DENTAL X-RAY SAFETY CHECKLIST: RADIATION PROTECTION & CALIBRATION

Created by ChecklistGuro (https://checklistguro.com)

--- PRE-PROCEDURE CHECKS ---
[ ] Last Equipment Calibration Date
[ ] Tube Current (mA) Setting
[ ] Kilovoltage (kVp) Setting
[ ] Exposure Time Setting
[ ] Collimation Check (Verified & Correct, Needs Adjustment)
[ ] Digital Receptor Check (Cleaned, Connected, Functional)
[ ] Image Processing Software Status (Up-to-date, Needs Update)

--- PATIENT PREPARATION ---
[ ] Pregnancy Status? (Yes, No, Unknown)
[ ] Approximate Gestational Age (if applicable)
[ ] Patient Communication Regarding Radiation Concerns? (Yes, No, N/A)
[ ] Details of Patient Concerns (if any)
[ ] Appropriate Shielding Applied? (Yes, No, N/A)
[ ] Consent Form (if applicable)
[ ] Patient Acknowledgement

--- EQUIPMENT CALIBRATION & TESTING ---
[ ] Tube Current (mA) Reading
[ ] Kilovoltage (kVp) Setting
[ ] Exposure Time (seconds)
[ ] Detector Type (Digital Sensor, Film, Phosphor Plate)
[ ] Calibration Date
[ ] Calibration Time
[ ] Output Reading (mR)
[ ] Calibration Status (Pass, Fail, Pending)

--- SHIELDING & PROTECTIVE BARRIERS ---
[ ] Lead Apron Thickness (for patient) (0.5 mm, 1.0 mm, 1.5 mm, 2.0 mm)
[ ] Thyroid Shield Used? (Yes, No)
[ ] Gonadal Shield Used (if applicable)? (Yes, No, Not Applicable)
[ ] Distance from X-ray Unit (feet)
[ ] Barrier Integrity Verified? (Yes, No)
[ ] Comments on Shielding/Barriers (e.g., repairs needed)

--- EXPOSURE PARAMETERS ---
[ ] kVp (Kilovoltage Peak)
[ ] mA (MilliAmperes)
[ ] Exposure Time (Seconds)
[ ] Image Receptor Type (Digital Sensor, Film, Phosphor Plate)
[ ] Collimation Technique (Correct, Needs Adjustment)
[ ] Notes on Exposure Settings (e.g., adjustments made, rationale)
[ ] Date of Parameter Validation

--- PERSONNEL SAFETY & MONITORING ---
[ ] Last Radiation Exposure Badge Reading (mSv)
[ ] Date of Last Radiation Safety Training
[ ] Radiation Safety Role (e.g., Radiation Safety Officer) (Radiation Safety Officer, Registered Dental Hygienist, Dental Assistant, Dentist)
[ ] PPE Utilized During Exposure (Thyroid Shield, Lead Apron, Gloves, Eyewear)
[ ] Notes on Individual Radiation Exposure Concerns
[ ] Date of Next Scheduled Radiation Safety Review

--- RECORD KEEPING & DOCUMENTATION ---
[ ] Calibration Date
[ ] Exposure Meter Reading (mR)
[ ] Notes on Calibration Procedure
[ ] Calibration Certificate (PDF)
[ ] Last Personnel Radiation Monitoring Date
[ ] Personnel Exposure Dose (mSv)
[ ] Equipment Maintenance Log Reviewed? (Yes, No)

--- EMERGENCY PROCEDURES ---
[ ] Contact Information for Radiation Safety Officer (RSO)
[ ] Emergency Contact Information (Police, Fire, Hazmat)
[ ] Dose Limits for Personnel (mSv/year)
[ ] Procedure for Reporting Radiation Incidents
[ ] Date of Last Emergency Drill
[ ] Time of Last Emergency Drill
[ ] Steps Taken During Radiation Incident (Evacuate Area, Notify RSO, Administer First Aid, Secure Equipment, Document Incident)
[ ] Photos/Documentation of Incident (if applicable)

--- END OF TEMPLATE ---
Transform this text into a digital, automated, and trackable mobile app!
Visit: https://checklistguro.com/templates/dental-management/dental-x-ray-safety-checklist-radiation-protection-calibration
(Click "Install Template" to launch your digital inspection tool immediately)