Sterile Technique Competency Checklist Form
Sterile Technique Competency Checklist Form
Performs proper hand hygiene before beginning the procedure
*
Competent
Needs Improvement
Not Observed
Dons gown and gloves using correct sterile technique
*
Competent
Needs Improvement
Not Observed
Prepares and maintains a sterile field throughout the procedure
*
Competent
Needs Improvement
Not Observed
Opens sterile packages without contaminating contents
*
Competent
Needs Improvement
Not Observed
Maintains aseptic technique when handling sterile instruments and supplies
*
Competent
Needs Improvement
Not Observed
Avoids reaching over or contaminating the sterile field
*
Competent
Needs Improvement
Not Observed
Identifies and corrects any breaks in sterile technique immediately
*
Competent
Needs Improvement
Not Observed
Properly disposes of contaminated materials after procedure
*
Competent
Needs Improvement
Not Observed
Demonstrates awareness of maintaining sterile boundaries at all times
*
Competent
Needs Improvement
Not Observed
Completes procedure maintaining aseptic technique throughout
*
Competent
Needs Improvement
Not Observed
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