External Cleaning Standards Audit Scores 2010 Survey

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External Cleaning Standards Audit Scores 2010

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Please ensure that all the information you have provided is correct before pressing the 'done' button.

1.	Public hospital or health service*

2.	Date that the external audit was undertaken* The value must be between 02/04/2010 and 05/08/2010, inclusive.
	dd/mm/yyyy

3.	Name of the auditor (person who undertook this audit)* Auditor must be a QVCSA

4.	Data submitter's (your) name*

5.	Data submitter's (your) phone number*

6.	Data submitter's (your) email*

7.	Your CEO must be made aware of any data you are submitting to the department. CEO has authorised data submission.* if No: please do not submit data until your CEO has been advised
	Yes No

8.	Enter score for Very high risk (category A)* Whole numbers only, Zero if N/A

9.	Enter score for High risk (category B)* Whole numbers only, Zero if N/A

10.	Enter score for Moderate risk (category C)* Whole numbers only, Zero if N/A

11.	Results of the internal auditing program*
	Pass
	Fail

Done

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