Run Case Cart Assembly Verification Log — Free

Verification Details

Case cart ID recorded

Enter the unique case cart identifier or cart number.

Procedure / service line recorded

Enter the scheduled procedure, service line, or case name tied to the pick list.

Pick list version or date matches current case critical (required)

Record the pick list version, date, or reference used for verification.

Verification completed in SPD staging area before OR transport critical (required)

Confirm the cart was checked at the designated staging location before release.

Yes No N/A

Contents Match Pick List

Required instruments present critical (required)

All instrument sets and individual instruments listed on the pick list are present.

Yes No N/A

Required disposable supplies present critical (required)

All disposable supplies, drapes, dressings, and consumables listed on the pick list are present.

Yes No N/A

Required implants or special-order items present critical (required)

Any implants, loaner items, or special-order items listed on the pick list are present and accounted for.

Yes No N/A

Quantity matches pick list critical (required)

Quantities of each item match the pick list with no shortages or overages.

Yes No N/A

Substitutions or omissions documented critical (required)

Any substitution, omission, or backorder is documented and communicated per facility process.

Yes No N/A

Package Integrity and Sterility

Packaging intact and undamaged critical (required)

Outer packaging, wrappers, and seals are intact with no tears, punctures, moisture, or compromise.

Yes No N/A

Sterile barrier maintained where applicable critical (required)

Sterile items remain within intact sterile barrier systems and are suitable for release.

Yes No N/A

Expiration dates verified where applicable critical (required)

Any dated supplies, implants, or sterile items are within expiration and not beyond use date.

Yes No N/A

Cart Readiness and Release

Cart is organized and secure for transport critical (required)

Items are secured to prevent shifting, damage, or contamination during transport.

Yes No N/A

Cart label and destination are correct critical (required)

Cart identification, case destination, and routing information are correct and legible.

Yes No N/A

Released for OR transport critical (required)

Cart is approved for transport only after all required items are verified and discrepancies resolved.

Yes No N/A

Inspector Attestation

Inspector name critical (required)

Enter the name of the staff member completing the verification.

Verification timestamp critical (required)

Record the date and time the case cart verification was completed.

Inspector signature critical (required)

Signature confirms the cart was verified against the pick list and released according to facility process.

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Run: Case Cart Assembly Verification Log

Verification Details

Contents Match Pick List

Package Integrity and Sterility

Cart Readiness and Release

Inspector Attestation

Get your results