REPROCESSING TRACKING SLIP (Airway Devices / Ultrasound Probes)
Hospital: ________________________ | Dept of Anesthesia / CSSD	Form Code: F-27 | Version: ___ | Effective: ___ | PAGE 1 of 1

SECTION 1 — ITEM IDENTIFICATION
Date: ______/______/_________ Time: ___________________ Area:   ☐ OR    ☐ NORA    ☐ PACU    ☐ Block Area	Patient MRN/Case ID (optional per policy): ________________________________________________
Item category:    ☐ Airway device    ☐ Laryngoscope blade/handle    ☐ Bronchoscope    ☐ Ultrasound probe    ☐ Other: _________________ Item description/model: ________________________________________________ Asset/Serial number (if applicable): ________________________________________________
Contamination level:    ☐ Routine use    ☐ Visible soil/blood    ☐ Isolation case Isolation Precautions:    ☐ Contact    ☐ Droplet    ☐ Airborne

SECTION 2 — REQUIRED REPROCESSING LEVEL

☐ Low-level disinfection (LLD)       ☐ High-level disinfection (HLD)       ☐ Sterilization IFU reference available:    ☐ Yes    ☐ No Notes: _________________________________________________________________________________________________________

SECTION 3 — SENT TO CSSD / HLD
Placed in closed container/bag labeled: ☐ Yes    ☐ No Sent to: ☐ CSSD Sterilization    ☐ HLD Unit    ☐ Other: ______________	Sent by (Name/Sign): ________________________________________________ Time: ________________ Received by CSSD/HLD (Name/Sign): ________________________________________________ Time: ________________

SECTION 4 — PROCESSING COMPLETION (CSSD/HLD)
Method used: ☐ HLD    ☐ Sterilization    ☐ Other: ________________ Cycle/Batch # (if applicable): ________________________________________________	Processing date/time: ________________________________________________ Processed by (Name/Initials): ________________________________________________

SECTION 5 — RETURN TO CLINICAL AREA / STORAGE
Returned to area:    ☐ OR    ☐ NORA    ☐ PACU    ☐ Block Area Time: ________________ Packaging integrity verified (if applicable): ☐ Yes    ☐ No Stored in clean designated storage: ☐ Yes    ☐ No	Returned by CSSD/HLD (Name/Sign): ________________________________________________ Received by clinical area (Name/Sign): ________________________________________________