Surgical Attire Observations

Observation #1
Who was observed?

Specify:

Type of area

Visibly clean scrubs. */**

Removes visibly soiled scrub attire as soon as possible and dons clean attire. */**

Personal clothing contained within scrub attire. */**

If 2 pc scrubs, top of scrub suit secured at the waist or tucked into pants. **

Surgical head cover/hood covers all hair and scalp skin. */**

If bearded, beard cover covers all facial hair. */**

Mask not hanging around neck. **

Shoe covers worn for wet procedures and when appropriate. */**

If used, shoe covers removed immediately after use, and hand hygiene performed. */**

Jewelry contained within scrub attire. **

Comments

Observation #2
Who was observed?

Specify:

Type of area

Visibly clean scrubs. */**

Removes visibly soiled scrub attire as soon as possible and dons clean attire. */**

Personal clothing contained within scrub attire. */**

If 2 pc scrubs, top of scrub suit secured at the waist or tucked into pants. **

Surgical head cover/hood covers all hair and scalp skin. */**

If bearded, beard cover covers all facial hair. */**

Mask not hanging around neck. **

Shoe covers worn for wet procedures and when appropriate. */**

If used, shoe covers removed immediately after use, and hand hygiene performed. */**

Jewelry contained within scrub attire. **

Comments

Observation #3
Who was observed?

Specify:

Type of area

Visibly clean scrubs. */**

Removes visibly soiled scrub attire as soon as possible and dons clean attire. */**

Personal clothing contained within scrub attire. */**

If 2 pc scrubs, top of scrub suit secured at the waist or tucked into pants. **

Surgical head cover/hood covers all hair and scalp skin. */**

If bearded, beard cover covers all facial hair. */**

Mask not hanging around neck. **

Shoe covers worn for wet procedures and when appropriate. */**

If used, shoe covers removed immediately after use, and hand hygiene performed. */**

Jewelry contained within scrub attire. **

Comments

Observation #4
Who was observed?

Specify:

Type of area

Visibly clean scrubs. */**

Removes visibly soiled scrub attire as soon as possible and dons clean attire. */**

Personal clothing contained within scrub attire. */**

If 2 pc scrubs, top of scrub suit secured at the waist or tucked into pants. **

Surgical head cover/hood covers all hair and scalp skin. */**

If bearded, beard cover covers all facial hair. */**

Mask not hanging around neck. **

Shoe covers worn for wet procedures and when appropriate. */**

If used, shoe covers removed immediately after use, and hand hygiene performed. */**

Jewelry contained within scrub attire. **

Comments

Observation #5
Who was observed?

Specify:

Type of area

Visibly clean scrubs. */**

Removes visibly soiled scrub attire as soon as possible and dons clean attire. */**

Personal clothing contained within scrub attire. */**

If 2 pc scrubs, top of scrub suit secured at the waist or tucked into pants. **

Surgical head cover/hood covers all hair and scalp skin. */**

If bearded, beard cover covers all facial hair. */**

Mask not hanging around neck. **

Shoe covers worn for wet procedures and when appropriate. */**

If used, shoe covers removed immediately after use, and hand hygiene performed. */**

Jewelry contained within scrub attire. **

Comments

Observation #6
Who was observed?

Specify:

Type of area

Visibly clean scrubs. */**

Removes visibly soiled scrub attire as soon as possible and dons clean attire. */**

Personal clothing contained within scrub attire. */**

If 2 pc scrubs, top of scrub suit secured at the waist or tucked into pants. **

Surgical head cover/hood covers all hair and scalp skin. */**

If bearded, beard cover covers all facial hair. */**

Mask not hanging around neck. **

Shoe covers worn for wet procedures and when appropriate. */**

If used, shoe covers removed immediately after use, and hand hygiene performed. */**

Jewelry contained within scrub attire. **

Comments

Observation #7
Who was observed?

Specify:

Type of area

Visibly clean scrubs. */**

Removes visibly soiled scrub attire as soon as possible and dons clean attire. */**

Personal clothing contained within scrub attire. */**

If 2 pc scrubs, top of scrub suit secured at the waist or tucked into pants. **

Surgical head cover/hood covers all hair and scalp skin. */**

If bearded, beard cover covers all facial hair. */**

Mask not hanging around neck. **

Shoe covers worn for wet procedures and when appropriate. */**

If used, shoe covers removed immediately after use, and hand hygiene performed. */**

Jewelry contained within scrub attire. **

Comments

Observation #8
Who was observed?

Specify:

Type of area

Visibly clean scrubs. */**

Removes visibly soiled scrub attire as soon as possible and dons clean attire. */**

Personal clothing contained within scrub attire. */**

If 2 pc scrubs, top of scrub suit secured at the waist or tucked into pants. **

Surgical head cover/hood covers all hair and scalp skin. */**

If bearded, beard cover covers all facial hair. */**

Mask not hanging around neck. **

Shoe covers worn for wet procedures and when appropriate. */**

If used, shoe covers removed immediately after use, and hand hygiene performed. */**

Jewelry contained within scrub attire. **

Comments

Observation #9
Who was observed?

Specify:

Type of area

Visibly clean scrubs. */**

Removes visibly soiled scrub attire as soon as possible and dons clean attire. */**

Personal clothing contained within scrub attire. */**

If 2 pc scrubs, top of scrub suit secured at the waist or tucked into pants. **

Surgical head cover/hood covers all hair and scalp skin. */**

If bearded, beard cover covers all facial hair. */**

Mask not hanging around neck. **

Shoe covers worn for wet procedures and when appropriate. */**

If used, shoe covers removed immediately after use, and hand hygiene performed. */**

Jewelry contained within scrub attire. **

Comments

Observation #10
Who was observed?

Specify:

Type of area

Visibly clean scrubs. */**

Removes visibly soiled scrub attire as soon as possible and dons clean attire. */**

Personal clothing contained within scrub attire. */**

If 2 pc scrubs, top of scrub suit secured at the waist or tucked into pants. **

Surgical head cover/hood covers all hair and scalp skin. */**

If bearded, beard cover covers all facial hair. */**

Mask not hanging around neck. **

Shoe covers worn for wet procedures and when appropriate. */**

If used, shoe covers removed immediately after use, and hand hygiene performed. */**

Jewelry contained within scrub attire. **

Comments

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.