We recognize that most hospitals will want to tailor the Checklist to the needs and processes of care in their specific environments and surgical disciplines.  This document outlines the considerations one must keep in mind while modifying the Checklist in order to ensure that modifications do not compromise the utility of the tool.  We invite you to create your modified version of the Checklist using this Word template.  Once your adapted checklist has been drafted, we encourage you to use this document to ensure that your checklist meets the goals of the WHO Surgical Safety Checklist.  Click here to see examples of other institutions' successfully modified checklists.


Translations: Arabic, Chinese, and Spanish.

After you've successfully created your own modified version of the checklist, we would love it if you would share it with us!  Please send it as an attachment in an email to safesurgery@hsph.harvard.edu and indicate whether you give permission for us to share it on our website.