Outpatient Care Facility Assessment Checklist

Outpatient Care Facility Name:

Facility Category: _______________________________________________________________________________________

Date of Assessment: Start time: End time:

Valid E-mail Address: _____________________________________ Contact No./s__________________________________

No. Description Yes No N/A Remarks

1. General Consideration and Accessibility
Facility outdoor signage is matching the DHA and Department of
1.1.
Economic Development (DED) trade name
1.2. Facility/building steps flooring are slip-resistant
1.3. Handicapped ramp elevation is less than 25 degrees
1.4. Building/facility elevator can accommodate wheel chairs
Clinical services of the facility is clearly displayed for patients/visitors
1.5.
and matching the approved services in Sheryan System
Facility operating hours is clearly display outside the facility main
1.6.
entrance
1.7. Reception location provides visual control of the waiting area
1.8. Separate Male and Female waiting area
1.9. Waiting area seats ratio is 2:1 for each consultation room
1.10. Waiting area chair material is cleanable and washable
1.11. Dedicated Pediatric waiting area (if service is provided)
The physician(s)/dentist(s) or healthcare professionals information
1.12.
displayed in the internal boards are matching the DHA license
1.13. At least one wheelchair is available in the facility
1.14. DHA facility license is clearly displayed is prominent area
Charter of Patients’ Rights and Responsibilities in two languages
1.15.
Arabic and English are displayed
Price list of medical services are displayed/accessible to patients and
1.16.
visitors
Emergency contact number for local police and Dubai Civil
1.17.
Defense are displayed
1.18. Patient registration form is available
1.19. Complaint/suggestion forms are accessible to patients/visitors
1.20. Flooring surface of the facility are clean, washable and without crack
No. Description Yes No N/A Remarks
No wooded materials or carpet flooring are used in treatment and
1.21.
procedure room
1.22. Dedicated Male and female toilet(s) are available
Accessible disabled restrooms in the facility or within the same
1.23.
building is available
1.24. All health facility corridors are more than 1.12 m
2. Consultation & Examination Rooms
Facility rooms space is not less than 12 m2 for consultation and
2.1.
examination (for consultation room only 9 m2)
2.2. Hand-washing station with hand soap and tissue is available all rooms
Hand washing educational posters available at the Hand-washing
2.3.
stations
Non-refillable hand sanitizer dispenser is available in each room with
2.4.
educational posters
Healthcare professionals can demonstrate proper hand hygiene
2.5.
technique
2.6. No storage is permitted under consultation/examination rooms sink
General and Medical waste collection bags/container are available
2.7.
in each room and properly labelled
Items found in collection bags/container are segregated as per each
2.8.
color code
2.9. Sharp containers kept above the ground level
2.10. No sharp containers filled more than 3/4 full
Washing and cleaning of curtains/privacy partitions is conducted
2.11.
and documented
3. Treatment/Procedure/Observation Rooms
3.1. Treatment room space is not less than 7.5 m2 for each bed
Observation room (if available) is convenient to the nursing station
3.2.
securing visual control
If specific procedures are conducted in the room e.g. casting,
3.3.
dermatology, etc. The room size is not less than 11.15 m2
Hand-washing station with hand soap and tissue is available inside
3.4.
the treatment/procedure room
Hand washing educational posters available at the Hand-washing
3.5.
station
Hand sanitizer dispenser is provided in each room with educational
3.6.
posters
3.7. Sharp containers kept above the ground level
3.8. No sharp containers filled more than 3/4 full
3.9. Needle recapping/separating is not practiced
No. Description Yes No N/A Remarks
3.10. Single-use gauze and cotton are used
3.11. A lockable refrigerator for medication use (No food is stored)
3.12. Refrigerator thermometer is available with daily monitoring chart
Sample medication (if available) are stored in the treatment/
3.13.
procedure room with updated record including expiry dates
Multiple use medications opening date is labelled with validation
3.14.
date as per manufacturer’s instruction
Emergency medications are available as per Outpatient Care
3.15.
Regulation (see appendix 8 in the regulation for details)
3.16. Emergency medications are securely stored
3.17. Medication inventory is available with documented expiry dates
Expired medications are properly segregated, labeled, and
3.18.
documented
Storage and usage of controlled/semi-controlled medications are
3.19.
documented and updated
3.20. No unregistered medications are available in the facility
Nutritional Supplements and cosmetic products are not sold or
3.21.
dispensed in the facility
Instruments/medications cupboards are clean, tidy and properly
3.22.
labelled
Crash trolley with defibrillator OR Automated External defibrillator
3.23.
(AED) is available and easily accessible in the facility
All healthcare professionals have valid training/certification of Basic
3.24.
Life Support (BLS)
If Cardiology Exercise Tolerance Testing (ETT) services is provided,
3.25. the Cardiologist has a valid training/certification for Advanced
Cardiac Life Support (ACLS)
Glucometer Quality control is performed regularly as per
3.26.
manufacturer’s instruction
Healthcare professionals are aware of actions to be taken if
3.27.
Glucometer quality controls out of acceptable ranges
3.28. Glucometer Quality control records are available for 4 months
4. Child Immunization
Register is used for recording information about child immunization
4.1.
(i.e manual or electronic records) remains in the health facility
Healthcare professionals are able to articulate standard procedures
4.2.
in case of adverse events
4.3. Severe adverse events forms are available
4.4. Anaphylaxis kit is available
4.5. Inventory of vaccines including expiry dates are available
No. Description Yes No N/A Remarks
Vaccine refrigerator is equipped with thermometer to ensure
4.6.
monitoring between 2 – 8 0C
4.7. The refrigerator is used only for vaccines and medication
4.8. Refrigerator temperature monitoring chart is completed twice daily
4.9. Refrigerator have an uninterrupted electric supply
Alternative refrigerator is available in the event of a break down or
4.10.
repair of vaccine refrigerator
4.11. Unused expired vaccines are disposed as per policy
Healthcare professionals are aware about the immediate action in
4.12.
case of electrical failure
Healthcare professionals knows how to read Vaccine Vial Monitor
4.13.
(VVM) color changes
Health professionals providing immunization attended specific
4.14. trainings which includes guidelines/information on vaccine use,
storage and the maintenance of the cold chain, etc.
4.15. Healthcare professionals are aware of multi vial policy
4.16. Vaccine carrier/s and thermometer are available
5. Anesthesia (level II)
5.1. Only Chloral Hydrate or Nitrous Oxide are used in the facility
5.2. If Nitrous Oxide is used, a training certificate for Dentist is available
Vital signs monitoring equipment are available including Blood
5.3.
pressure, ECG 3 leads and pulse oximeter
5.4. Records of vital monitoring for each case is maintained
The physician/dentist providing level II anesthesia has a valid ACLS
5.5. certification or Pediatric Advanced Life Support (PALS) if pediatric
service is provided
6. Dental
Room and dental chair arrangement ensure patient privacy
6.1.
(patient’s face directed away from clinic door)
Hand-washing station with hand soap and tissue is available
6.2.
inside dental rooms
Hand washing educational posters available at the Hand-washing
6.3.
station
Non-refillable hand sanitizer dispenser is available in dental room
6.4.
with educational posters
Sterile surgical gloves are available for invasive patient
6.5.
procedures
6.6. Protective Eyewear/Face Shields are available and used
6.7. Protective clothing are available and used
No. Description Yes No N/A Remarks
Dental Assistant/Nurse can demonstrate proper dental
6.8.
environment cleaning/ methods.
Dental Assistant/Nurse have an access to DHA Guidelines on Dental
6.9.
Infection Prevention and Safety or similar dental guidelines
Testing of dental water quality is conducted regularly and a
6.10. document is maintained (Bacterial counts in the water should be <
200 CFU/mL)
Only sterile irrigant such as sterile water or sterile saline is used for
6.11.
dental surgical procedures

