Surgical Safety Checklist
Three pauses, nineteen questions, read aloud by one person. Sign In before anaesthesia · Time Out before skin incision · Sign Out before the patient leaves the theatre
What it is
The WHO Surgical Safety Checklist as a one-page, print-ready A4 sheet: Sign In, Time Out, Sign Out. Read aloud by a single checklist coordinator; every item answered by name.
Where to use it
Laminated in every operating theatre and anaesthetic room; on the wall at the head of the table. Evidence for: Hospital Standard 4 (Care & Treatment) — surgical safety criteria; Universal Floor — patient identification and informed consent. Evidence for: Hospital Standard 4 (Care & Treatment) — surgical safety criteria; Universal Floor — patient identification and informed consent. Evidence for: Hospital Standard 4 (Care & Treatment) — surgical safety criteria; Universal Floor — patient identification and informed consent. Evidence for: Hospital Standard 4 (Care & Treatment) — surgical safety criteria; Universal Floor — patient identification and informed consent. Evidence for: Hospital Standard 4 (Care & Treatment) — surgical safety criteria; Universal Floor — patient identification and informed consent. Evidence for: Hospital Standard 4 (Care & Treatment) — surgical safety criteria; Universal Floor — patient identification and informed consent. Evidence for: Hospital Standard 4 (Care & Treatment) — surgical safety criteria; Universal Floor — patient identification and informed consent. Evidence for: Hospital Standard 4 (Care & Treatment) — surgical safety criteria; Universal Floor — patient identification and informed consent. Evidence for: Hospital Standard 4 (Care & Treatment) — surgical safety criteria; Universal Floor — patient identification and informed consent. Evidence for: Hospital Standard 4 (Care & Treatment) — surgical safety criteria; Universal Floor — patient identification and informed consent.
Translate and adapt
English master edition. Georgian and other translations are added as they are clinically reviewed. Any facility may translate, add its logo and adapt wording to local practice — keeping the ASF block, the source attribution and the licence line on the sheet. Clinical thresholds and drug doses must be confirmed against national protocols before use.
The same code is printed on the tool itself. Scan it in any facility to reach this page.
Time-Out Briefing Card
Surgical Safety Checklist — Implementation Guide
Have We Done the Time Out?
Checklist Compliance Audit Form
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