Introduction Insertion of a chest drain is a common, potentially life-saving procedure, and most doctors will be required to insert a chest drain at some stage of their career, regardless of their specialty. Complications can occur during this procedure that can be life threatening. Not having the required equipment at the crucial time has been highlighted as an important cause of iatrogenic complications. Objectives Our objectives were to formulate a checklist of items required for the safe insertion of chest drains and to assess the adequacy of the equipment available for the procedure within the tertiary care setting of Sri Lanka based on this checklist. Methods A checklist was compiled based on the British Thoracic Society guidelines with modifications according to the Sri Lankan setting. This was further modified after a consensus from an expert panel using the Delphi technique. This checklist was used to perform a descriptive cross-sectional study within tertiary care units in Sri Lanka selected using a multi-staged sampling technique. Results A checklist was formulated consisting of 10 items in the units and nine items in a chest drain pack. Twenty nine units were assessed from five tertiary care hospitals of five provinces of Sri Lanka: Although 75.9% units had designated "chest drain insertion packs", the mean availability of instruments inside them were 52.5%. Only 73% of units had curved instruments to facilitate safe insertion of a drain. Only 7% of units had more than one pack. The availability of equipment required to be easily available within the unit was 94.8%. However, only 24% units used the safer non-trocar chest drain exclusively. Conclusions There is a deficiency of organized instruments and especially non-trocar tubes, even in our tertiary care hospitals. This is likely to make chest drain insertion unsafe in the majority of our units. Availability of a "chest drain checklist" among units could guide the nurses to keep available the required equipment at hand and to set up the trolley at short notice.