Discharging water and air for a minimum of 20-30 seconds after

each patient from any device connected to the dental water system
6.12.
that enters the patient's mouth (e.g., hand pieces, ultrasonic scalers,
air/water syringes) is practiced.
At the end of each day, the ultrasonic cleaner tank is emptied,
6.13.
cleaned and left dry
Flushing of waterlines at the start of the day to reduce overnight or
6.14.
weekend biofilm accumulation is performed
6.15. Sharp containers are kept above the ground level
6.16. No sharp containers are filled more than 3/4 full
6.17. Needle recapping/ separating is not practiced
6.18. General and Medical waste collection bag/container is available
6.19. No storage is permitted under the sink in dental rooms
Dedicated area for dental instrument sterilization with sink is
6.20.
available which is separate from the dental room
Autoclave/Sterilization indicators and records are maintained
6.21.
for each cycle
Weekly monitoring of sterilizers using biological indicator for
6.22.
each sterilizer load (if applicable) is available
Sterile instruments are checked regularly to ensure the
6.23.
sterility and removal of damaged pouch
Stock rotation is maintained according to the principle "first-in
6.24.
first out" so that older items are used first
6.25. Staff immunization status for Hbv is documented

6.26. Thyroid lead Apron is available

6.27. Radiation protection program is documented

FANR licensed is available for dental radiology equipment

6.28.
(intraoral and OPG)
No. Description Yes No N/A Remarks

7. TCAM Services and Supplies

7.1. No selling/dispensing of TCAM medications in the facility

Only approved and registered medicinal products and oils are
7.2. available in the facility as part of patient treatment (as per
Outpatient Regulation)
Only disposable supplies of Traditional Chinese Medicine are
7.3. used; including acupuncture needles, moxibustion and cupping
supplies
Compounding of TCAM medication is not conducted in the
7.4.
facility
8. Phlebotomy area and Clinical Laboratory
8.1. Laboratory accreditation is valid
If Laboratory Services is outsourced, a valid signed contract/
8.2. agreement is available between the facility and the
outsourced provider
If specimen is collected for laboratory investigations the
following are available:
 reclining chair or gurney
8.3.
 hand-washing Station
 Safe Sharp disposal
 Curtain to ensure patient privacy
8.4. Sample collection manual is available
8.5. Specimen transport carriers are available
Timeframe for maintaining and transporting specimens are
8.6.
documented
Turn-around time is documented for specimen sent outside
8.7.
the facility
An active Full/part time Licensed Clinical Pathologist is
8.8.
available to supervise the laboratory
Access to the laboratory area is restricted to authorized
8.9.
personnel only
A dedicated sample receiving area in the laboratory is
8.10.
identified
Laboratory technician(s) are aware of sample acceptance or
8.11.
rejection criteria
A permanent, sequential logbook or electronic record of
8.12.
received samples is in place
Laboratory working countertops are monolithic, heat
8.13.
resistant, antimicrobial and impermeable
Foot/elbow/sensor operated hand-washing station with hand soap,
8.14.
tissue and hand sanitizer dispenser are available
No. Description Yes No N/A Remarks
8.15. Laboratory cupboards are clean, tidy and properly labelled

Laboratory coats are only worn in the laboratory and removed

8.16.
before leaving
8.17. Clinical sink for laboratory use is available
8.18. Emergency shower is available
8.19. Stand-alone/disposable eye wash bottles is available
8.20. Spill Kit is available
Periodic Emergency Shower and eyewash station checking
8.21.
procedure is conducted and documented
8.22. Laboratory staff are using closed footwear
At least two designated storage refrigerators for samples and
8.23.
reagents/solvents are available

If microbiology service is provided, a separate dedicated area

is available with the following:
 biological hood Level II (kept closed if not in use)
8.24.  biological hood filters are changed as per the
Manufacturer’s recommendation and documented
 with negative pressure
 Separate dedicated area for autoclave

No Food and beverages are available in the laboratory

8.25.
premises

8.26. Abnormal results are reviewed and signed by the pathologist

Samples are disposed according to the facility policy but not

8.27.
exceeding seven days

8.28. Safety cabinet for hazardous materials is available

8.29. List of hazardous materials used in the laboratory is available

8.30. Material Safety Data Sheet (MSDS) is available and easily accessible

Calibration of pipettes and thermometers is performed and

8.31.
documented regularly

Written Policy and Procedures on the following are available:

