Minor Procedure Safety Checklist — Clinic and Dental
The surgical checklist cut to clinic size: before, during, after — for biopsies, excisions, injections, extractions, implants, sutures
What it is
A three-pause checklist for procedures done in a clinic or dental chair: identity, consent, site, allergies, anticoagulants, equipment and sterility before; the pause before starting; counts, specimen, instructions and follow-up after.
Where to use it
Every treatment room and dental surgery; on the chart for every procedure. Evidence for: Ambulatory Standard 4 — procedures; dental endorsement; Universal Floor — identification, consent. Evidence for: Ambulatory Standard 4 — procedures; dental endorsement; Universal Floor — identification, consent. Evidence for: Ambulatory Standard 4 — procedures; dental endorsement; Universal Floor — identification, consent. Evidence for: Ambulatory Standard 4 — procedures; dental endorsement; Universal Floor — identification, 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.
Same-Day Access and Triage — Reception Protocol
Dental Infection Control — Instrument Reprocessing and Waterline Checklist
Clinic Emergency Box — Contents and Monthly Check
Referral Letter Template and Referral Tracking Log
Consent for a Clinic or Dental Procedure — Form and Record
Print to share.
