Phototherapy Service Audit: Part One Registration Core information about your phototherapy unit OK 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. OK Question Title * 1. Hospital / Organisation name (select from list): Aintree University Hospital NHS Foundation Trust Alder Hey Children's NHS Foundation Trust Ashford and St Peter's Hospitals NHS Foundation Trust Barking, Havering and Redbridge University Hospitals NHS Trust Barnsley Hospital NHS Foundation Trust Barts Health NHS Trust Basildon and Thurrock University Hospitals NHS Foundation Trust Bedford Hospital NHS Trust Birmingham Children's Hospital NHS Foundation Trust Birmingham Treatment Centre Blackpool Teaching Hospitals NHS Foundation Trust BMI - Bishops Wood BMI Woodlands Hospital Bodmin NHS Treatment Centre Bolton NHS Foundation Trust Bradford Teaching Hospitals NHS Foundation Trust Bridgewater Community Healthcare NHS Foundation Trust Brighton and Sussex University Hospitals NHS Trust Buckinghamshire Healthcare NHS Trust Burton Hospitals NHS Foundation Trust Calderdale and Huddersfield NHS Foundation Trust Cambridge University Hospitals NHS Foundation Trust Cambridgeshire Community Services NHS Trust Central Manchester University Hospitals NHS Foundation Trust Chelsea and Westminster Hospital NHS Foundation Trust Chesterfield Royal Hospital NHS Foundation Trust Circle - Nottingham NHS Treatment Centre Clitheroe Health Centre Cobham Day Surgery Hospital Colchester Hospital University NHS Foundation Trust Countess of Chester Hospital NHS Foundation Trust County Durham and Darlington NHS Foundation Trust Croydon Health Services NHS Trust Derby Teaching Hospitals NHS Foundation Trust Derbyshire Community Health Services NHS Foundation Trust Doncaster and Bassetlaw Hospitals NHS Foundation Trust Dorking General Hospital Dorset County Hospital NHS Foundation Trust Dorset Healthcare University NHS Foundation Trust Duchy Hospital East and North Hertfordshire NHS Trust East Cheshire NHS Trust East Kent Hospitals University NHS Foundation Trust East Lancashire Hospitals NHS Trust East Sussex Healthcare NHS Trust Epsom and St Helier University Hospitals NHS Trust Epsom Day Surgery (Ebbisham Clinics) Epsom Day Surgery Limited Frimley Health NHS Foundation Trust George Eliot Hospital NHS Trust Gloucestershire Hospitals NHS Foundation Trust Great Ormond Street Hospital for Children NHS Foundation Trust Great Western Hospitals NHS Foundation Trust Guy's and St Thomas' NHS Foundation Trust Hampshire Hospitals NHS Foundation Trust Harrogate and District NHS Foundation Trust Heart of England NHS Foundation Trust Healthub Homerton University Hospital NHS Foundation Trust Hull and East Yorkshire Hospitals NHS Trust Imperial College Healthcare NHS Trust Ipswich Hospital NHS Trust Isle of Wight NHS Trust James Paget University Hospitals NHS Foundation Trust Kettering General Hospital NHS Foundation Trust King's College Hospital NHS Foundation Trust Kingston Hospital NHS Foundation Trust Lancashire Teaching Hospitals NHS Foundation Trust Leeds Teaching Hospitals NHS Trust Lewisham and Greenwich NHS Trust London North West Healthcare NHS Trust Luton and Dunstable University Hospital NHS Foundation Trust Medway NHS Foundation Trust Mid Cheshire Hospitals NHS Foundation Trust Mid Essex Hospital Services NHS Trust Mid Yorkshire Hospitals NHS Trust Milton Keynes University