Anesthesia Equipment Checklist
Complete this checklist to ensure all anesthesia equipment is present, functional, and ready for use before each procedure.
Staff Name
*
First Name
Last Name
Date of Equipment Check
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Location/Operating Room
*
Anesthesia Machine: Checked and functional?
*
Yes
No
Oxygen Supply: Cylinder and pipeline supply checked?
*
Yes
No
Suction Apparatus: Checked and functional?
*
Yes
No
Airway Devices: Present and appropriate sizes available? (e.g., masks, airways, laryngoscope)
*
Yes
No
Monitoring Equipment: ECG, pulse oximeter, BP cuff, capnograph checked?
*
Yes
No
Emergency Drugs and Equipment: Available and accessible?
*
Yes
No
IV Access and Fluids: Checked and ready?
*
Yes
No
Additional Comments/Issues Noted
Signature (Confirming completion of checklist)
*
Submit Checklist
Submit Checklist
Should be Empty: