Information

  • Audit Title

  • Conducted on

  • Prepared by

SURGICAL ATTIRE

  • Socks or stockings are worn.

  • Shoes are appropriate: No holes on top. If holes on side, shoes must be worn with shoe covers when at the sterile field and there is risk of exposure to blood or body fluids.

  • All personal clothing (t-shirts, cloth hats, etc) are completely covered by hospital provided and laundered surgical attire.

  • Anyone entering in street clothing or non-hospital provided scrubs who need to pass the red line for a brief period of time must wear the appropriate cap / bouffant, shoe coverings and bunny suit. Bunny suit cannot be worn at the sterile field.

  • No rings past the red line.

  • All hair is covered by hood, skull cap or bouffant, including the back of head when passing the red line. All facial hair (beards, mustaches, etc) that is "grabbable or pullable" must be covered with masks or combination of head coverings when passing the red line.

  • No watches or bracelets past the red line.

  • Earrings, necklaces or visible piercings (nose, eyebrow, lips, etc) must be covered. Acceptable coverings are: Cap or bouffant, mask or bandage tape. If the item cannot be covered (bandage falls off, etc) then it must be removed.

  • No cloth lanyards are worn.

  • Persons entering the restricted area have proper identification.

PERSONAL PROTECTIVE EQUIPMENT (PPE)

  • Protective eyewear is worn when the patient is in the room during a procedure.

  • Protective eyewear is cleaned/disinfected or discarded after each procedure.

  • Gloves worn when transporting contaminated items to CS.

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.