Hospital NHS Foundation Trust Mount Stuart Hospital Norfolk and Norwich University Hospitals NHS Foundation Trust North Bristol NHS Trust North Cumbria University Hospitals NHS Trust North Downs Hospital North Middlesex University Hospital NHS Trust Northampton General Hospital NHS Trust Northern Devon Healthcare NHS Trust Northern Lincolnshire and Goole NHS Foundation Trust Nottingham University Hospitals NHS Trust Nuffield Health, Plymouth Hospital Other Oxford University Hospitals NHS Foundation Trust Park Hill Hospital Peterborough and Stamford Hospitals NHS Foundation Trust Plymouth Hospitals NHS Trust Poole Hospital NHS Foundation Trust Portsmouth Hospitals NHS Trust Queen Victoria Hospital NHS Foundation Trust Rivers Hospital Royal Berkshire NHS Foundation Trust Royal Brompton & Harefield NHS Foundation Trust Royal Cornwall Hospitals NHS Trust Royal Devon and Exeter NHS Foundation Trust Royal Free London NHS Foundation Trust Royal Liverpool and Broadgreen University Hospitals NHS Trust Royal Surrey County Hospital NHS Foundation Trust Royal United Hospitals Bath NHS Foundation Trust Salford Royal NHS Foundation Trust Salisbury NHS Foundation Trust Sandwell and West Birmingham Hospitals NHS Trust Sentinel Assessment & Treatment Services - Mount Gould LCC Sheffield Children's NHS Foundation Trust Sheffield Teaching Hospitals NHS Foundation Trust Shepton Mallet NHS Treatment Centre Sherwood forest Hospitals NHS Foundation Trust Shrewsbury and Telford Hospital NHS Trust Shropshire Community Health NHS Trust Torbay and South Devon NHS Foundation Trust South Tees Hospitals NHS Foundation Trust South Tyneside NHS Foundation Trust South Warwickshire NHS Foundation Trust Southern Health NHS Foundation Trust Southport and Ormskirk Hospital NHS Trust Spire Hull and East Riding Hospital St George's University Hospitals NHS Foundation Trust St Helens and Knowsley Hospital Services NHS Trust St Peters Centre Staffordshire and Stoke On Trent Partnership NHS Trust Surrey and Sussex Healthcare NHS Trust Tameside Hospital NHS Foundation Trust Taunton and Somerset NHS Foundation Trust Tees Valley Treatment Centre Tetbury Hospital Trust The Dudley Group NHS Foundation Trust The Hillingdon Hospitals NHS Foundation Trust The Newcastle upon Tyne Hospitals NHS Foundation Trust The Princess Alexandra Hospital NHS Trust The Queen Elizabeth Hospital, King's Lynn, NHS Foundation Trust The Rotherham NHS Foundation Trust The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust The Royal Marsden NHS Foundation Trust The Royal Wolverhampton NHS Trust The Whittington Hospital NHS Trust The Yorkshire Clinic United Lincolnshire Hospitals NHS Trust University College London Hospitals NHS Foundation Trust University Hospital of South Manchester NHS Foundation Trust University Hospital Southampton NHS Foundation Trust University Hospitals Birmingham NHS Foundation Trust University Hospitals Bristol NHS Foundation Trust University Hospitals Coventry and Warwickshire NHS Trust University Hospitals of Leicester NHS Trust University Hospitals of Morecambe Bay NHS Foundation Trust University Hospitals of North Midlands NHS Trust Virgin Care East Riding LLP Walsall Healthcare NHS Trust West Hertfordshire Hospitals NHS Trust West Suffolk NHS Foundation Trust Western Sussex Hospitals NHS Foundation Trust Wirral University Teaching Hospital NHS Foundation Trust Woodland Hospital Worcestershire Acute Hospitals NHS Trust Worcestershire Health and Care NHS Trust Wrightington, Wigan and Leigh NHS Foundation Trust Wye Valley NHS Trust Yarnspinners Primary Health Care Centre Yeovil District Hospital NHS Foundation Trust York Teaching Hospital NHS Foundation Trust Other (please specify) OK Question Title * 2. Please list the sites where your phototherapy service(s) is/are provided. 