Title Page
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Conducted on
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Prepared by
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Facility Name
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Campus
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SPD Location
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Campus
- Bellevue
- Elmhurst
- Harlem
- Jacobi
- Kings
- Lincoln
- Metropolitan
- North Central Bronx
- Queens
- South Brooklyn - Coney
- Woodhull
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Campus
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SPD Location
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SPD Location
Case Cart Audit
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Date of Surgery
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OR Room Number
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Case Cart Number
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Case Picked By
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Case ID Number
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Are trays inside cart undamaged and sterile?
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What trays are damaged and unsterile?
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Is the case cart complete?
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What is missing?
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Are all special needs and/or loaners accounted for?
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What is missing?
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Are trays missing instruments or incomplete?
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What trays are incomplete?
