The following is a step by step list of procedures to which NAME OF COMPANY will adhere in completing audits.

1. Once a scheduled audit date has been established, a memorandum is sent to the Senior Site Official and NAME OF APPROPRIATE CORPORATE OFFICIAL in preparation of the upcoming audit.
2. A blank Audit Questionnaire is sent confidentially to the Auditor who is conducting the facility audit.  (Note:  This document, in its uncompleted or completed form, is not to be copied.)
3. Once the facility audit has been completed, the Audit Questionnaire and Recommended Action List, are forwarded confidentially to NAMES OF APPROPRIATE COMPANY OFFICIAL’S. Audit results are then input into a Numerical Rating Report.  Input of audit results is done at this time as a backup before the original audit is forwarded to retained counsel.
4. The original Facility Audit Questionnaire and Recommended Action List are then forwarded to retained counsel for review, comment, and returned to NAME OF APPROPRIATE COMPANY OFFICIAL.
5. When the Audit Questionnaire and Recommended Action List are returned from retained counsel, the Numerical Rating Report and Recommended Action List are reviewed by the NAME OF APPROPRIATE COMPANY OFFICIAL.
6. At every third audit, the Numerical Rating Report will be sent to retained counsel for review to monitor any legal issues that may need updating.  A log will be maintained by APPROPRIATE COMPANY OFFICIAL to assist in the process.
7. After final review by authorized persons, a copy of the Recommended Action List, Proposed Corrective Action Plan with directions for completion, and cover memorandum are sent confidentially to the Senior Site Official and THE APPROPRIATE COMPANY OFFICIAL.
8. The original Audit Questionnaire, Numerical Rating Report, and Recommended Action List will be retained in a locked, dedicated, confidential file in PREDETERMINED LOCATION.
9. This audit program will be conducted every two (2) years at each facility.  When a second audit is conducted at any given location, a hard copy is completed and transferred to the Numerical Database; the prior audit will be destroyed by shredding.  The Numerical Database Report will be retained by THE APPROPRIATE COMPANY OFFICIAL.

   General Information
   All audit related information will be stored in a locked, dedicated, confidential file in A PREDETERMINED LOCATION.  The following items will be kept on file:

   • Individual Facility Files
   • All Audit Booklets
   • Numerical Rating Report
   • Recommended Action List
   • Audit Log
   • Electronic File Media

   Documentation in this file can be reviewed by management or executive management level personnel designated by the TITLE OF APPROPRIATE COMPANY OFFICIAL.  Originals will not leave the office and copies of the original documentation will not be made.

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