Self-Audit
Review Form
INTRODUCTION
In accordance with our mandate to act in the public’s interest this checklist will assist dentists in preparing
their ofces and understanding how to safely provide in-person care in response to the COVID-19
pandemic. For comprehensive information, consult the College’s guidance document and the Ministry of
Health’s COVID-19 Operational Requirements: Health Sector Restart document.
Circumstances surrounding Ontario’s COVID-19 crisis are constantly evolving and, dentists are advised to
be aware of, and responsive to, new developments. Examples include:
Any future changes to this guidance document or the College’s COVID-19 FAQ,
New or changing guidance from the Chief Medical Ofcer of Health or Public Health Ontario, and
Changes to the Province’s regional approach to re-opening, including any decision to loosen or
tighten restrictions. As the rates of community transmission ebb and ow, dentists may consider
exceeding the requirements contained in this document as circumstances or professional judgment
require.
Dental ofces are at a high risk for spreading COVID-19 given the aerosol generating nature of dental
procedures, the proximity of the operating eld to the upper respiratory tract, and the number of
patients seen per day. Dentists must comply with the direction of government and the College to maintain
the safety of their patients, staff, and themselves, and to not contribute to the transmission of COVID-19.
All dentists are strongly encouraged to undertake regular audits of their compliance with the College’s
COVID-19 guidance document along with the IPAC policies and procedures in their dental ofce.
COVID-19 GUIDANCE DOCUMENT
2
SELF-AUDIT REVIEW FORM - COVID-19 GUIDANCE DOCUMENT
RCDSO
ADDITIONAL COVID-19 REQUIREMENTS
FOR IPAC AUDITS, 2020
Updated September 3, 2020
Date:
Completed by:
Dentists Name: Dr. RCDSO #:
Practice Address:
REQUIREMENT YES NO N/A NOTES
General Staff Requirements
Wear ofce attire at work.
Y
N
N/A
Maintain 2 meters of physical distancing
except when providing patient care.
Y
N
N/A
Self-monitor for any symptoms of COVID-19
and record the ndings.
Y
N
N/A
Ofce Setup
Limit points of entry into the ofce.
Y
N
N/A
Install physical barriers (i.e. plexiglass) at key
contact points, including reception.
Ensure receptionists wear proper PPE (as per
guidance document) if barrier is absent.
Y
N
N/A
Remove magazines, toys and any other
non-essential items from ofce, reception area
and operatories.
Y
N
N/A
Place signage in common areas requiring
patients:
to wash and/or sanitize hands upon entry;
to wear a mask within the ofce;
to maintain physical distancing (except during
the provision of care); and
to report signs and symptoms of COVID-19.
Y
N
N/A
Provide 70-90% ABHR at all entry points
to the ofce and in reception area.
Y
N
N/A
Provide tissues and receptacles lined with
garbage bags.
Y
N
N/A
3
SELF-AUDIT REVIEW FORM - COVID-19 GUIDANCE DOCUMENT
RCDSO
REQUIREMENT YES NO N/A NOTES
Scheduling Appointments
Schedule appointments by phone or
teledentistry, after patients are triaged.
Y
N
N/A
Screen patients for COVID-19 using the Ministry
of Health’s screening questions.
Y
N
N/A
Do not treat patients who have screened
or tested positive for COVID-19, except as
needed for emergency or urgent care.
Y
N
N/A
Instruct patients who screen positive
for COVID-19 to contact their primary care
provider or Telehealth Ontario at
1-866-797-0000.
Y
N
N/A
Patient Arrival Protocol
Screen everyone a second time for COVID-19
before permitting entry to the ofce. Record
screening results in the patient’s record.
Y
N
N/A
Patients and visitors must wear a mask at all
times while in the ofce except during the
provision of care.
Y
N
N/A
Patients (and guests) must perform hand
hygiene upon entering and before leaving
the ofce.
Y
N
N/A
During Dental Care
Staff must wear appropriate PPE:
Non-aerosol generating procedures (NAGPs)
when the patient has screened negative for
COVID-19
ASTM level 2 or 3 procedure/ surgical mask
Gloves
Eye protection OR face shield
Y
N
N/A
Non-aerosol generating procedures (NAGPs)
when the patient has screened positive for
COVID-19
ASTM level 2 or 3 procedure/ surgical mask
Gloves
Eye protection OR face shield
Protective gown
Y
N
N/A
4
SELF-AUDIT REVIEW FORM - COVID-19 GUIDANCE DOCUMENT
RCDSO
REQUIREMENT YES NO N/A NOTES
Aerosol generating procedures (AGPs)
when the patient has screened negative for
COVID-19
N95 respirator (t-tested, seal-checked),
or the Health Canada approved equivalent,
OR ASTM level 2 or 3 procedure/surgical
mask
Gloves
Eye protection AND/OR face shield
Protective gown (optional)
Y
N
N/A
Aerosol generating procedures (AGPs) when
the patient has screened positive for COVID-19
N95 respirator (t-tested, seal-checked), or
the Health Canada approved equivalent
Gloves
Eye protection AND face shield
Protective gown
Y
N
N/A
Cleaning and disinfection of operatory or
other treatment area
ASTM level 1 procedure mask
Gloves
Eye protection
Y
N
N/A
Reprocessing of reusable instruments
ASTM level 2 or 3 procedure/ surgical mask
Heavy duty utility-gloves
Eye protection or face shield
Protective gown
Y
N
N/A
Ensure staff are trained in and use proper
donning and dofng procedures for PPE.
Y
N
N/A
Fallow Time (Patients who have Screened Negative for COVID-19)
15 to 30 minutes following an aerosol-
generating procedure.
Fallow period begins after completion
of clinical care but before cleaning and
disinfection.
Y
N
N/A
End of Day Sanitation
Clean and disinfect high touch surfaces at least
twice a day (i.e. door knobs, plexiglass barriers,
hand rails, counters, and the arms of chairs).
Y
N
N/A
5
SELF-AUDIT REVIEW FORM - COVID-19 GUIDANCE DOCUMENT
RCDSO
REQUIREMENT YES NO N/A NOTES
Patient Arrival Protocol for Patients who have Screened or Tested
Positive for COVID-19
Immediately place COVID-positive patients into
an operatory alone and close the door.
Y
N
N/A
During Dental Care (Patients who have Screen Positive for COVID-19)
Ask COVID-positive patients to rinse with
1% - 1.5% hydrogen peroxide or 1%
providone-iodine for 60 seconds before
examination of the oral cavity.
Y
N
N/A
Perform aerosol-generating procedures on
COVID-positive patients in an operatory with
oor-to-ceiling walls and a door (or other
barrier).
Y
N
N/A
Conrm N95 masks (or Health Canada
approved equivalents) have been t-tested
and seal-checked and documentation of this
is on le.
Y
N
N/A
Fallow Time (Patients who have Screened Positive for COVID-19)
Conrm the dentist has calculated the correct
fallow time for AGPs involving COVID-positive
patients.
Ensure calculation and HVAC assessment
documentation is on le.
Y
N
N/A
10 /20 _ 5172
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