• Surgical Scrub Training Checklist Form

    Use this form to document surgical scrub training completion, technique checks, and evaluator notes.

  • Trainee and Session Details

  • Training Date*
     - -

  • Surgical Scrub Checklist

  • Hand and forearm jewelry removed*
  • Nails clean and short*
  • Sleeves secured and hands/forearms exposed as required*
  • Scrub sink and supplies available and ready*
  • Hands and forearms prewashed if required by local procedure*
  • Timed scrub completed to required duration*
  • Hands and forearms scrubbed in correct sequence*
  • Proper rinse direction maintained*
  • Hands kept above elbows after scrub*
  • Sterile gowning and transition readiness achieved after scrub*

  • Evaluator Summary

  • Follow-up Required
  • Should be Empty:
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