Surgical Safety Checklist

General

Is the room’s entrance wide enough to accommodate an ambulance stretcher, wheelchair, etc?

Yes No Na

Is the first aid room within a building?

Yes No Na

Is the first-aid room locked to prevent theft?

Yes No Na

Are records maintained for the first aid given?

Yes No Na

Is there adequate seating in the first aid room?

Yes No Na

Are there adequate blankets and pillows?

Yes No Na

Is there a designated cabinet to store equipment?

Yes No Na

Are electric points clean and secured?

Yes No Na

Does the room have adequate ventilation?

Yes No Na

Is the first aid room adequate enough?

Yes No Na

Is the room clean and well-maintained?

Yes No Na

Is the temperature comfortable?

Yes No Na

Is no smoking sign posted at the entrance of the first aid room?

Yes No Na

Are there movable screens, suspended curtains, or a door that can be closed to maintain privacy?

Yes No Na

Is information displayed on the door mentioning names, location, contact numbers of the first aiders?

Yes No Na

Are desks/counters cleaned and disinfected?

Yes No Na

Are instruments and first aid equipment secured and stored appropriately?

Yes No Na

Is the first-aid stock checked regularly for expiry, disposal, replacement, etc?

Yes No Na

Is no smoking sign posted inside the first aid room?

Yes No Na

Is there a handwashing area inside the first-aid room?

Yes No Na

Is there a water supply at all times?

Yes No Na

Is there a facility of telephone or other means of communication?

Yes No Na

Are there adequate soaps/sanitizer/paper towels?

Yes No Na

Are all frequently touched surfaces clean?

Yes No Na

Is a dedicated person assigned for the upkeep of the first aid room?

Yes No Na

Is the room located near to a point of access for transport to the hospital?

Yes No Na

Is drinking water available?

Yes No Na

Are protective garments for first aiders available?

Yes No Na

Are used first-aid equipment properly discarded?

Yes No Na

Is there a trash can inside the first-aid room?

Yes No Na

Is the trash regularly emptied?

Yes No Na

Additional information

Inspectors Name/signature:

SIGNATURE

Inspection Date:

Pre-Anaesthesia Checks

Has the patient confirmed his/her identity, site, procedure, and consent?

Yes No

Is the site marked?

Yes No

Is the anaesthesia machine and medication check complete?

Yes No

Is the pulse oximeter on the patient and functioning?

Yes No

Does the patient have a known allergy?

Yes No

Does the patient have a difficult airway or aspiration risk?

Yes No

Does the patient have a risk of >500ml blood loss (7ml/kg in children)?

Yes No

Confirm all team members have introduced themselves by name and role

Yes No

Confirm the patient's name, procedure, and where the incision will be made

Yes No

Had antibiotic prophylaxis have been given within the last 60 minutes?

Yes No

What are the critical or non-routine steps? How long will the case take? What is the anticipated blood loss?

What would be the critical or non-routine steps? How much time will the case take? How much blood loss is anticipated?

Are there any patient specific concerns?

Yes No

Has sterility (including indicator results) been confirmed?

Yes No

Are there equipment issues or any concerns?

Yes No

Is essential imaging displayed?

Yes No

Nurse Verbally Confirms the name of the procedure?,Nurse Verbally Confirms completion of instrument, sponge and needle counts,Nurse Verbally Confirms specimen labelling (read specimen labels aloud, including patient name),Nurse Verbally Confirms Whether there are any equipment problems to be addressed

Name of the procedure Completion of instrument Sponge and needle count Specimen labelling(read specimen labels aloud including patients name) Whether there are any equipment problems to be addressed

Are there any key concerns for recovery and management of this patient?

Yes No

Surgical Safety Checklist

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