Radiology Shift Safety Checklist Form
Complete this checklist before starting your radiology shift to ensure a safe working environment.
Shift Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Staff Name
*
First Name
Last Name
Is all radiology equipment powered on and functioning correctly?
*
Yes
No
Not Applicable
Are all required PPE (Personal Protective Equipment) available and in good condition?
*
Yes
No
Not Applicable
Are emergency stop buttons and alarms tested and functional?
*
Yes
No
Not Applicable
Is the radiology room clean and free of obstructions?
*
Yes
No
Are radiation warning signs clearly visible at all entrances?
*
Yes
No
Select any additional safety checks performed:
Lead aprons inspected
Fire extinguisher accessible
Eye wash station operational
All sharps containers available
Other
Are all patient records and imaging requests available for the shift?
*
Yes
No
Not Applicable
Comments or issues identified (if any)
Submit Checklist
Should be Empty: