Checklist template

Dental Office

A ready-to-use checklist with 85 items in 8 sections, covering Patient Reception & Privacy, Operatory Readiness, Sterilization & Hygiene, Imaging & X-Ray Safety, Clinical Lab & Medications, Dental Unit Waterlines and more. Use it as-is in Bindy, or adapt it to your own standards in minutes.

  • 8 Sections
  • 85 Items
  • 69 Yes / No checks
  • 8 Scored ratings
  • 1145 Points

Use this template How audits work

1. Patient Reception & Privacy 11 items

  1. Was the patient greeted by name within 30 seconds? Yes / No 10 pts
  2. Are all computer screens angled away from guest view? Yes / No 20 pts
  3. Is the Notice of Privacy Practices clearly posted? Yes / No 15 pts
  4. Are phone calls regarding treatment made in private? Yes / No 15 pts
  5. Is the lobby furniture free of tears, stains, and dust? Yes / No 10 pts
  6. Are Medical History forms updated for every patient? Yes / No 20 pts
  7. Is the lobby music or white noise at a discreet level? Yes / No 5 pts
  8. Are toys or magazines (if present) sanitized daily? Yes / No 10 pts
  9. Is the floor free of trip hazards or wet spots? Yes / No 10 pts
  10. General atmosphere of the waiting area: Rating
    • Calm/Professional 10 pts
    • Clinical/Cold 5 pts
    • Disorganized/Loud 0 pts
  11. Name of the Front Desk Lead: Short text

2. Operatory Readiness 11 items

  1. Is the dental chair upholstery free of tears or cracks? Yes / No 15 pts
  2. Are all surfaces wiped with disinfectant between patients? Yes / No 25 pts
  3. Is the room temperature between 68°F–74°F (20°C–23°C)? Yes / No 10 pts
  4. Are plastic barriers used on the light handle and air/water? Yes / No 20 pts
  5. Is the High-Volume Evacuator (HVE) suction strong? Yes / No 15 pts
  6. Are sharps containers less than 75% full? Yes / No 20 pts
  7. Is the biohazard waste bin lid closed and functional? Yes / No 20 pts
  8. Are patient bibs and safety glasses clean and ready? Yes / No 10 pts
  9. Is the Curing Light functional and lens clear? Yes / No 10 pts
  10. Visual cleanliness of the operatory: Rating
    • Sterile Appearance 15 pts
    • Minor Clutter 5 pts
    • Poor/Unsanitary 0 pts
  11. Current Operatory Temp (°F or °C): Number

3. Sterilization & Hygiene 11 items

  1. Is the autoclave/sterilizer log current indicating Pass? Yes / No 25 pts
  2. Are sterile pouches dated and the tape color-changed? Yes / No 20 pts
  3. Are Clean and Dirty areas clearly separated? Yes / No 25 pts
  4. Is the ultrasonic cleaner solution changed daily? Yes / No 15 pts
  5. Are dental handpieces lubricated and sterilized correctly? Yes / No 20 pts
  6. Are staff wearing appropriate PPE (masks/shields/gloves)? Yes / No 20 pts
  7. Is the hand sink stocked with soap and paper towels? Yes / No 20 pts
  8. Are Cassettes wrapped and sealed with chemical indicators? Yes / No 15 pts
  9. Is the floor free of spilled liquids or used gauze? Yes / No 10 pts
  10. Cleanliness of the reprocessing room: Rating
    • Immaculate 15 pts
    • Average 5 pts
    • Unsanitary 0 pts
  11. Date of last spore test for the autoclave: Short text

4. Imaging & X-Ray Safety 11 items

  1. Is the Lead Apron with thyroid collar in good condition? Yes / No 20 pts
  2. Are X-ray sensors covered with fresh plastic barriers? Yes / No 20 pts
  3. Is the Exposure Button located behind a lead wall? Yes / No 25 pts
  4. Are X-ray logs maintained for all radiation exposures? Yes / No 15 pts
  5. Is the Panoramic machine clean and functional? Yes / No 15 pts
  6. Are there no Leaking X-ray tube heads (stay in place)? Yes / No 10 pts
  7. Is the Developer or digital software functioning? Yes / No 15 pts
  8. Are staff wearing dosimeter badges (if required)? Yes / No 10 pts
  9. Is the imaging room temp 65°F–75°F (18°C–24°C)? Yes / No 5 pts
  10. Status of radiation safety signage: Rating
    • Clearly Posted 10 pts
    • Faded/Missing 0 pts
  11. Date of last state X-ray inspection: Short text

5. Clinical Lab & Medications 11 items

  1. Is the dental lab bench clean and free of dust? Yes / No 10 pts
  2. Are Impressions disinfected before being handled? Yes / No 20 pts
  3. Is the dental fridge between 36°F–46°F (2°C–8°C)? Yes / No 20 pts
  4. Are there no food/drinks in the clinical fridge? Yes / No 25 pts
  5. Are all medications/anesthetics within expiration dates? Yes / No 20 pts
  6. Are temperature logs recorded twice daily (AM/PM)? Yes / No 20 pts
  7. Are dental materials (composites) dated when opened? Yes / No 10 pts
  8. Is the First Aid kit accessible and fully stocked? Yes / No 15 pts
  9. Is the Oxygen Tank secured and full? Yes / No 20 pts
  10. Organization of clinical supplies: Rating
    • Highly Organized 10 pts
    • Slightly Cluttered 5 pts
    • Safety Hazard 0 pts
  11. Current Clinical Fridge Temp (°F or °C): Number

6. Dental Unit Waterlines 11 items

  1. Are waterlines treated with tablets or straws daily? Yes / No 25 pts
  2. Are lines flushed for 2 minutes at the start of the day? Yes / No 15 pts
  3. Are lines flushed for 30 seconds between patients? Yes / No 15 pts
  4. Is the Shock Treatment performed as per schedule? Yes / No 20 pts
  5. Is the independent water bottle cleaned and dry? Yes / No 15 pts
  6. Are waterline test results (CFU count) within limits? Yes / No 25 pts
  7. Is the Suction Trap cleaned and replaced weekly? Yes / No 10 pts
  8. Are Backflow Prevention valves functional? Yes / No 15 pts
  9. Is the water temperature at the tap consistent? Yes / No 10 pts
  10. Compliance with waterline protocols: Rating
    • Fully Compliant 15 pts
    • Minor Gaps 5 pts
    • Non-Compliant 0 pts
  11. Detail any specific waterline test failures: Comments

7. Staff & Facility Safety 9 items

  1. Are all fire extinguishers charged and tagged? Yes / No 20 pts
  2. Is the Emergency Crash Cart inspected and sealed? Yes / No 25 pts
  3. Are Wet Floor signs used when needed? Yes / No 15 pts
  4. Are staff licenses/certifications up to date on file? Yes / No 10 pts
  5. Are all electrical panels unobstructed? Yes / No 15 pts
  6. Is the SDS binder (Safety Data Sheets) accessible? Yes / No 15 pts
  7. Is the HVAC set to 70°F (21°C) +/- 2 degrees in clinic? Yes / No 10 pts
  8. Staff safety awareness: Rating
    • High/Alert 10 pts
    • Minor Issues 5 pts
    • Critical Risk 0 pts
  9. Final audit summary and corrective actions: Comments

8. Restrooms & Amenities 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 free of expired food? 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

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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