Run Operating Room Pre-Procedure Verification Checklist — Free

Inspection Details

Procedure date and start time recorded critical (required)

Operating room / procedure room identified critical (required)

Primary surgeon documented critical (required)

Circulating nurse / procedural lead documented critical (required)

Anesthesia provider documented critical (required)

Sign-In: Patient, Consent, and Site Verification

Patient identity verified using two identifiers critical (required)

Confirm patient identity using two approved identifiers before sedation or anesthesia.

Yes No N/A

Procedure, laterality, and site match consent and schedule critical (required)

Verify the planned procedure, side/site, and any implants or special steps against the consent form and surgical schedule.

Yes No N/A

Surgical site marked when applicable critical (required)

Confirm site marking is present, legible, and performed by the responsible clinician when required.

Yes No N/A

Consent form present and signed critical (required)

Confirm informed consent is available, current, and signed for the planned procedure.

Yes No N/A

Allergies and adverse reactions reviewed critical (required)

Verify documented allergies, latex sensitivity, medication reactions, and other relevant adverse reactions are communicated to the team.

Yes No N/A

Airway or aspiration risk identified critical (required)

Confirm the anesthesia team has reviewed airway difficulty, aspiration risk, and any special precautions.

Yes No N/A

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.

Yes No N/A

Time-Out: Team Briefing and Readiness

All team members stop for formal time-out critical (required)

Confirm the procedure is paused and the entire team participates in the time-out before incision or start of intervention.

Yes No N/A

Patient, procedure, and site verbally confirmed by team critical (required)

The surgeon, anesthesia provider, and circulating nurse verbally confirm the correct patient, procedure, and site.

Yes No N/A

Antibiotic prophylaxis addressed when indicated

Confirm prophylactic antibiotics were administered within the required time window or document why not indicated.

Yes No N/A

Estimated blood loss risk reviewed

Confirm the team discussed anticipated blood loss, transfusion needs, and availability of blood products if applicable.

Yes No N/A

Critical equipment and implants available critical (required)

Verify required instruments, devices, implants, and specialty equipment are present, functional, and sterile as applicable.

Yes No N/A

Sterility and package integrity verified critical (required)

Confirm sterile supplies are within date, packaging is intact, and any sterile field concerns are resolved before proceeding.

Yes No N/A

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 critical (required)

Verify anesthesia delivery and monitoring equipment have passed pre-use checks and are ready for the case.

Yes No N/A

Suction, oxygen, and emergency airway equipment available critical (required)

Confirm suction, oxygen source, bag-mask ventilation equipment, and emergency airway devices are immediately available.

Yes No N/A

Electrosurgical safety and grounding precautions addressed critical (required)

Confirm electrosurgical unit settings, dispersive electrode placement, and fire-risk precautions are appropriate for the procedure.

Yes No N/A

Required PPE available for team critical (required)

Verify appropriate PPE is available and used based on anticipated exposure risk, including gloves, masks, eye protection, and gowns.

Yes No N/A

Environmental cleanliness and sterile field maintained critical (required)

Confirm the room is clean, traffic is controlled, and the sterile field is intact before the procedure begins.

Yes No N/A

Sharps and biohazard disposal setup ready

Verify sharps containers, biohazard waste handling, and spill response supplies are available and correctly positioned.

Yes No N/A

Sign-Out: Counts, Specimens, and Handoff

Instrument, sponge, and needle counts reconciled critical (required)

Confirm counts are correct or discrepancies are resolved and documented before the patient leaves the room.

Yes No N/A

Specimens labeled correctly and sent to destination critical (required)

Verify all specimens are labeled with patient identifiers, source, and destination, and are transferred per policy.

Yes No N/A

Post-procedure diagnosis and procedure documented

Confirm the performed procedure and relevant findings are documented in the operative record.

Yes No N/A

Postoperative plan communicated to receiving team critical (required)

Verify postoperative destination, pain plan, wound care, drains, restrictions, and follow-up needs were communicated during handoff.

Yes No N/A

Unexpected events or deviations documented

Record any intraoperative complications, near misses, equipment issues, or deviations from the planned procedure.

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Run: Operating Room Pre-Procedure Verification Checklist

Inspection Details

Sign-In: Patient, Consent, and Site Verification

Time-Out: Team Briefing and Readiness

Equipment, Environment, and Infection Control

Sign-Out: Counts, Specimens, and Handoff

Get your results