Personal purchases through the practice's supplier account are either forbidden or paid for with a record on file Yes / No 1 pt
  18. Online supplier accounts are set to ship only to the practice address Yes / No 1 pt
  19. Disposal or sale of used equipment is approved in writing by the dentist-owner or head office Yes / No 1 pt
  20. Employees' bags and coats are kept in lockers or a staff room, away from the storeroom Yes / No 1 pt
  21. Security of materials and small equipment Rating
    • Locked, counted and listed 5 pts
    • Locked but counts or register out of date 3 pts
    • Unsecured or unlisted 1 pt

3. Drugs 22 items

  1. Does the practice stock controlled drugs for sedation? Choice
    • Yes
    • No
  2. Controlled drugs are kept in a locked cabinet fixed to the building, as required by local regulation Yes / No 1 pt
  3. The keys or codes to the controlled drug cabinet are held only by the persons named in the drug policy Yes / No 1 pt
  4. Each dose given is entered in the register with the date, the patient, the drug, the dose and the provider Yes / No 1 pt
  5. Unused portions of a controlled drug are wasted in front of a witness who co-signs the register Yes / No 1 pt
  6. Controlled drugs are counted by two people on the schedule set by company policy Yes / No 1 pt
  7. The count made during the visit matched the register for every controlled drug Yes / No 1 pt
  8. Controlled drug discrepancies found during the visit Number
  9. Controlled drugs are ordered only by the dentist registered to do so Yes / No 1 pt
  10. Controlled drugs received are checked against the order and entered in the register on the day of receipt Yes / No 1 pt
  11. Expired controlled drugs are set apart and disposed of through an authorized service, with the record kept Yes / No 1 pt
  12. Any loss or theft of controlled drugs in the last 12 months was reported as required by local regulation Yes / No 1 pt
  13. Boxes of local anesthetic cartridges are kept in the storeroom and counted on the inventory Yes / No 1 pt
  14. Boxes of local anesthetic cartridges on hand Number
  15. The emergency drug kit is closed with a numbered tamper seal Yes / No 1 pt
  16. The seal number of the emergency drug kit matches the number on its check sheet Yes / No 1 pt
  17. Nitrous oxide cylinders are stored in a locked room or cage Yes / No 1 pt
  18. The number of nitrous oxide cylinders on site matches the supplier's delivery and return records Yes / No 1 pt
  19. Antibiotics and prescription rinses held for dispensing are locked up Yes / No 1 pt
  20. Drug samples left by representatives are recorded before they are stored Yes / No 1 pt
  21. Drawers holding anesthetic and needles are closed when a patient is alone in the operatory Yes / No 1 pt
  22. Security of drugs Rating
    • Locked, counted and recorded 5 pts
    • Locked but records incomplete 3 pts
    • Unlocked or uncounted 1 pt

4. Prescription pads 19 items

  1. Paper prescription pads are kept in a locked drawer or cabinet Yes / No 1 pt
  2. Prescription pads found unsecured in operatories or at the front desk Number
  3. Prescription pads are numbered and their stock is recorded in a log Yes / No 1 pt
  4. Each pad issued to a dentist is signed for in the log Yes / No 1 pt
  5. No pre-signed blank prescription was found during the visit Yes / No 1 pt
  6. Prescriptions are written and signed only by a dentist Yes / No 1 pt
  7. Each dentist uses personal credentials for electronic prescribing Yes / No 1 pt
  8. Electronic prescribing passwords and security tokens are not shared with assistants or front desk employees Yes / No 1 pt
  9. Each of 5 prescriptions sampled is recorded in the patient's chart with the drug, the dose and the quantity Yes / No 1 pt
  10. The chart of each opioid prescription sampled shows the procedure that justified it Yes / No 1 pt
  11. The prescription monitoring database is consulted before a controlled drug is prescribed, as required by local regulation Yes / No 1 pt
  12. Prescriptions phoned to a pharmacy are noted in the chart with the name of the person who called Yes / No 1 pt
  13. Pharmacy calls to verify a prescription are passed to the prescribing dentist Yes / No 1 pt
  14. Pads of dentists who left the practice have been shredded, with the destruction recorded Yes / No 1 pt
  15. Electronic prescribing accounts of dentists who left the practice have been deactivated Yes / No 1 pt
  16. Security paper for printed prescriptions is locked up Yes / No 1 pt
  17. Signature stamps, if any exist, are locked up Yes / No 1 pt
  18. Dentists' prescriber registration numbers are not posted or left visible to patients Yes / No 1 pt
  19. Security of prescription pads and prescribing credentials Rating
    • Locked, logged and personal 5 pts
    • Locked but not logged 3 pts
    • Pads or credentials accessible to others 1 pt

