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Yes                                                    No

If No, why?

DRESSING ROOM:

The checklist provides information about the room and its contents, including important issues like sterilization of the room and equipment.

Supervisory checklist for

Dressing room

General observation for the room

I/General cleanness of the room

Clean

Yes

No

If No, please comment:

II/Cleanness of the room equipments:

No

Yes

-Surgical instruments

If No, Please comment: ----------------------------------------------------------------------------------------------------------------------------------------------------

No

Yes

-Boiler

If No, please comment: -----------------------------------------------------------------------------------------

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