 Quality Assurance manual
8.32.
 Laboratory Standard Operating Procedures
 Sample preparation and storage/disposal
No. Description Yes No N/A Remarks
Written Policy and Procedures on the following are available (Cont.):
 Reporting of results (if applicable)
 Instrument calibration
8.33.  Quality control and corrective action
 Equipment performance evaluation
 Validated Reagents & supplies
 Test performance
9. Diagnostic Imaging Services
If diagnostic imaging services is outsourced, a valid signed contract/
9.1.
agreement is available between the facility and the providers
9.2. Specific radiology registration form is available
9.3. Ten Days Rule for women of child bearing age is followed
9.4. Radiation warning signs and posters are available
Green/Red warning light sign indicating when the X-ray beam is
9.5.
OFF/ON is available
9.6. Federal Authority for Nuclear Regulation (FANR) license is available
9.7. Conventional radiography room size shall be at least 15 m2
Dedicated patient gowning area with safe storage for valuables and
9.8.
clothing is available
Radiography room shielding thicknesses comply with FANR and DHA
9.9.
requirements
9.10. Digital Film processing is available
9.11. Quality assurance for digital imaging is conducted and documented
9.12. Dosimeter are maintained and measurements are recorded
9.13. Policy for pregnant Healthcare Professionals is available
Various type of Lead aprons are available and mounted in
9.14.
specialized hanger
9.15. Annual testing of aprons is conducted and documented
Ultrasound room measurement not less than 7 meters with
9.16.
accessible patient toilet within the room
X-ray equipment are subject to periodic Quality Control testing and
9.17.
calibration are conducted and documented
9.18. Last quality control testing of x-ray machine is documented
Records confirming testing and maintenance of x-ray machine is
9.19.
available
9.20. Patient Registry Logbook or electronic records is available
At least 1 DHA licensed Consultant/Specialist Radiologist must
9.21.
supervise the services on part time basis to provide reports
No. Description Yes No N/A Remarks
9.22. At least 1 full time licensed radiographer is available
Training records on Radiation Safety for Radiation Safety Officer
9.23.
(radiologist/radiographer) is available
All radiology investigations conducted in the facility are reported by
9.24. the radiologist within the specified time frame as per the
organization policy
Copy of the radiology reports (electronic/manual) are archived in
9.25.
patient files
10. Medical Equipment and Supplies
10.1. General storage area for equipment and supplies are available
10.2. Manufacturer’s maintenance manuals available
Preventive Maintenance (PM) contract for all medical equipment in
10.3.
the facility are available
10.4. Valid PPM labels is available on each equipment
10.5. Documentation of failure incidence and repairs are available
10.6. Operational and Safety manuals are available
Installation and maintenance service logbook for all equipment is
10.7.
available
10.8. No extension cords are used in the facility
Healthcare Professionals new equipment training program is available
10.9.
and documented
11. Human Resources and Administration
The Medical Director of the facility is available and matching Shreyan
11.1.
system
DHA is notified within 10 days in case of changing the Medical
11.2.
Director
All healthcare professionals working in the facility maintain a valid
11.3.
DHA license
Healthcare professional staffing ratio is meeting the DHA
11.4.
requirements
All Healthcare professional display ID badges/DHA license during
11.5.
their practice in the facility
A dedicated employee is available for administrative and insurance
11.6.
activities
Dedicated personal(s) in the facility responsible for the DHA online
11.7.
sick leave purchasing and attestation

11.8. No manual sick leave forms available/issued by facility

11.9. Facility sick leave charges is matching the DHA official charges
No. Description Yes No N/A Remarks
Staff are aware of the procedures and reporting requirements of
11.10.
Dubai Statistics Centre (DSC)
11.11. Statistics reporting is conducted regularly as per the DSC requirements

11.12. Dedicated complaint files is maintained in the facility

List of procedures/interventions requiring informed consent is
11.13.
available in the facility
No promotional activities for any medicinal/ Nutritional Supplements
11.14.
or cosmetic products is conducted in the facility
DHA approval is obtained for all promotional and campaign activities
11.15.
outside the facility
The facility management prohibits displaying of materials, pictures or
11.16.
advertisements violating the public morality and ethics.
Documented Continuing Professional Development (CPD) activities
11.17.
for all healthcare professionals is available
11.18. DHA is notified for suspending of any clinical services within 10 days
11.19. Staff lounge with lockers for staff personal belongings are available

12. Policies and Procedures

Documented policies and procedures in the facility are available
including but not limited to the following:
 Infection Prevention and Control Policies and Guidelines
 Medical and Hazardous waste management
 Medication management
 Patient transfer and referral Policy
12.1.  Fire and Safety Plan
 Radiation Safety (if applicable)
 Complaint Management Policy and Feedback Procedure
 Health Record Management and Retention Policy
 Staff Orientation and Training Program
 Lost and Found Items Policy

13. Health Records

A unique identification number is created for each new file with a
13.1.
copy of official ID
13.2. Allergy status is documented in each patient’s health record
13.3. Initial assessment is conducted for each patients
Pain Assessment is conducted for all newly registered patients ( e.g.
13.4.
pain scale tool)
Each healthcare professionals note/entry must be identified and
13.5.
authenticated with stamp and signature
No. Description Yes No N/A Remarks
13.6. Time and date of each visit is documented
Patient identification data is available in all forms/records within the
13.7.
patient health file
If Electronic Health Record (EHR) is used, entries are authenticated
13.8.
by staff username and password
13.9. EHR are meeting all of the above requirements
13.10. Informed consent is available (if applicable)
13.11. Approved abbreviation list is available in the facility
Un-approved abbreviations are not used in the patient health
13.12.
records
13.13. No abbreviations are used in consent forms
Secure filing cabinets/storage for paper based health records are
13.14.
available
13.15. Access to the filing area is restricted
Retention and destruction of health record is in compliance with
13.16.
DHA regulations and guidelines

14. Infection Prevention and Control

14.1. A designated Infection Control Coordinator is available

14.2. Infection control audit tool/checklist is available
14.3. Staff are aware of the universal/standard precautions
Cleaning and disinfection of toys and play area (if available) is
14.4.
documented
14.5. Staff can demonstrate safe handling and disposal of sharps

Staff are aware of needle stick management and post-exposure

14.6.
prophylaxis

Staff are aware of the proper use of antiseptic/disinfectants based on

14.7.
manufacturer’s instruction
Health care worker are aware of the management of blood or body
14.8.
fluids spillage
14.9. Approved list of antiseptic and disinfectants is available
Infection Prevention and Control training sessions are conducted and
14.10. documented for all health care workers (including administrative staff
and contracted employees)
Vaccination record of all health care worker are maintained and
14.11.
updated
Staff are aware of the DHA Infectious Diseases Notification system
14.12.
for reporting communicable disease
 No. Description Yes No N/A Remarks

Staff have an access to list of communicable disease required

14.13.
reporting as per the local and federal regulations

15. Hazard and Waste Management

All bags are tied, labeled and secured before leaving the place of
15.1.
generation (e.g. treatment room)
15.2. Medical wasted bags are removed daily from place of generation
Independent medical waste storage area with proper ventilation is
15.3.
available
Medical waste are removed in the storage area at maximum on
15.4.
weekly basis
15.5. Valid contract is available with a specialized company to regularly
collect, transport and discard medical waste
16. Fire and Safety
16.1. All facility fire extinguishers are maintained with valid date
16.2. Fire evacuation maps are posted in the facility
16.3. Self-illuminated emergency “exists signage” are available
Basic fire safety training is provided for all staff and documented
16.4.
evidence is maintained in staff files
Staff able to verbalise the acronym and its meaning to be followed in
16.5.
case of fire

Important note:
Required structural changes apply only to new purpose-built facilities, or existing buildings that require renovation, or in a
combination of both.

Inspector’s name and signature:

1. Name: Signature:

2. Name: Signature:

3. Name: Signature:

Name and Signature of Facility Representative/s:

1. Name: Signature:

2. Name: Signature: