Operating Room Pre-Procedure Verification Checklist

A surgical safety inspection template for verifying patient, procedure, site, equipment, and team readiness during WHO-style sign-in, time-out, and sign-out phases.

Inspection Details

• Procedure date and start time recorded
• Operating room / procedure room identified
• Primary surgeon documented
• Circulating nurse / procedural lead documented
• Anesthesia provider documented

Sign-In: Patient, Consent, and Site Verification

• Patient identity verified using two identifiers
  Confirm patient identity using two approved identifiers before sedation or anesthesia.
• Procedure, laterality, and site match consent and schedule
  Verify the planned procedure, side/site, and any implants or special steps against the consent form and surgical schedule.
• Surgical site marked when applicable
  Confirm site marking is present, legible, and performed by the responsible clinician when required.
• Consent form present and signed
  Confirm informed consent is available, current, and signed for the planned procedure.
• Allergies and adverse reactions reviewed
  Verify documented allergies, latex sensitivity, medication reactions, and other relevant adverse reactions are communicated to the team.
• Airway or aspiration risk identified
  Confirm the anesthesia team has reviewed airway difficulty, aspiration risk, and any special precautions.
• Required pre-op imaging, labs, or diagnostics available
  Verify relevant imaging, laboratory results, and diagnostic reports are available and reviewed when needed for the procedure.

Time-Out: Team Briefing and Readiness

• All team members stop for formal time-out
  Confirm the procedure is paused and the entire team participates in the time-out before incision or start of intervention.
• Patient, procedure, and site verbally confirmed by team
  The surgeon, anesthesia provider, and circulating nurse verbally confirm the correct patient, procedure, and site.
• Antibiotic prophylaxis addressed when indicated
  Confirm prophylactic antibiotics were administered within the required time window or document why not indicated.
• Estimated blood loss risk reviewed
  Confirm the team discussed anticipated blood loss, transfusion needs, and availability of blood products if applicable.
• Critical equipment and implants available
  Verify required instruments, devices, implants, and specialty equipment are present, functional, and sterile as applicable.
• Sterility and package integrity verified
  Confirm sterile supplies are within date, packaging is intact, and any sterile field concerns are resolved before proceeding.
• Team concerns or anticipated critical events discussed
  Document any anticipated complications, positioning concerns, specimen needs, or other critical events raised by the team.

Equipment, Environment, and Infection Control

• Anesthesia machine and monitoring equipment functional
  Verify anesthesia delivery and monitoring equipment have passed pre-use checks and are ready for the case.
• Suction, oxygen, and emergency airway equipment available
  Confirm suction, oxygen source, bag-mask ventilation equipment, and emergency airway devices are immediately available.
• Electrosurgical safety and grounding precautions addressed
  Confirm electrosurgical unit settings, dispersive electrode placement, and fire-risk precautions are appropriate for the procedure.
• Required PPE available for team
  Verify appropriate PPE is available and used based on anticipated exposure risk, including gloves, masks, eye protection, and gowns.
• Environmental cleanliness and sterile field maintained
  Confirm the room is clean, traffic is controlled, and the sterile field is intact before the procedure begins.
• Sharps and biohazard disposal setup ready
  Verify sharps containers, biohazard waste handling, and spill response supplies are available and correctly positioned.

Sign-Out: Counts, Specimens, and Handoff

• Instrument, sponge, and needle counts reconciled
  Confirm counts are correct or discrepancies are resolved and documented before the patient leaves the room.
• Specimens labeled correctly and sent to destination
  Verify all specimens are labeled with patient identifiers, source, and destination, and are transferred per policy.
• Post-procedure diagnosis and procedure documented
  Confirm the performed procedure and relevant findings are documented in the operative record.
• Postoperative plan communicated to receiving team
  Verify postoperative destination, pain plan, wound care, drains, restrictions, and follow-up needs were communicated during handoff.
• Unexpected events or deviations documented
  Record any intraoperative complications, near misses, equipment issues, or deviations from the planned procedure.