Template

Surgical Checklists & Briefings Observation Tool

by Christopher Broom, from the Community

10+

This observation tool helps surgical teams assess the quality and consistent use of safety checklists and briefings during operations. Capture theatre location, specialty, team composition, list order, anaesthetic review, equipment readiness, and escalation plans. Record compliance across checklist stages and identify issues in real time to improve patient safety, communication, and workflow. Ideal for OR managers, anaesthetic and surgical leads, and quality teams standardizing intraoperative practices.

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Digitize any process, procedure or policy

Eliminate mistakes made by paper-based processes

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Confirm accountability and compliance with a digital log

With SafetyCulture you can

Digitize any process, procedure or policy

Eliminate mistakes made by paper-based processes

Create and share professional reports instantly

Confirm accountability and compliance with a digital log

About author

Community

This community page makes available free workplace checklists and templates created by other users within the SafetyCulture community. SafetyCulture has re-published this content and where possible, has credited the original author. SafetyCulture has not verified the accuracy, reliability or suitability of any community content. You agree that your use of any of this content is in accordance with SafetyCulture’s Terms and Conditions.

Template
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Use this checklist to assess compliance with CMS hospital surgical services requirements. It covers organization and staffing, circulating and scrub roles, surgical privileges, policies and protocols, informed consent, required equipment, and provisions for immediate postoperative care. Includes guidance on outpatient alignment with inpatient quality, PACU monitoring, and safety practices such as alcohol based skin prep risk reduction and surgical counts.
by Chad Niemeyer, from the Community
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SCABs Follow Up Surgical Debrief QI Checklist
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by Huon Snelgrove, from the Community
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Template
WHO Surgical Safety Checklist
The WHO Surgical Safety Checklist was developed after extensive consultation aiming to decrease errors and adverse events, and increase teamwork and communication in surgery. The surgical checklist has gone on to show significant reduction in both morbidity and mortality and is now used by a majority of surgical providers around the world. The checklist is not intended to be comprehensive. Additions and modifications to fit local practice are encouraged. Based on the WHO Surgical Safety Checklist,Copyright World Health Organization 2009. All rights reserved.
by SafetyCulture
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MEM - Niv II R2A Surgical Readiness Checklist
This surgical readiness checklist helps teams assess the capability of a surgical module across key areas: personnel staffing and training, equipment availability and fitness for purpose, supply levels, and published procedures including C2 arrangements. Items are evaluated with capability ratings FC, C, or CL to identify risks and limitations and support compliance with SOPs.
by Paul Roodenburg, from the Community
Downloads: 10+
Get

CMS Surgical Services Requirements Checklist

Use this checklist to assess compliance with CMS hospital surgical services requirements. It covers organization and staffing, circulating and scrub roles, surgical privileges, policies and protocols, informed consent, required equipment, and provisions for immediate postoperative care. Includes guidance on outpatient alignment with inpatient quality, PACU monitoring, and safety practices such as alcohol based skin prep risk reduction and surgical counts.

by Chad Niemeyer, from the Community

20+

Get

Template

SCABs Follow Up Surgical Debrief QI Checklist

This SCABs Follow Up template supports the WHO Surgical Safety process by guiding end-of-list debriefs in the operating theatre. Capture issues across equipment and instruments, staffing and competencies, preparation and planning, operating room environment, and patient-related incidents. Record details, attach media, and escalate items to management for timely resolutions and continuous quality improvement. Any member of the surgical team can complete the form or nominate a scribe, helping standardize communication and drive safer surgery.

by Huon Snelgrove, from the Community

20+

Get

Template

WHO Surgical Safety Checklist

The WHO Surgical Safety Checklist was developed after extensive consultation aiming to decrease errors and adverse events, and increase teamwork and communication in surgery. The surgical checklist has gone on to show significant reduction in both morbidity and mortality and is now used by a majority of surgical providers around the world. The checklist is not intended to be comprehensive. Additions and modifications to fit local practice are encouraged. Based on the WHO Surgical Safety Checklist,Copyright World Health Organization 2009. All rights reserved.

by SafetyCulture

300+

Get

Template

MEM - Niv II R2A Surgical Readiness Checklist

This surgical readiness checklist helps teams assess the capability of a surgical module across key areas: personnel staffing and training, equipment availability and fitness for purpose, supply levels, and published procedures including C2 arrangements. Items are evaluated with capability ratings FC, C, or CL to identify risks and limitations and support compliance with SOPs.

by Paul Roodenburg, from the Community

10+

Get

Surgical Checklists & Briefings Observation Tool

About author

You might also like

CMS Surgical Services Requirements Checklist

SCABs Follow Up Surgical Debrief QI Checklist

WHO Surgical Safety Checklist

MEM - Niv II R2A Surgical Readiness Checklist

You might also like

CMS Surgical Services Requirements Checklist

SCABs Follow Up Surgical Debrief QI Checklist

WHO Surgical Safety Checklist

MEM - Niv II R2A Surgical Readiness Checklist