• Anesthesia Cart Checklist

    Use this form to verify anesthesia cart readiness, stock, equipment function, and any needed restocking or follow-up before the cart is used.

  • Cart Identification and Checklist Details

  • Checklist Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Checklist Time*

  • Medication and Supply Verification

  • Anesthesia medications stock status*
  • Syringes and needles status*
  • IV supplies status*
  • Airway supplies status*
  • Emergency items and consumables status*

  • Equipment and Function Checks

  • Drawers sealed and organized*
  • Suction available*
  • Oxygen source available*
  • Monitors or devices functional*

  • Restock, Actions, and Final Status

  • Items Restocked
  • Final Cart Readiness Status*
  • Should be Empty:
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