Staff Education Tool: Evaluation Form for Phlebotomy Safety Devices

The Premier Safety Institute offers a free, downloadable evaluation form for phlebotomy safety devices.


The one-page sample form asks staff members to address 16 key performance issues about a specific phlebotomy safety device, including the following:

  • The product is satisfactory for standard phlebotomy purposes .
  • The product is satisfactory for patients with fragile veins.
  • Both hands remain behind the needle during engagement of safety feature.
  • This product allowed me to see what I needed to see during the blood draw.
  • The product could be disposed of into the sharps container that is available for my use.


The form then asks the staff member to provide additional feedback on the product's use.


Download the Premier Safety Institute's evaluation form for phlebotomy safety devices (doc) for adaptation and use by your facility.


Note: View our database providing reports that link to free, downloadable and adaptable tools for use in hospitals, surgery centers and other organizations by clicking here.


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