SURGICAL CHECKLIST:

Before Induction of Anaesthesia Yes No Not Applicable

1. Site, procedure and consent? □ □ □

2. Is the site marked? □ □ □
Is the anaesthesia machine and medication check
3.
complete? □ □ □
Is the pulse oximeter on the patient and
4.
functioning? □ □ □
5. Does the patient have a known allergy? □ □ □
6. Difficult airway or aspiration risk? □ □ □
7. Risk of >500ml blood loss (7ml/kg in children)? □ □ □
Before Skin Incision

Confirm all team members have introduced

1.
themselves by name and role. □ □ □
Confirm the patient's name, procedure, and
2.
where the incision will be made. □ □ □
Has antibiotic prophylaxis been given within the
3.
last 60 minutes? □ □ □