Sterilization record audit

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Yes

  No

  N/A

Sterilizer cycle sheet

• Helix and vacuum completed

  Yes

  No

  N/A

• Date place on sheet

  Yes

  No

  N/A

• Loaded by marked

  Yes

  No

  N/A

• Wrapped or unwrapped circled

  Yes

  No

  N/A

• Cycle number entered

  Yes

  No

  N/A

• Total of items released

  Yes

  No

  N/A

• Load released by

  Yes

  No

  N/A

• Circled pass or fail

  Yes

  No

  N/A

Printout

• Circle date

  Yes

  No

  N/A

• Circle load number

  Yes

  No

  N/A

• Circle if pressure is between 200 and 220

  Yes

  No

  N/A

• Circle if hold time for 3 min

  Yes

  No

  N/A

• Circle type of load

  Yes

  No

  N/A

• Circle serial number of autoclave

  Yes

  No

  N/A

• Circle cycle complete

  Yes

  No

  N/A

• Sign printout

  Yes

  No

  N/A