Hospital Sterilization Quality Control Inspection Form
Date:
Inspection Location:
Inspector Name:
Sterilization Equipment
Equipment
Identification No.
Cleanliness
Working Condition
Remarks
Pass
Fail
Operational
Needs Repair
Out of Service
Pass
Fail
Operational
Needs Repair
Out of Service
Sterilization Process Parameters
Load No.
Cycle Type
Temperature/Pressure
Time
Results
Remarks
Pass
Fail
Pass
Fail
Biological & Chemical Indicators
Indicator Type
Batch No.
Result
Date
Remarks
Pass
Fail
Not Done
Pass
Fail
Not Done
Staff Hygiene & PPE
Staff Name/ID
Hand Hygiene
PPE Compliance
Remarks
Compliant
Non-compliant
Compliant
Non-compliant
Compliant
Non-compliant
Compliant
Non-compliant
Additional Comments / Observations
Inspector Signature:
Date: