SPOT CHECK FORM
To ensure quality, safety, and compliance with company standards and regulatory requirements during care delivery.
Date of Spot Check
*
/
Day
/
Month
Year
Date
Time of Spot Check
Hour Minutes
AM
PM
AM/PM Option
Section 1: General Information:
Location (Client's home /Community)
*
Client ID
*
Carer Information
*
Supervisor / Checker's Name
*
Section 2: Professionalism and Conduct
Carer arrived on time / Within acceptable time frame
*
YES
No
N/A
Carer wearing correct uniform and ID badge
*
Yes
No
N/A
Carer greeted client professionally and introduced self
*
Yes
No
N/A
Carer demonstrated respect empathy and positive attitude
*
Yes
No
N/A
Section 3: Care Delivery and Practice:
PPE used accurately (gloves, apron, masks etc)
*
Yes
No
N/A
Carer maintained client dignity and privacy
*
Yes
No
N/A
Personal care tasks (e.g. washing and dressing) delivered to a high standard
*
Yes
No
N/A
Carer followed Care Plan correctly
*
Yes
No
N/A
Carer communicated clearly and involved client in care
*
Yes
No
N/A
Moving and handling equipment (e.g. hoist, stand aids, etc.) was used appropriately
*
Yes
No
N/A
Carer followed infection control procedures
*
Yes
No
N/A
Section 4: Medication Administration
Medication administered or prompted as per the MAR chart
*
Yes
No
N/A
Carer recorded medication accurately on the MAR chart
*
Yes
No
N/A
Section 5: Health and Safety
Carer ensured the environment is safe (e.g. no hazards, items in reach)
*
Yes
No
N/A
Fire Safety measures in place (smoke alarm checks, heaters unobstructed)
*
Yes
No
N/A
Carer reports any concerns and hazards to the office
*
Yes
No
N/A
Section 6: Documentation and Communication
Daily notes completed accurately and legibly
*
Yes
No
N/A
Medication records updated correctly
*
Yes
No
N/A
Any concerns reported to office prompty
*
Yes
No
N/A
Handover / Communication with next carer appropriate
*
Yes
No
N/A
Environment left clean, safe and tidy
*
Yes
No
N/A
Medication records updated correctly
*
Yes
No
N/A
Section 7: Client Feedback (if appropriate)
Are you happy with the care provided today?
*
Yes
No
N/A
Any Suggestions or Concerns
Supervisor Summary
Supervisor's Summary
*
Satisfactory
Requires Improvement
Unsatisfactory
Summary of findings
Actions and Recommendations
Additional Information
To be completed by whom?
To be completed by when?
Carer's Signature
*
Date
*
/
Day
/
Month
Year
Date
Supervisor's Signature
*
Date
*
/
Day
/
Month
Year
Date
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