• Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel


  • Perform hand hygiene

  • Wipe a clean tray or use cannula pack

  • Gather equipment

  • Perform hand hygiene

  • Open equipment protect key sites I.e. syringe hubs, cannula

  • prepare flush and extension set ensuring key parts are protected from contamination at all times

Patient Zone

  • Determine site and apply tourniquet preferably disposable otherwise clean before applying

  • Perform hand hygiene

  • Apply non sterile gloves, asepsis is maintained if key parts are not touched

  • Clean skin with chlorhexidine alcohol swab, allow to dry.

  • Once dry insert cannula ensuring tip and site of entry are not touched

  • Flush cannula ensure tip of syringe and hub of cannula are not touched. Disinfect with chlorhexidine alcohol swab if touched

  • Attach extension tubing maintaining non touch to key parts

  • Discard sharps into sharps container


  • Remove glove perform hand hygiene

  • Discard all used equipment as per policy. Wipe down trolley if used

  • Perform hand hygiene

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.