Registration

Core information about your phototherapy unit
Where a Trust has multiple sites, and each site is a main hospital in their own right, with their own staffing and governance etc. - these phototherapy units should register separately to complete the survey. The main Trust provider site is still required to list all the sites as part of their registration, but only complete the self-assessment survey for their own phototherapy unit.

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* 1. Hospital / Organisation name (select from list):

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* 2. Please list the sites where your phototherapy service(s) is/are provided.

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* 3. Name of person completing audit:

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* 4. Job title:

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* 5. Email Address:

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* 6. Please indicate the unit's stage of audit against the phototherapy standards:

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* 7. Start Date of Audit:

Date / Time

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* 8. Completion date of Audit:

Date / Time
Phototherapists

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* 9. Do you keep an up to date list of all professionals involved in any way in phototherapy (including technical staff etc.)?

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* 10. For each site, please complete the requisite details for all staff members of the phototherapy unite below.

  Job Title Clinical Grade Part-Time of Full Time Years of Experience in Phototherapy
Phototherapy Unit Lead 1
Phototherapy Unit Lead 2
Phototherapy Lead Nurse 1
Phototherapy Lead Nurse 2
Medical Physicist/Calibration Expert
Staff Member 1
Staff Member 2
Staff Member 3
Staff Member 4
Staff Member 5
Staff Member 6
Staff Member 7
Staff Member 8
Phototherapy Treatments

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* 11. What types of phototherapy treatments do you offer?

  TL01 Whole Body TL01 Hand and Foot TL01 Local Psoracomb PUVA Whole Body Bath PUVA Whole Body Oral PUVA Hand and Foot PUVA Local Topical Broadband UVB UVA 1
Site 1
Site 2
Site 3
Site 4
Hours of Service

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* 12. Phototherapy Service Operating Hours

  Opening Hours Closing Hours
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

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* 13. Do phototherapists carry and display valid and appropriate identification at all times?

Thank you for registering to the Phototherapy Service Audit. Please follow the link below to complete Part Two. Please note, all sections must be completed at once.

www.surveymonkey.co.uk/r/FVLRWQT

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