Ambulatory Surgery Center Safety Checklist [FREE PDF]
ASC administrators and quality directors use this checklist per CMS Ambulatory Surgery Center Conditions for Coverage 42 CFR 416 and state ambulatory surgery licensure requirements.
- Industry: Healthcare / Surgery
- Frequency: Monthly
- Estimated Time: 20-25 minutes
- Role: ASC Administrator
- Total Items: 8
- Compliance: CMS 42 CFR Part 416, State ASC Licensure
Surgical Safety & Time-Out
Verify surgical safety protocols and timeout procedures.
- Is the surgical time-out performed before every procedure (patient, site, procedure)?
- Are informed consents signed, site-marked, and verified before sedation?
- Are instrument, sponge, and needle counts completed and reconciled?
- Surgical safety notes
Environment & Emergency Readiness
Inspect surgical environment and emergency preparedness.
- Are sterilization records current with biological indicators passing?
- Is the crash cart/emergency equipment checked and fully stocked?
- Is the hospital transfer agreement current and staff know the transfer protocol?
- Environment notes
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Why Use This Ambulatory Surgery Center Safety Checklist [FREE PDF]?
This ambulatory surgery center safety checklist [free pdf] helps healthcare / surgery teams maintain compliance and operational excellence. Designed for asc administrator professionals, this checklist covers 8 critical inspection points across 2 sections. Recommended frequency: monthly.
Ensures compliance with CMS 42 CFR Part 416, State ASC Licensure. Regulatory-aligned for audit readiness and inspection documentation.
Frequently Asked Questions
What does the Ambulatory Surgery Center Safety Checklist [FREE PDF] cover?
This checklist covers 8 inspection items across 2 sections: Surgical Safety & Time-Out, Environment & Emergency Readiness. It is designed for healthcare / surgery operations and compliance.
How often should this checklist be completed?
This checklist should be completed monthly. Each completion takes approximately 20-25 minutes.
Who should use this Ambulatory Surgery Center Safety Checklist [FREE PDF]?
This checklist is designed for ASC Administrator professionals in the healthcare / surgery industry. It can be used for self-assessments, team audits, and regulatory compliance documentation.
Can I download this checklist as a PDF?
Yes, this checklist is available as a free PDF download. You can also use it digitally in the POPProbe mobile app for real-time data capture, photo documentation, and automatic reporting.