1 2 3 4 OK Question Title * 3. Name of person completing audit: OK Question Title * 4. Job title: OK Question Title * 5. Email Address: OK Question Title * 6. Please indicate the unit's stage of audit against the phototherapy standards: Pre- audit (to implementation) self assessment audit (standards implemented) self assessment review (upate since implemented) OK Question Title * 7. Start Date of Audit: Date / Time Date OK Question Title * 8. Completion date of Audit: Date / Time Date OK Phototherapists OK Question Title * 9. Do you keep an up to date list of all professionals involved in any way in phototherapy (including technical staff etc.)? Yes No OK Question Title * 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 N/A Consultant (with CCT or CESR) Locum Consultant (without CCT or CESR) Specialty Grade Doctor Associate Specialist Dermatology Clinical Nurse Specialist 1st Level Registered Nurse Staff Nurse Dermatology Nurse Practitioner Advanced Nurse Practitioner Senior Dermatology Sister Physiotherapist Healthcare Assistant Medical Physicist/Calibration Expert Other Phototherapy Unit Lead 1 Job Title menu N/A Consultant Specialty Grade Associate Specialist 1st Level Registered Nurse Nurse Chartered Physiotherapist Healthcare Assistant Medical Physicist/Calibration Expert Phototherapy Unit Lead 1 Clinical Grade menu N/A Part-Time Full-Time Phototherapy Unit Lead 1 Part-Time of Full Time menu N/A 0 1 2 3 4 5 6 7 8 9 10 10+ Phototherapy Unit Lead 1 Years of Experience in Phototherapy menu Phototherapy Unit Lead 2 N/A Consultant (with CCT or CESR) Locum Consultant (without CCT or CESR) Specialty Grade Doctor Associate Specialist Dermatology Clinical Nurse Specialist 1st Level Registered Nurse Staff Nurse Dermatology Nurse Practitioner Advanced Nurse Practitioner Senior Dermatology Sister Physiotherapist Healthcare Assistant Medical Physicist/Calibration Expert Other Phototherapy Unit Lead 2 Job Title menu N/A Consultant Specialty Grade Associate Specialist 1st Level Registered Nurse Nurse Chartered Physiotherapist Healthcare Assistant Medical Physicist/Calibration Expert Phototherapy Unit Lead 2 Clinical Grade menu N/A Part-Time Full-Time Phototherapy Unit Lead 2 Part-Time of Full Time menu N/A 0 1 2 3 4 5 6 7 8 9 10 10+ Phototherapy Unit Lead 2 Years of Experience in Phototherapy menu Phototherapy Lead Nurse 1 N/A Consultant (with CCT or CESR) Locum Consultant (without CCT or CESR) Specialty Grade Doctor Associate Specialist Dermatology Clinical Nurse Specialist 1st Level Registered Nurse Staff Nurse Dermatology Nurse Practitioner Advanced Nurse Practitioner Senior Dermatology Sister Physiotherapist Healthcare Assistant Medical Physicist/Calibration Expert Other Phototherapy Lead Nurse 1 Job Title menu N/A Consultant Specialty Grade Associate Specialist 1st Level Registered Nurse Nurse Chartered Physiotherapist Healthcare Assistant Medical Physicist/Calibration Expert Phototherapy Lead Nurse 1 