Stationary Veterinary Clinic:
Pre-Assessment Questionnaire
Clinic name:
Date
Clinic address:
Clinic phone number:
Contact person:
E-mail
Assessment by:
Type of veterinary practice:
(please select one)
 Small animal only
 Small animal only with boarding and/or grooming
 Mixed animal practice
1. Number of veterinarians employed.
Full time:
Part time:
2. Number of technicians/assistants employed.
Full time:
Part time:
3. Number of support staff employed.
Full time:
Part time:
4. Average number of animals seen in the practice
per day.
1-5
21-40
81-100
6-10
41-60
101 or more
11-20
61-80
5. Who is responsible for developing infection
control procedures at the practice?
6. Who is responsible for monitoring infection
control procedures at the practice?
7. Who is responsible for staff training at the
practice?
8. What infectious diseases are of most concern to
the practice?
9. What is perceived as the greatest infection
control challenge(s) for the practice?
March 2005