Biomedical Engineering Reference
In-Depth Information
Table 17.1
Laser Audit Checklist
Comments on Defi ciencies Noted
and Action Taken
Item
Yes
No
N/A
Date Corrected
1.
Administrative Controls
a) Copies of ANSI Z136.3 at the laser use site
b) Written policies and
procedures at use site
c) Laser log located at laser site and completed
properly
d) All users have read and have knowledge of p/p
and standards
2.
Laser and Accessories
a) Keys accessed by authorized persons only
b) No unauthorized modifi cations to equipment
c) Equipment properly cleaned and stored
d) Laser keys in proper storage location
3.
Safety Glasses
a) Appropriate to the laser in use
b) Labels intact and clearly readable
c) Lenses clean and free of defects
d) Cleaned and stored properly after use
4.
Electrical Safety
a) Electrical components in good repair
b) Scheduled testing/maintenance up to date and
documented
5.
Fire Safety
a) Extinguisher available to every room where
laser procedures performed
b) Fire exits free of obstruction and working
properly
6.
Observation
a) Proper staff handling and positioning of
laser and accessory equipment
b) Laser keys removed from laser after use
c) Only authorized persons allowed in the room
during laser use
d) Patient properly protected
Comments: ____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________
Audited by _____________________________ Date _____________________
Report received by LSO ___________________ Date _____________________
