BACKGROUND: The application of surgical safety checklist in the health service has succeeded in improving patient safety in surgical room. The use of similar tools might be useful in hemodialysis service. The purpose of this research is to arrange the safety checklist in hemodialysis service. Method: This study uses a qualitative method with an action research approach. Data obtained from activities series of observation, interview and Focus Group Discussion in Nitipuran Hemodialysis Clinic. Result and discussion: On the stages of Diagnosis Action obtained that the early screening activities and the supervision along hemodialysis activities are still deficient and have a risk of increasing the morbidity and mortality of patients. It’s approved to use the tool of hemodialysis safety checklist which consists by 4 assessment period namely sign in (before action starts), time out (before vascular access), intra (monitoring along dialysis) and sign out (before patient leave hemodialysis room). Tool implemented for 2 weeks. The results of the implementation are very important to provide information about the patient and be written documentary evidence about the compliance of the officer to the actions and supervision that must be performed on the patient. Conclusion: Hemodialysis safety checklist is useful for helping clinical staff to comply with initial screening activities and monitoring patients during and after the procedure. The obstacles in its implementation need a further evaluation