General Hospital • Operating Theatre

Safe Surgery Checklist (WHO)

F-OT-03

Sign In

Before induction of anesthesia

Time Out

Before skin incision

Anticipated Critical Events

Sign Out

Before patient leaves operating room

Nurse Verbally Confirms:

To Surgeon, Anesthetist and Nurse:

Sign In Verification (Nurse / Anesthetist)

Time Out Verification (Surgeon / Nurse)

Sign Out Verification (Nurse / Surgeon)