Clinical Grade menu N/A Part-Time Full-Time Phototherapy Lead Nurse 1 Part-Time of Full Time menu N/A 0 1 2 3 4 5 6 7 8 9 10 10+ Phototherapy Lead Nurse 1 Years of Experience in Phototherapy menu Phototherapy Lead Nurse 2 N/A Consultant (with CCT or CESR) Locum Consultant (without CCT or CESR) Specialty Grade Doctor Associate Specialist Dermatology Clinical Nurse Specialist 1st Level Registered Nurse Staff Nurse Dermatology Nurse Practitioner Advanced Nurse Practitioner Senior Dermatology Sister Physiotherapist Healthcare Assistant Medical Physicist/Calibration Expert Other Phototherapy Lead Nurse 2 Job Title menu N/A Consultant Specialty Grade Associate Specialist 1st Level Registered Nurse Nurse Chartered Physiotherapist Healthcare Assistant Medical Physicist/Calibration Expert Phototherapy Lead Nurse 2 Clinical Grade menu N/A Part-Time Full-Time Phototherapy Lead Nurse 2 Part-Time of Full Time menu N/A 0 1 2 3 4 5 6 7 8 9 10 10+ Phototherapy Lead Nurse 2 Years of Experience in Phototherapy menu Medical Physicist/Calibration Expert N/A Consultant (with CCT or CESR) Locum Consultant (without CCT or CESR) Specialty Grade Doctor Associate Specialist Dermatology Clinical Nurse Specialist 1st Level Registered Nurse Staff Nurse Dermatology Nurse Practitioner Advanced Nurse Practitioner Senior Dermatology Sister Physiotherapist Healthcare Assistant Medical Physicist/Calibration Expert Other Medical Physicist/Calibration Expert Job Title menu N/A Consultant Specialty Grade Associate Specialist 1st Level Registered Nurse Nurse Chartered Physiotherapist Healthcare Assistant Medical Physicist/Calibration Expert Medical Physicist/Calibration Expert Clinical Grade menu N/A Part-Time Full-Time Medical Physicist/Calibration Expert Part-Time of Full Time menu N/A 0 1 2 3 4 5 6 7 8 9 10 10+ Medical Physicist/Calibration Expert Years of Experience in Phototherapy menu Staff Member 1 N/A Consultant (with CCT or CESR) Locum Consultant (without CCT or CESR) Specialty Grade Doctor Associate Specialist Dermatology Clinical Nurse Specialist 1st Level Registered Nurse Staff Nurse Dermatology Nurse Practitioner Advanced Nurse Practitioner Senior Dermatology Sister Physiotherapist Healthcare Assistant Medical Physicist/Calibration Expert Other Staff Member 1 Job Title menu N/A Consultant Specialty Grade Associate Specialist 1st Level Registered Nurse Nurse Chartered Physiotherapist Healthcare Assistant Medical Physicist/Calibration Expert Staff Member 1 Clinical Grade menu N/A Part-Time Full-Time Staff Member 1 Part-Time of Full Time menu N/A 0 1 2 3 4 5 6 7 8 9 10 10+ Staff Member 1 Years of Experience in Phototherapy menu Staff Member 2 N/A Consultant (with CCT or CESR) Locum Consultant (without CCT or CESR) Specialty Grade Doctor Associate Specialist Dermatology Clinical Nurse Specialist 1st Level Registered Nurse Staff Nurse Dermatology Nurse Practitioner Advanced Nurse Practitioner Senior Dermatology Sister Physiotherapist Healthcare Assistant Medical Physicist/Calibration Expert Other Staff Member 2 Job Title menu N/A Consultant Specialty Grade Associate Specialist 1st Level Registered Nurse Nurse Chartered Physiotherapist Healthcare Assistant Medical Physicist/Calibration Expert Staff Member 2 Clinical Grade menu N/A Part-Time Full-Time Staff Member 2 Part-Time of Full Time menu N/A 0 1 2 3 4 5 6 7 8 9 10 10+ Staff Member 2 Years of Experience in Phototherapy menu Staff Member 3 N/A Consultant (with CCT or CESR) Locum Consultant (without CCT or CESR) Specialty Grade Doctor Associate Specialist Dermatology Clinical Nurse Specialist 1st Level Registered Nurse Staff Nurse Dermatology Nurse Practitioner Advanced Nurse Practitioner Senior Dermatology Sister Physiotherapist Healthcare Assistant Medical Physicist/Calibration Expert Other Staff Member 3 Job Title menu N/A Consultant Specialty Grade Associate Specialist 1st Level Registered Nurse Nurse Chartered Physiotherapist Healthcare Assistant Medical Physicist/Calibration Expert Staff Member 3 Clinical Grade menu N/A Part-Time Full-Time Staff Member 3 Part-Time of Full Time menu N/A 0 1 2 3 4 5 6 7 8 9 10 10+ Staff Member 3 Years of Experience in Phototherapy menu Staff Member 4 N/A Consultant (with CCT or CESR) Locum Consultant (without CCT or CESR) Specialty Grade Doctor Associate Specialist Dermatology Clinical Nurse Specialist 1st Level Registered Nurse Staff Nurse Dermatology Nurse Practitioner Advanced Nurse Practitioner Senior Dermatology Sister Physiotherapist Healthcare Assistant Medical Physicist/Calibration Expert Other Staff Member 4 Job Title menu N/A Consultant Specialty Grade Associate Specialist 1st Level Registered Nurse Nurse Chartered Physiotherapist Healthcare Assistant Medical Physicist/Calibration Expert Staff Member 4 Clinical Grade menu N/A Part-Time Full-Time Staff Member 4 Part-Time of Full Time menu N/A 0 1 2 3 4 5 6 7 8 9 10 10+ Staff Member 4 Years of Experience in Phototherapy menu Staff Member 5 N/A Consultant (with CCT or CESR) Locum Consultant (without CCT or CESR) Specialty Grade Doctor Associate Specialist Dermatology Clinical Nurse Specialist 1st Level Registered Nurse Staff Nurse Dermatology Nurse Practitioner Advanced Nurse Practitioner Senior Dermatology Sister Physiotherapist Healthcare Assistant Medical Physicist/Calibration Expert Other Staff Member 5 Job Title menu N/A Consultant Specialty Grade Associate Specialist 1st Level Registered Nurse Nurse Chartered Physiotherapist Healthcare Assistant Medical Physicist/Calibration Expert Staff Member 5 Clinical Grade menu N/A Part-Time Full-Time Staff Member 5 Part-Time of Full Time menu N/A 0 1 2 3 4 5 6 7 8 9 10 10+ Staff Member 5 Years of Experience in Phototherapy menu Staff Member 6 N/A Consultant (with CCT or CESR) Locum Consultant (without CCT or CESR) Specialty Grade Doctor Associate Specialist Dermatology Clinical Nurse Specialist 1st Level Registered Nurse Staff Nurse Dermatology Nurse Practitioner Advanced Nurse Practitioner Senior Dermatology Sister Physiotherapist Healthcare Assistant Medical Physicist/Calibration Expert Other Staff Member 6 Job Title menu N/A Consultant Specialty Grade Associate Specialist 1st Level Registered Nurse Nurse Chartered Physiotherapist Healthcare Assistant Medical Physicist/Calibration Expert Staff Member 6 Clinical Grade menu N/A Part-Time Full-Time Staff Member 6 Part-Time of Full Time menu N/A 0 1 2 3 4 5 6 7 8 9 10 10+ Staff Member 6 Years of Experience in Phototherapy menu Staff Member 7 N/A Consultant (with CCT or CESR) Locum Consultant (without CCT or CESR) Specialty Grade Doctor Associate Specialist Dermatology Clinical Nurse Specialist 1st Level Registered Nurse Staff Nurse Dermatology Nurse Practitioner Advanced Nurse Practitioner Senior Dermatology Sister Physiotherapist Healthcare Assistant Medical Physicist/Calibration Expert Other Staff Member 7 Job Title menu N/A Consultant Specialty Grade Associate Specialist 1st Level Registered Nurse Nurse Chartered Physiotherapist Healthcare Assistant Medical Physicist/Calibration Expert Staff Member 7 Clinical Grade menu N/A Part-Time Full-Time Staff Member 7 Part-Time of Full Time menu N/A 0 1 2 3 4 5 6 7 8 9 10 10+ Staff Member 7 Years of Experience in Phototherapy menu Staff Member 8 N/A Consultant (with CCT or CESR) Locum Consultant (without CCT or CESR) Specialty Grade Doctor Associate Specialist Dermatology Clinical Nurse Specialist 1st Level Registered Nurse Staff Nurse Dermatology Nurse Practitioner Advanced Nurse Practitioner Senior Dermatology Sister Physiotherapist Healthcare Assistant Medical Physicist/Calibration Expert Other Staff Member 8 Job Title menu N/A Consultant Specialty Grade Associate Specialist 1st Level Registered Nurse Nurse Chartered Physiotherapist Healthcare Assistant Medical Physicist/Calibration Expert Staff Member 8 Clinical Grade menu N/A Part-Time Full-Time Staff Member 8 Part-Time of Full Time menu N/A 0 1 2 3 4 5 6 7 8 9 10 10+ Staff Member 8 Years of Experience in Phototherapy menu OK Phototherapy Treatments OK Question Title * 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 1 TL01 Whole Body Site 1 TL01 Hand and Foot Site 1 TL01 Local Site 1 Psoracomb Site 1 PUVA Whole Body Bath Site 1 PUVA Whole Body Oral Site 1 PUVA Hand and Foot Site 1 PUVA Local Topical Site 1 Broadband UVB Site 1 UVA 1 Site 2 Site 2 TL01 Whole Body Site 2 TL01 Hand and Foot Site 2 TL01 Local Site 2 Psoracomb Site 2 PUVA Whole Body Bath Site 2 PUVA Whole Body Oral Site 2 PUVA Hand and Foot Site 2 PUVA Local Topical Site 2 Broadband UVB Site 2 UVA 1 Site 3 Site 3 TL01 Whole Body Site 3 TL01 Hand and Foot Site 3 TL01 Local Site 3 Psoracomb Site 3 PUVA Whole Body Bath Site 3 PUVA Whole Body Oral Site 3 PUVA Hand and Foot Site 3 PUVA Local Topical Site 3 Broadband UVB Site 3 UVA 1 Site 4 Site 4 TL01 Whole Body Site 4 TL01 Hand and Foot Site 4 TL01 Local Site 4 Psoracomb Site 4 PUVA Whole Body Bath Site 4 PUVA Whole Body Oral Site 4 PUVA Hand and Foot Site 4 PUVA Local Topical Site 4 Broadband UVB Site 4 UVA 1 OK Hours of Service OK Question Title * 12. Phototherapy Service Operating Hours Opening Hours Closing Hours Monday 7am 8am 9am 10am 11am 12am Monday Opening Hours menu 1pm 2pm 3pm 4pm 5pm 6pm 7pm 8pm Monday Closing Hours menu Tuesday 7am 8am 9am 10am 11am 12am Tuesday Opening Hours menu 1pm 2pm 3pm 4pm 5pm 6pm 7pm 8pm Tuesday Closing Hours menu Wednesday 7am 8am 9am 10am 11am 12am Wednesday Opening Hours menu 1pm 2pm 3pm 4pm 5pm 6pm 7pm 8pm Wednesday Closing Hours menu Thursday 7am 8am 9am 10am 11am 12am Thursday Opening Hours menu 1pm 2pm 3pm 4pm 5pm 6pm 7pm 8pm Thursday Closing Hours menu Friday 7am 8am 9am 10am 11am 12am Friday Opening Hours menu 1pm 2pm 3pm 4pm 5pm 6pm 7pm 8pm Friday Closing Hours menu Saturday 7am 8am 9am 10am 11am 12am Saturday Opening Hours menu 1pm 2pm 3pm 4pm 5pm 6pm 7pm 8pm Saturday Closing Hours menu Sunday 7am 8am 9am 10am 11am 12am Sunday Opening Hours menu 1pm 2pm 3pm 4pm 5pm 6pm 7pm 8pm Sunday Closing Hours menu OK Question Title * 13. Do phototherapists carry and display valid and appropriate identification at all times? Yes No OK 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 OK DONE