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Tool / guidance28 March 2020

Surgical safety checklist templates

Use these templates to get started with surgical safety checklists.
Quality improvementCommunication and teamworkSurgery and anaesthesia

Surgical safety checklist templates

We have two formats available for download (.pdf).

Download template version 1 (440KB)Download template version 2 (70KB)

Your surgical safety checklist can take any form that works for your team and your practice. Some teams choose to have standard forms for all procedures, while others develop individual forms for different procedures. We have supplied these surgical safety checklist templates as examples for you to trial.

Version 1 includes dedicated space for your notes, alongside the checklist. This document was published in March 2020.

Version 2 focuses on the checklist. It was first published in March 2020 and updated in February 2024.

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