GO DIGITAL TODAY

Convert your paper

checklists into digital forms
Scan this QR code to use this
paper checklist on your
smartphone or tablet. Visit
www.iauditor.com

Title Page

Department/Division

Healthcare Facility 

Audit Lead

Conducted on 

Clinical Audit Cycle Checklist

Stage 1 (Preparation & Planning)

Involve stakeholders

Complete Incomplete
 Determine the audit topic

Complete Incomplete

Plan the delivery of audit fieldwork

Complete Incomplete

Stage 2 (Selecting the Standard/Criteria)

Identify evidence-based standard

Complete Incomplete

Specify audit criteria or measurable statements of what should be happening

Complete Incomplete

Set targets or expected performance levels

Complete Incomplete

Agree on acceptable exceptions (if appropriate)

Complete Incomplete

Stage 3 (Measuring Performance)

Carry out a short pilot of the data collection method

Complete Incomplete
 Collect accurate, timely, and representative data

Complete Incomplete

Analyze data

Complete Incomplete

Draw conclusions

Complete Incomplete

Present results to department/division

Complete Incomplete

Stage 4 (Implementing Changes)

Share audit report

Complete Incomplete

Review areas for improvement and agree on priorities for action

Complete Incomplete

Identify appropriate interventions

Complete Incomplete
 Develop quality improvement plan (if required)

Complete Incomplete

Identify persons responsible for each task/action and a reasonable timescale for
completion

Complete Incomplete

Determine how and when progress will be measured

Complete Incomplete

Ensure that change is supported by those with the necessary authority to effect
such change

Complete Incomplete

Stage 5 (Sustaining Improvements)

Monitor implementation of changes

Complete Incomplete

Report on the progress of implementation as required

Complete Incomplete

Re-audit to ensure changes have improved practice and decide if further audit
procedures are required

Complete Incomplete
Completion

Additional Comments

Audit Lead Name & Signature 

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's
solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice.
You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. Any ratings
or scores displayed in our Public Library have not been verified by SafetyCulture for accuracy. Users of our platform may provide a rating or score
that is incorrect or misleading. You should independently determine whether the template is suitable for your circumstances. You can use our
Public Library to search based on criteria such as industry and subject matter. Search results are based on their relevance to your search and
other criteria. We may feature checklists based on subject matters we think may be of interest to our customers.