subject_line
Equipment Sterilization Check
Month
*
January
February
March
April
May
June
July
August
September
October
November
December
Year
*
2024
2025
2026
2027
All Equipment Sterile? (Verified by color change of the indicator strip)
*
If Some Equipment Not Sterile, Describe Action Taken?
*
Date Checked on All Sterile Instruments Verified to be within the next 1 year? If not, give explanation.
*
Notes
*
Date Check Performed
*
+
Signature of Nurse Performing Check
*
clear