• Catheter Inpsection

  • Visit Number

  • Room Number

  • Conducted on

  • Select date


  • Checklist completed

  • Department


  • Urinary Retention or Bladder outlet obstruction

  • Accurate urine output measurements in the critically ill patient

  • Selected surgical procedures

  • Enter Procedure Type:

  • Patient requires prolonged immobilization<br>

  • Assist in healing of open sacral wounds in the incontinent patient<br>

  • Improve comfort at end of life<br>

  • Catheter to discontinue order<br>

Insertion Best Practices

  • How full is bag?

  • Orange sticker

  • Date on Sticker

  • Initials on the sticker

  • Securement (Statlock)

  • Tamper Evident Seal (TES) Intact

  • No Dependent Loops

  • Tubbing and bag below bladder

  • Bag NOT touching the floor


  • Staff Signature

  • Auditor Signature

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.