Healthcare Regulatory Compliance Assessment Questionnaire
Use this form to assess healthcare compliance readiness, control gaps, and follow-up priorities for the organization or site being reviewed.
Organization and Assessment Scope
Organization Name
*
Department or Site Being Reviewed
*
Primary Compliance Area in Scope
*
Privacy Practices
Documentation & Recordkeeping
Staff Training
Incident Response
Vendor Oversight
Overall Program Review
Compliance Readiness and Controls
Current Status by Control Area
*
Rows
Not Started
Partially Implemented
Implemented
Consistently Monitored
Policy availability
1
2
3
4
Staff training completion
5
6
7
8
Documentation retention
9
10
11
12
Incident reporting process
13
14
15
16
Audit/review cadence
17
18
19
20
Third-party/vendor oversight
21
22
23
24
Overall Readiness Score
*
1
2
3
4
5
Most Important Gap Identified
Follow-Up and Improvement Planning
Target timeline for remediation or follow-up
*
Immediate
30 Days
60 Days
90 Days
Not Yet Defined
Priority actions needed
Preferred follow-up owner or team role
Submit Assessment
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