Checklist template

Supply and equipment loss control for clinics

A ready-to-use checklist with 107 items in 6 sections, covering Storage security, Counts, Portable equipment, Vendor deliveries, Waste, Variances. Use it as-is in Bindy, or adapt it to your own standards in minutes.

  • 6 Sections
  • 107 Items
  • 85 Yes / No checks
  • 6 Scored ratings
  • 115 Points

Use this template How audits work

1. Storage security 17 items

  1. The main supply room door is locked or badge-controlled when no staff member is inside Yes / No 1 pt
  2. The supply room cannot be reached from the waiting room without passing a staffed point Yes / No 1 pt
  3. The list of supply room key or badge holders matches the staff who restock Yes / No 1 pt
  4. High-cost injectables (vaccines, long-acting contraceptives, joint injections) are kept in a locked refrigerator or cabinet Yes / No 1 pt
  5. Implantable devices and intrauterine devices are kept in a locked cabinet with a sign-out sheet Yes / No 1 pt
  6. Wound care dressings with a high unit cost are stored in the supply room, not in open exam room drawers Yes / No 1 pt
  7. Exam room cabinets hold only the par quantity posted inside the door Yes / No 1 pt
  8. Suture kits and procedure trays are stocked in the procedure room only, not in every exam room Yes / No 1 pt
  9. Boxes of gloves and masks are not left on counters within reach of the waiting room Yes / No 1 pt
  10. Point-of-care test kits (strep, flu, pregnancy, glucose strips) are stored in a staff-only area Yes / No 1 pt
  11. Durable medical goods for dispensing (braces, boots, crutches, slings) are kept in a locked closet Yes / No 1 pt
  12. Overflow stock is not stored in corridors, the staff break room or under exam tables Yes / No 1 pt
  13. Staff bags and coats are kept in lockers away from the supply room Yes / No 1 pt
  14. The clinic's exterior supply shed or basement storage, where one exists, is locked Yes / No 1 pt
  15. Cameras, where installed, cover the supply room door Yes / No 1 pt
  16. The supply room was found locked on arrival for the visit Yes / No 1 pt
  17. Security of supply storage Rating
    • Locked and limited to restocking staff 5 pts
    • Locked but keys widely held 3 pts
    • Open to anyone in the clinic 1 pt

2. Counts 17 items

  1. Items that are easy to resell or use at home (test strips, dressings, over-the-counter products) are on a spot-count list Yes / No 1 pt
  2. Date of the last spot count of listed items Date
  3. High-cost injectables are counted at the end of each clinic day Yes / No 1 pt
  4. The daily injectable count is signed by two staff members Yes / No 1 pt
  5. Vaccine doses on hand match the vaccine inventory log for 3 products sampled Yes / No 1 pt
  6. Implantable device serial numbers on the shelf match the sign-out sheet Yes / No 1 pt
  7. Durable medical goods dispensed last week each have a matching charge on a patient account (5 sampled) Yes / No 1 pt
  8. Point-of-care test kits used last week exceed the tests billed by no more than the allowance set by company policy Yes / No 1 pt
  9. Counts are done by someone other than the person who places the orders Yes / No 1 pt
  10. Count sheets record the actual quantity found and are not pre-filled with the expected quantity Yes / No 1 pt
  11. Count sheets for the last 3 months are on file Yes / No 1 pt
  12. The on-hand quantity in the inventory system is corrected only by the clinic manager or a named delegate Yes / No 1 pt
  13. A blind recount of 5 items during the visit matched the inventory record Yes / No 1 pt
  14. Items recounted during the visit Number
  15. Items recounted that did not match the inventory record Number
  16. Value of supply inventory on hand at the last count (dollars) Number
  17. Reliability of supply counts Rating
    • Counts match on every item sampled 5 pts
    • One or two differences 3 pts
    • Counts not done or widely off 1 pt

3. Portable equipment 20 items

  1. The clinic keeps a list of portable equipment with the serial number and home location of each item Yes / No 1 pt
  2. Each item on the list carries a company asset tag Yes / No 1 pt
  3. All otoscope and ophthalmoscope heads on the list were found in their assigned rooms Yes / No 1 pt
  4. All pulse oximeters on the list were found Yes / No 1 pt
  5. All portable vital signs monitors and blood pressure units on the list were found Yes / No 1 pt
  6. Handheld dopplers and portable ultrasound probes are locked up when the clinic closes Yes / No 1 pt
  7. Dermatoscopes and other pocket instruments owned by the clinic are signed out to a named clinician Yes / No 1 pt
  8. Laptops and tablets are counted against the IT asset list at closing Yes / No 1 pt
  9. Thermometers and glucose meters are numbered and assigned to a room or station Yes / No 1 pt
  10. Wheelchairs are marked with the clinic name Yes / No 1 pt
  11. Every clinic wheelchair was back at the entrance at the last closing check Yes / No 1 pt
  12. Equipment sent out for repair is recorded with the date, the vendor and the expected return Yes / No 1 pt
  13. Loaner equipment from vendors is listed separately with its return date Yes / No 1 pt
  14. Equipment lent to another clinic of the network is recorded on a transfer sheet signed by both sites Yes / No 1 pt
  15. Equipment taken on home visits or outreach is signed out and signed back in Yes / No 1 pt
  16. Retired equipment is removed from the list only with the approval required by company policy Yes / No 1 pt
  17. Date of the last full check of the portable equipment list Date
  18. Items on the portable equipment list Number
  19. Listed items not found during the visit Number
  20. Accountability for portable equipment Rating
    • Every listed item located 5 pts
    • One or two items not located 3 pts
    • No current list or several items missing 1 pt

