Surgical Time-Out Verification Checklist
Perform comprehensive surgical time-out immediately before incision to verify correct patient, procedure, and site as required by Joint Commission Universal Protocol.
- Industry: Healthcare
- Frequency: Before every surgical procedure
- Estimated Time: 2-3 minutes
- Role: Surgical Team
- Total Items: 29
- Compliance: Joint Commission Universal Protocol, WHO Surgical Safety Checklist, CMS CoP
Team Introduction
Team member identification
- All team members introduced by name and role?
- All required team members present?
Patient Verification
Confirm patient identity
- Patient identified using two identifiers?
- Consent form verified and complete?
- Consent matches planned procedure?
Procedure & Site Verification
Confirm procedure and site
- Procedure confirmed by surgeon?
- Surgical site marked (if applicable)?
- Site marking visible after draping?
- Laterality confirmed (L/R)?
- Imaging displayed (if applicable)?
Safety Checks
Pre-incision safety verification
- Allergies confirmed?
- Prophylactic antibiotics given (if indicated)?
- Blood products available (if needed)?
- VTE prophylaxis addressed?
- All required equipment available?
- Implants verified (if applicable)?
Anesthesia Verification
Anesthesia safety check
- Airway concerns addressed?
- Aspiration risk assessed?
- Anticipated blood loss discussed?
Pre-Assessment Information
Initial assessment documentation and patient/facility identification
- Assessor Name / Credentials
- Assessment Date
- Department / Unit
- Assessment Type (Routine/Annual/Complaint)
- Previous assessment findings reviewed?
Infection Prevention & Control
Verify infection control practices per CDC and Joint Commission standards
- Hand hygiene compliance observed?
- Appropriate PPE available and properly used?
- Isolation precautions properly implemented?
- Sharps containers available and not overfilled?
- High-touch surfaces properly disinfected?
Related Healthcare Checklists
- VTE Prophylaxis Assessment Checklist
- Patient Handoff SBAR Communication Checklist
- Patient Restraint Assessment & Monitoring Checklist
- Pressure Ulcer/Injury Prevention Checklist
- Central Line Insertion Bundle Checklist
- CAUTI Prevention Bundle Checklist
- Surgical Site Infection Prevention Bundle Checklist
- Medication Administration Safety Checklist
Related Patient Safety Checklists
- Patient Fall Prevention Assessment Checklist - FREE Download
- Surgical Site Marking & Time-Out Checklist - FREE Download
- Patient Restraint Assessment & Monitoring Checklist - FREE Download
- Healthcare Infection Control Audit Checklist - FREE Download
- Patient Discharge Planning Checklist - FREE Download
- Patient Transport Checklist - FREE Download
- Patient Identification Audit - FREE Download
- Pressure Injury Prevention - FREE Download
- Patient Safety Event Investigation - FREE Download
- Pressure Ulcer Prevention Audit - FREE Download
Why Use This Surgical Time-Out Verification Checklist?
This surgical time-out verification checklist helps healthcare teams maintain compliance and operational excellence. Designed for surgical team professionals, this checklist covers 29 critical inspection points across 7 sections. Recommended frequency: before every surgical procedure.
Ensures compliance with Joint Commission Universal Protocol, WHO Surgical Safety Checklist, CMS CoP. Regulatory-aligned for audit readiness and inspection documentation.
Frequently Asked Questions
What does the Surgical Time-Out Verification Checklist cover?
This checklist covers 29 inspection items across 7 sections: Team Introduction, Patient Verification, Procedure & Site Verification, Safety Checks, Anesthesia Verification, Pre-Assessment Information, Infection Prevention & Control. It is designed for healthcare operations and compliance.
How often should this checklist be completed?
This checklist should be completed before every surgical procedure. Each completion takes approximately 2-3 minutes.
Who should use this Surgical Time-Out Verification Checklist?
This checklist is designed for Surgical Team professionals in the healthcare 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.