5. Access 18 items

  1. The rear and staff doors are kept locked during working hours Yes / No 1 pt
  2. Keys and fobs issued are listed on a key register signed by each holder Yes / No 1 pt
  3. Keys and fobs were recovered from every employee who left in the last 12 months Yes / No 1 pt
  4. Each employee has a personal alarm code Yes / No 1 pt
  5. Alarm codes of former employees have been deleted Yes / No 1 pt
  6. The alarm opening and closing report is reviewed monthly for entries outside working hours Yes / No 1 pt
  7. Entries outside working hours on last month's alarm report Number
  8. Cleaners and contractors working after hours have no key to the drug cabinet, the storeroom or the scrap container Yes / No 1 pt
  9. Sales representatives and service technicians sign in at the front desk Yes / No 1 pt
  10. Visitors are escorted in the clinical and storage areas Yes / No 1 pt
  11. Cameras cover the rear door and the storeroom door Yes / No 1 pt
  12. Camera recordings can be played back for the number of days set by company policy Yes / No 1 pt
  13. Keys to the safe and the drug cabinet are removed from the premises or locked in a key cabinet overnight Yes / No 1 pt
  14. The laboratory and sterilization areas are closed to patients by a door or a sign Yes / No 1 pt
  15. The closing checklist includes locking the drug cabinet, the storeroom and the scrap container Yes / No 1 pt
  16. The closing checklist was signed on each of the last 5 working days Yes / No 1 pt
  17. Date the locks or alarm codes were last changed Date
  18. Access control at the practice Rating
    • Keys, codes and visitors controlled 5 pts
    • Minor gaps 3 pts
    • Keys or codes unaccounted for 1 pt

6. Logs 19 items

  1. Scrap log entries are written in ink with no blank lines between entries Yes / No 1 pt
  2. Corrections in the controlled drug register are struck through and initialed, with no correction fluid Yes / No 1 pt
  3. Controlled drug registers are kept for the period required by local regulation Yes / No 1 pt
  4. Supplier invoices for controlled drugs are filed apart from other invoices Yes / No 1 pt
  5. The monthly count of whitening kits and boxed power toothbrushes equals stock received less units sold Yes / No 1 pt
  6. The equipment register was checked against the equipment on site in the last 12 months Yes / No 1 pt
  7. Date of the last check of the equipment register Date
  8. The nitrous oxide log records each cylinder change with the date and the number of patients treated since the last change Yes / No 1 pt
  9. The nitrous oxide log has been reviewed for cylinder use out of line with the patients treated Yes / No 1 pt
  10. The emergency drug kit is checked against its contents list every month, with the check recorded Yes / No 1 pt
  11. The logs are initialed monthly by a dentist or manager who does not keep them Yes / No 1 pt
  12. Discrepancies recorded in the logs in the last 12 months Number
  13. Each recorded discrepancy has a written investigation on file Yes / No 1 pt
  14. Thefts and unexplained losses were reported to head office within the time set by company policy Yes / No 1 pt
  15. Every employee has signed the policy on scrap metal, drugs and prescriptions Yes / No 1 pt
  16. Corrective actions from the previous review have been completed Yes / No 1 pt
  17. Name of the dentist responsible for the drug records Short text
  18. Overall security of gold, materials and drugs Rating
    • Strong 5 pts
    • Partial 3 pts
    • Weak 1 pt
  19. Findings and corrective actions Comments

About this template

This checklist is part of the Bindy 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 Bindy you can add photos, assign corrective actions, require sign-off and compare results across sites.

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