Medical Device Sterilization Audit Form
Audit and document sterilization procedures for medical devices to ensure compliance and safety.
Audit Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Auditor Full Name
*
First Name
Last Name
Department or Area Audited
*
Please Select
Operating Room
Central Sterile Supply
Outpatient Clinic
Other
Sterilization Method Used
*
Steam Autoclave
Ethylene Oxide (EtO)
Hydrogen Peroxide Plasma
Other
Are sterilization records complete and up to date?
*
Yes
No
Partially
Sterilization Equipment Condition
*
Fully Functional
Requires Maintenance
Out of Order
Compliance with Sterilization Protocols
*
1
2
3
4
5
Audit Checklist
*
Rows
Yes
No
N/A
Proper labeling of sterilized devices
1
2
3
Physical separation of sterile and non-sterile items
4
5
6
Routine biological indicator testing
7
8
9
Observations or Comments
Submit Audit
Should be Empty: