Sharps Safety Checklist Form
Document sharps safety inspections, checklist items, incidents, and follow-up actions in your facility.
Location/Area Inspected
*
Department
*
Date of Inspection
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Time of Inspection
*
Hour Minutes
AM
PM
AM/PM Option
Inspector Name
*
First Name
Last Name
Sharps Safety Checklist
*
Rows
Yes
No
N/A
Sharps containers are available at point of use
1
2
3
Sharps containers are not overfilled (below fill line)
4
5
6
Sharps containers are properly labeled
7
8
9
Sharps are disposed of immediately after use
10
11
12
Sharps are not left unattended in work areas
13
14
15
Personal protective equipment (PPE) is available and used
16
17
18
Sharps containers are securely closed when full
19
20
21
No evidence of sharps in inappropriate waste bins
22
23
24
Overall Condition of Sharps Disposal Areas
*
1
2
3
4
5
Were any incidents or exposures reported during this inspection?
*
No
Yes (please describe below)
Incident or Exposure Details (if any)
Corrective Actions Required
Follow-up/Verification Notes
Submit Inspection
Should be Empty: