New Branch Evaluation

A. Reception / Waiting Area Section Avg: 0

Cleanliness & order (Floors, seats, tables, glass)

1 2 3 4 5

Waste management (bins emptied, liners; no odor)

1 2 3 4 5

Aroma/Ambience (scent diffuser working)

1 2 3 4 5

Lighting & sound (all lights operational & sound level appropriate)

1 2 3 4 5

Signages & Service Menu operational (Acrylic/TV/Sintra Board)

1 2 3 4 5

Remarks

B. Treatment Rooms Section Avg: 0

Treatment bed & linens clean; changed per patient

1 2 3 4 5

Surfaces disinfected between clients

1 2 3 4 5

Tools/consumables organized

1 2 3 4 5

Machines present, clean & functional

1 2 3 4 5

Room condition (floors, comfort, privacy)

1 2 3 4 5

Remarks

C. Procedure / Prep Section Avg: 0

Hand hygiene before & during procedure

1 2 3 4 5

New & used items separated on tray

1 2 3 4 5

Tools & sharps positioned safely in tray

1 2 3 4 5

Consumables properly scaled

1 2 3 4 5

Remarks

D. Restroom & Utility Section Avg: 0

Toilets/sinks/floors cleaned & disinfected

1 2 3 4 5

Soap/tissue/towels replenished

1 2 3 4 5

Odor/ventilation acceptable; fixtures working

1 2 3 4 5

Mirrors & surfaces spotless; no water spots

1 2 3 4 5

Trash bins closed; no foul odor

1 2 3 4 5

Remarks

E. Hallway Section Avg: 0

Surfaces (panels/fixtures/mirrors) clean; no dust buildup

1 2 3 4 5

Lighting operational

1 2 3 4 5

Storage organized & labeled

1 2 3 4 5

Floors clutter-free; no slip/trip hazard

1 2 3 4 5

Remarks

F. Utility / Pantry / Machine / Inventory Room Section Avg: 0

FIFO observed for products & clinic use

1 2 3 4 5

Proper segregation (products/clinic use/tools)

1 2 3 4 5

Shelving neat, labeled, and off-floor

1 2 3 4 5

Remarks

G. Equipment Care Section Avg: 0

Machines wiped after use; no exposed wires

1 2 3 4 5

Cords/cables stored safely

1 2 3 4 5

PM logs up to date; inventory tags present & updated

1 2 3 4 5

Incident/accident reports submitted when applicable

1 2 3 4 5

Remarks