DENTAL EMERGENCY PREPAREDNESS CHECKLIST: SAFETY & PROTOCOLS

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--- EMERGENCY CONTACT INFORMATION ---
[ ] Patient Full Name
[ ] Patient Medical History Summary
[ ] Emergency Contact Name
[ ] Emergency Contact Phone Number
[ ] Relationship to Patient (Spouse, Parent, Guardian, Friend, Other)
[ ] Additional Contact Information/Notes

--- MEDICAL EMERGENCY RESPONSE ---
[ ] Patient's Pulse Rate (BPM)
[ ] Patient's Blood Pressure (Systolic/Diastolic)
[ ] Patient's Level of Consciousness (LOC) (Alert, Verbal, Painful, Unresponsive)
[ ] Brief Description of Emergency Situation
[ ] Date of Incident
[ ] Time of Incident
[ ] Administered Medication (if any) (None, Oxygen, Epinephrine, Other (Specify in long text))

--- FIRE SAFETY & EVACUATION ---
[ ] Last Fire Extinguisher Inspection Date
[ ] Fire Extinguisher ABC Rating (e.g., 2.5 lbs)
[ ] Fire Alarm System Status (Operational, Needs Repair)
[ ] Evacuation Route Obstructions (Clear, Boxes, Equipment, Other)
[ ] Notes on Evacuation Route Obstructions
[ ] Last Fire Drill Date
[ ] Time of Last Fire Drill

--- NATURAL DISASTER PREPAREDNESS ---
[ ] Estimated Flood Zone Elevation
[ ] Last Earthquake Drill Date
[ ] Designated Evacuation Assembly Point
[ ] Specific Instructions for Earthquake Procedure
[ ] Potential Disaster Threats (Select all that apply) (Earthquake, Flood, Hurricane, Tornado, Wildfire)
[ ] Map of Evacuation Routes
[ ] Estimated time to secure building during disaster warning

--- POWER OUTAGE PROTOCOL ---
[ ] Generator Fuel Level (Gallons)
[ ] Last Generator Test Time
[ ] Generator Status (Operational, Needs Maintenance, Out of Service)
[ ] Date of Last Generator Service
[ ] Notes Regarding Generator Performance/Issues
[ ] Emergency Lighting Functionality (Fully Functional, Partially Functional, Not Functional)

--- OXYGEN & CPR EQUIPMENT ---
[ ] Oxygen Tank Pressure (PSI)
[ ] Last Oxygen Tank Inspection Date
[ ] Flow Meter Calibration (LPM)
[ ] Expiration Date - Nasal Cannula
[ ] Expiration Date - Face Mask with Oxygen Port
[ ] CPR Certification Status - Staff Member 1 (e.g., Current, Expired, Not Certified) (Current, Expired, Not Certified)
[ ] AED Pad Expiration Date Checked? (Yes, No)
[ ] AED Battery Voltage (V)

--- HAZARDOUS MATERIALS MANAGEMENT ---
[ ] Nitrous Oxide Cylinder Pressure (PSI)
[ ] Last Mercury Spill Kit Inspection Date
[ ] Mercury Spill Kit Availability (Available, Not Available)
[ ] Notes on Current Hazardous Material Storage Conditions
[ ] Amalgam Waste Disposal Method (Recycling, Other - Specify in Long Text)
[ ] Photos of Hazardous Material Storage Area

--- SECURITY & ACTIVE SHOOTER RESPONSE ---
[ ] Security System Operational? (Yes, No, N/A)
[ ] Door Locking Procedure Reviewed? (Yes, No)
[ ] Brief Description of Security Personnel (if applicable)
[ ] Date of Last Security Drill/Training
[ ] Security Measures in Place: (Security Cameras, Alarm System, Controlled Access, Panic Buttons, Security Personnel)
[ ] Brief Summary of Active Shooter Response Protocol
[ ] Staff Trained in Active Shooter Response? (Yes, No)

--- COMMUNICATION & NOTIFICATION ---
[ ] Emergency Contact Phone Numbers (Primary)
[ ] Emergency Contact Phone Numbers (Secondary)
[ ] Primary Communication Method (Staff) (Phone Call, Text Message, Email, Paging System)
[ ] Emergency Service Notification Method (911, Direct Line to Local EMS, Hospital Contact)
[ ] Last Communication Plan Review Date
[ ] Detailed Communication Protocol (Staff and External Parties)
[ ] Staff Members Responsible for Communication (Office Manager, Lead Dental Assistant, Dentist)

--- REGULAR REVIEW & UPDATES ---
[ ] Last Review Date
[ ] Review Frequency (Months)
[ ] Summary of Changes Made
[ ] Review Trigger (e.g., incident, regulatory change) (Incident, Regulatory Change, Staff Training, Periodic Review)
[ ] Supporting Documentation (e.g., meeting minutes)
[ ] Review Status (Not Started, In Progress, Completed)

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