Checklist for Phlebotomy Equipment
Note: For clinical sites that are accredited, narrative describing the safety equipment
available for blood collections will suffice. This form may be used for clinical sites that are
not accredited by CAP, TJC (JCAHO), CLIA, or COLA.
Program/Site Name: __________________________________ Date of Review: _____________
Report Prepared by: __________________________________ __________________________
Name
Title
Instructions: Please indicate quantities for the supply items listed in bold.
Available in Student Lab?
Supply Item
Yes
Artificial phlebotomy practice arms & blocks
Artificial phlebotomy practice heels and hands
#
#
Phlebotomy chairs with locking armrests
#
#
#
Phlebotomy trays/baskets
Centrifuges
Aliquot supplies
Biohazard waste containers, sharps containers
Biohazard spill kit
Personal protective equipment
Plastic vacuum tubes, blood culture bottles
Vacuum collection set ups with safety needles
Tourniquets
Gauze, alcohol wipes, iodine, bandages, tape
Butterfly collection set ups with safety needles
Syringes with safety needles, transfer devices
Dermal puncture devices
Capillary tubes, microtainers
Tube racks
Specimen requirement guides/catalogs
Phlebotomy procedure manual, MSDS
No