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About Us
Who We Are
About Our Founder
FAQ
What We Do
Organizational Certification & Training
Conference & Event Presentation
Sonographer Staffing Solutions
Educational Content
Why It Matters
Soft Tissue Recovery
Ergo-Mechanics
White Paper
#CaptheCaseload Campaign
Resources
Blog
Podcast
Contact
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Safety Checklist
Step
1
of
2
- Facility Information
50%
Facility Information
Point of Contact
(Required)
Email
(Required)
Facility Name
Phone Number
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Country
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
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Belgium
Belize
Benin
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Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
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Brazil
British Indian Ocean Territory
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Chile
China
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Comoros
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Congo, Republic of the
Cook Islands
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Venezuela
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Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Ultrasafe Certification Checklist
Facility Setting
Single Site
Private Practice
Multi-Site
Public Entity
Facility Type
Teaching Facility
Trauma Center
Physician Group
Acute Care
Outpatient Clinic
Number of Sonographers
Number of Ultrasound rooms
Ultrasound Equipment
Please list all makes, models and years
Electronic Health Record Systems (EHR)
Medium for impression reporting for EHR
Digital
Worksheets
Triage Practices
Thermometer
Safety Protocols forms and content
Hand Hygiene
Yes
No
Breath Barrier
Face Shields
Standalone
HEPA approved Air Purifying System
Yes
No
Transvaginal probe storage
Yes
No
Skin-film barriers made available for exams that expose shared equipment to non-intact skin
Yes
No
High Level Disinfection for probes that encounter mucus membranes or non-intact skin?
If yes, please send logs for the past 90 days
Yes
No
Log File
Max. file size: 50 MB.
Ultrasound Quality Assurance program utilized
Yes
No
Accreditation Needs for (ICAVL, IAC JACHO, TJC)
Yes
No
Participated in Training to optimize Ergonomic, Biomechanical, and environmental Risk factors in the Ultrasound clinical setting.
Yes
No
Soft tissue recovery tools available
Stretching Stick, Ice Pack, Massage Ball, etc.
Yes
No
Soft tissue recovery time allotted in your workflow
Yes
No
Sonographer WRMSDs claims in the last 3 years
Yes
No
Sonographer WC claims in the last 3 years
Yes
No
Have you ever implemented an Ergonomic Process?
ROI up to 400%
Yes
No
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