Medical Student OR Orientation Checklist (please bring to OR orientation)
Facility (1)________________________(2)________________________(3)___________________
Objectives
 Describe rationale for proper OR surgical attire
 Review OR Etiquette
 Identify Principles of Aseptic Technique
 Explain basic OR safety considerations
Action Items
Environmental
Scan
1. Process for
obtaining scrubs.
2. Location of locker
room with assigned
locker.
3. Tour of the OR:
Phone ext:__________
Charge Nurse
Admin Asst
4. Tour of the PACU:
Phone ext___________
Charge Nurse
Admin Asst
Surgical Attire
Considerations
Pyxis if applicable
Logistics of Rooms /Instrument Room/ Xray
Supplies
Supplies
5. Tour of Pre-Op:
Phone ext:__________
Charge Nurse
Admin Asst
Chart Location
6. Patient Whiteboard
OR Daily Schedule
7. Surgical Scrubs
-Clean/ Dirty scrubs (Only scrubs laundered by
the facility can be worn to OR)
-Undergarments /Jewelry
8. Hair Covering
9. Mask
10. Eye Wear
-Nailpolish/Perfumes
Hat/ Hood
Within the OR / Outside the OR
1
Medical Student OR Orientation Checklist (please bring to OR orientation)
Facility (1)________________________(2)________________________(3)___________________
OR Etiquette
Who’s Who in
the operating
Room
11. Shoe covering
12. Hospital ID
Mandatoy PPE/Optional PPE
13. Introduce self to
circulating RN in
room
14. Write name on
white board if
applicable
15. Offer to obtain
gown and glove
16. Make certain that
you have eaten
prior to scrubbing
in the OR
17. Either turn off your
pager or have it
assigned to
someone prior to
scrubbing in the OR
Always give a quick knock on door.
18. Review the various
roles and
responsibilities of
the disciplines and
roles
Surgeon
Do not open gown and gloves. Hand them to the
circulating RN
Backpacks, fannypacks etc are not allowed inside
OR
Lab coats, and jackets etc are not allowed in the
OR
Anesthesiologist
Circulating Nurse
Scrub Person
OR Assistant
Radiology
Aseptic
Technique/
Set of rules
that govern
the OR
environment
19. Placement of
Surgical mask
20. Methods of Hand
Antisepsis
21. Donning a sterile
gown
22. Open Gloving
Hand rub/ Hand scrub
Double Gloving with Blue Underglove
Glove Size:__________________
2
Medical Student OR Orientation Checklist (please bring to OR orientation)
Facility (1)________________________(2)________________________(3)___________________
23. Closed Gloving
24. Changing gown or
gloves during the
procedure
25. Removal of Gown
after procedure
26. Removal of gloves
after procedure
Break in technique /Cross Contamination -Do not
leave OR suite with gown or gloves on
Wash hands after glove removal
27. Where is the sterile
field
28. Mayo Stand
29. Surgical Conscience
Below sterile level is considered unsterile
Universal
Protocols
30. Wrong Site Surgery
31. Time Out
Everyone is expected to participate and follow
protocol carefully
Time
32. All students are
expected to be on
time to the OR
3
Medical Student OR Orientation Checklist (please bring to OR orientation)
Facility (1)________________________(2)________________________(3)___________________
Stations:
(signature)
Scrub Demo/Return
complete
yes
Gown Demo/Return
Double Glove (Blue)
Demo/Return
Validator #1
Validator #2
Validator #3
Validator #1
Validator #2
Validator #3
Validator #1
Validator #2
Validator #3
no
complete
yes
(if needed)
no
complete
yes
(if needed)
no
Size:
Inner:_________________
Outer:_________________
Student Name: ___________________________________________________________________________________
Date: _____________________________________________________________________________________________
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