4. Vendor deliveries 18 items

  1. Deliveries are received by a staff member at the back door or reception, not left in a public corridor Yes / No 1 pt
  2. The number of cartons is checked against the carrier's delivery record before signing Yes / No 1 pt
  3. Packing slips are checked line by line against the purchase order Yes / No 1 pt
  4. The person who checks the delivery is not the person who placed the order Yes / No 1 pt
  5. Shortages and damaged cartons are noted on the packing slip on the day of delivery Yes / No 1 pt
  6. Cartons that arrive with a broken or re-taped seal are opened and counted before the driver leaves Yes / No 1 pt
  7. The delivery door is kept locked between deliveries Yes / No 1 pt
  8. Delivered cartons are moved to the supply room the same day Yes / No 1 pt
  9. 3 invoices sampled were paid only for the quantities signed as received on the packing slip Yes / No 1 pt
  10. Sales representatives leave samples and trial products only with the staff member named by the clinic manager Yes / No 1 pt
  11. Vendor representatives do not restock shelves or enter the supply room unescorted Yes / No 1 pt
  12. Returns to the distributor are recorded with a return authorization number Yes / No 1 pt
  13. Credits for returned goods were received for the last 3 returns sampled Yes / No 1 pt
  14. Drop shipments made when the clinic is closed go to a locked receiving point Yes / No 1 pt
  15. Parcels addressed to a provider by name are opened and recorded by the receiving staff like any other delivery Yes / No 1 pt
  16. Deliveries received in the last 7 days Number
  17. Deliveries in the last 7 days with a signed packing slip on file Number
  18. Checking of deliveries Rating
    • Counted and matched to the order every time 5 pts
    • Signed for without a full check 3 pts
    • Not checked 1 pt

5. Waste 17 items

  1. Expired supplies removed from the shelves are recorded by item and quantity before disposal Yes / No 1 pt
  2. Expired product is returned for credit where the distributor accepts it Yes / No 1 pt
  3. Opened but unused sterile supplies are recorded on a waste sheet at the procedure room Yes / No 1 pt
  4. Procedure trays are opened only when the clinician confirms the procedure will go ahead Yes / No 1 pt
  5. Custom procedure packs were reviewed in the last 12 months to remove items that are routinely discarded Yes / No 1 pt
  6. Vaccine doses drawn up but not given are recorded on the vaccine wastage log Yes / No 1 pt
  7. Multi-dose vials are used up before a new vial of the same product is opened Yes / No 1 pt
  8. Wasted doses of high-cost injectables are witnessed by a second staff member Yes / No 1 pt
  9. Supplies are not taken home by staff; two employees asked confirmed the rule Yes / No 1 pt
  10. Supplies bought by staff from clinic stock, where company policy allows it, are paid for and recorded by the clinic manager Yes / No 1 pt
  11. Donations of surplus supplies to outside organizations are approved in writing by the clinic manager Yes / No 1 pt
  12. A single item needed during a procedure is taken from loose stock, not by opening a full kit Yes / No 1 pt
  13. Empty cartons are flattened before they go to the trash area, so no product leaves inside them Yes / No 1 pt
  14. No full unopened boxes of supplies were found in the trash or recycling area during the visit Yes / No 1 pt
  15. Opened but unused sterile items recorded on the waste sheet last month Number
  16. Vaccine doses recorded as wasted in the last 3 months Number
  17. Control of supply waste Rating
    • Recorded and reviewed 5 pts
    • Recorded in part 3 pts
    • Not recorded 1 pt

6. Variances 18 items

  1. Usage of the 10 highest-cost supply items is compared each month with the number of patient visits Yes / No 1 pt
  2. Value of missing stock written off in the last 3 months (dollars) Number
  3. Write-offs of missing stock are approved by someone above the clinic manager Yes / No 1 pt
  4. A written explanation is on file for each of 3 sampled count differences above the limit set by company policy Yes / No 1 pt
  5. Missing portable equipment is reported to the regional office within the time set by company policy Yes / No 1 pt
  6. A theft or suspected theft is reported to loss prevention or security on the day it is found Yes / No 1 pt
  7. Usage of high-cost injectables is reconciled each month with the doses billed Yes / No 1 pt
  8. Unbilled durable medical goods found in the reconciliation are followed up with the provider Yes / No 1 pt
  9. Order quantities that jump compared with the previous 3 months are questioned before approval Yes / No 1 pt
  10. Purchases made outside the approved distributor are reviewed each month Yes / No 1 pt
  11. Items with repeated count differences are moved to locked storage or a sign-out sheet Yes / No 1 pt
  12. Results of the last supply count were shared with the clinic staff Yes / No 1 pt
  13. Corrective actions from the previous loss control review have been completed Yes / No 1 pt
  14. Unexplained count differences open at the time of the visit Number
  15. Name of the employee responsible for supply ordering Short text
  16. Name of the clinic manager Short text
  17. Overall control of supply and equipment loss Rating
    • Storage locked, counts matching and equipment all located 5 pts
    • Controls in place, with count differences or gaps in records 3 pts
    • Unlocked stock, missing equipment or no counts 1 pt
  18. Corrective actions required 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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