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State of California <br />8+ :• <br />Memorandum <br />Date <br />TO DR <br />CHIEF DENTIST, <br />From Deuel Vocational Institution, Tracy, CA 95378 <br />Subject : WEEKLY INSPECTION OF CLINIC <br />Today, the Dental Clinic was inspected <br />The following checklist was used: <br />Question Yes No <br />SAFE WORK CONDITIONS: <br />1. Emergency & First Aid available & current? [ ] [ J <br />2. Personal Alarms/Whistles worn? [ J [ ] <br />3. Floors and rooms clear of clutter? [ J [ J <br />4. Exits clear and marked? [ J [ J <br />5. Fire extinguishers clear? [ ] [ J <br />SAFE WORK PRACTICES; <br />6. Universal Precautions used in cleanup? [ ] [ J <br />7. Sharps disposed into sharps container?[ J [ J <br />8. Instruments sterilized/bagged? [ J [ J <br />PERSONAL PROTECTIVE EQUIPMENT: <br />9. Are latex gloves available? [ ] [ J <br />10. Are nitryle gloves available and in good condition? [ ] [ J <br />11. Are masks available? [ J [ J <br />12. Is eye protection for staff and p6tiets available? [ ] [ J <br />13. Are Xray lead aprons available and in good condition? [ J [ J <br />WASTE DISPOSAL: <br />14. Are trash conatiners in good condition? <br />15. Are traps cleaned and / or dispoised? [ ] [ ] <br />16. Is the PERIOPRO @ mechanism cleaned? { J [ ] <br />17. Is the amalgam waste 3/4ths full and ready for shipment? [ ] [ J <br />18. Is the lead foil 4/5ths full andready fordisposal? [ J [ J <br />AUTOCLAVES: <br />19. Was the Autoclave spore tested, cleaned, and drained? { ] [ ] <br />Alternative Weeks: <br />20. Autoclaves inspected? <br />21. Are the cold sterilizers emptied and airdried? r 1 f <br />NAME: <br />Department of Corrections <br />