Instrument Sterilization Checklist Form
Use this form to record and verify the sterilization status of instruments. Complete all fields for accurate tracking.
Date of Sterilization
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Person Responsible
*
First Name
Last Name
Instrument Name/Type
*
Batch/Lot Number
*
Sterilization Method
*
Please Select
Steam Autoclave
Dry Heat
Chemical Vapor
Ethylene Oxide
Other
Pre-Cleaning Completed
*
Yes
No
Sterilization Cycle Parameters Met
*
Yes
No
Chemical/Biological Indicator Result
*
Pass
Fail
Post-Sterilization Inspection Completed
*
Yes
No
Storage Location Confirmed
*
Submit
Should be Empty: