ISPT Operating Room & Delivery Room

• Conducted on

  Date

• Prepared by

• Location
  Address

OB Delivery Room Checklist

1.Triage/Environment

• Designated staff assigned for triaging patients for consultation and emergency procedures

  Yes

  No

  N/A

• Specific area provided for triaging

  Yes

  No

  N/A

• Specific area for donning and doffing provided

  Yes

  No

  N/A

• Lavatory for handwashing accessible

  Yes

  No

  N/A

• Area clean and well maintained

  Yes

  No

  N/A

2.Supplies and Waste Disposal

• PPE and supplies are available 24/7

  Yes

  No

  N/A

• Stock cards maintained and tallied for every receipt and consumption

  Yes

  No

  N/A

• Disinfecting supplies, gloves,

  Yes

  No

  N/A

• trashbag available

  Yes

  No

  N/A

• Proper disposal of waste

  Yes

  No

  N/A

• Disinfection thoroughly done

  Yes

  No

  N/A

• using proper disinfecting solution

  Yes

  No

  N/A

• Transport of waste using designated

  Yes

  No

  N/A

• trolleys

  Yes

  No

  N/A

• Yes

  No

  N/A

Operating Room CHECKLIST

A. Supplies

• Supplies are made avaiable 24/7 like :

  Yes

  No

  N/A

• PPE

  Yes

  No

  N/A

• Disinfecting supplies, gloves, trash bag

  Yes

  No

  N/A

• OR supplies needed for the procedure

  Yes

  No

  N/A

• Circulating forms/pen

  Yes

  No

  N/A

• Emergency cart

  Yes

  No

  N/A

• Irrigating solutions, cling wrap

  Yes

  No

  N/A

B. Ante Room/donning/Doffing/Shower Area

• 1.Specific area provided for donning, doffing and shower room provided

  Yes

  No

  N/A

C. Environment/Waste

• Receiving area and holding area clean and well maintained

  Yes

  No

  N/A

• Sterility inside or maintained and monitored at all times

  Yes

  No

  N/A

• Specific stretcher for covid patient provided

  Yes

  No

  N/A

• Cleaning materials dedicated for OR used made available

  Yes

  No

  N/A

• Plastic cover sheet for each covid patient provided

  Yes

  No

  N/A

• Disinfection thoroughly done using disinfectant solution

  Yes

  No

  N/A

• Instruments and packs wash and labelled with COVID before sending to CSR for autoclaving/sterilization

  Yes

  No

  N/A

• Unused items on the trolley are considered contaminated and must be properly disposed/discarded

  Yes

  No

  N/A