Surgical Scrub Checklist Form
Complete this checklist to verify all steps of surgical scrub preparation are properly followed before entering the sterile area.
Remove all jewelry and accessories
*
Completed
Inspect hands and forearms for cuts, abrasions, or lesions
*
Inspected and clear
Wet hands and forearms thoroughly with water
*
Completed
Apply antimicrobial soap and scrub hands and forearms
*
Completed
Clean under fingernails using a disposable nail cleaner
*
Completed
Rinse hands and forearms from fingertips to elbows
*
Completed
Repeat scrub process as per facility protocol
*
Completed
Dry hands and forearms with a sterile towel
*
Completed
Don sterile gown and gloves
*
Completed
Final verification: Ready to enter the sterile area
*
Verified
Submit Checklist
Should be Empty: