Health Information Storage and Disposal Compliance Checklist Form
Complete this checklist to track compliance with best practices for the storage and disposal of health information. This form is not intended for collecting sensitive health or medical data.
Organization Name
*
Name of Responsible Person
*
First Name
Last Name
Primary Method of Health Information Storage
*
Electronic (cloud-based)
Electronic (on-premises)
Paper records
Other
Are access controls in place to restrict unauthorized access to stored health information?
*
Yes
No
Partially
What is the retention policy for health information?
*
Please Select
Less than 1 year
1-3 years
3-7 years
More than 7 years
No policy in place
Describe the process for secure disposal of health information
*
Has staff received training on health information storage and disposal procedures?
*
Yes, all staff
Some staff
No training provided
Date of Last Compliance Review
*
-
Month
-
Day
Year
Date
Is there a documented incident response plan for data breaches?
*
Yes
No
In development
Additional Comments or Notes
Submit Checklist
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