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 01/12/2009 and 31/12/2010, inclusive.
	dd/mm/yyyy

3.	Name of the auditor (person who undertook this audit)*

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)*

9.	Enter score for High risk (category B)*

10.	Enter score for Moderate risk (category C)*

11.	Your overall score: This figure should auto calculate when you click in the box or on the 'Done' button below. It is calculated by adding the scores for Very high, High and Moderate together and dividing by 3.

12.	Results of the internal auditing program*
	Pass
	Fail

Done

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