Nursing Supply Cart Checklist Form
Complete this form to verify readiness and proper stocking of the nursing supply cart. Please review each item below for operational compliance.
Date of Inspection
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Cart Location or Identifier (last 4 digits only)
*
Personal Protective Equipment (PPE) stocked
*
Gloves
Masks
Gowns
IV Supplies available
*
IV Catheters
IV Tubing
Saline Flushes
Medication labels and syringes stocked
*
Medication Labels
Syringes
Wound care supplies present
*
Dressings
Tape
Antiseptic swabs
Sharps container present and not full
*
Sharps container present
Sharps container not full
All items within expiration date
*
Yes
No
Cart is clean and organized
*
Yes
No
Inspector's initials (for accountability)
*
Additional comments or notes
Submit Checklist
Should be Empty: