A surgical safety checklist is essential to ensure patient safety. The purpose of this study was to evaluate the implementation of surgical time-out at an academic medical center in Saudi Arabia, and to reveal potential factors that may influence the compliance of time-out. A cross-sectional study observing elective surgeries was performed at King Abdulaziz University Hospital. Sixteen operating theaters were screened, corresponding to 15 different specialties being examined. Overall, one hundred and sixteen elective procedures were observed.  The time-out checklist was employed by staff in 45.7% of cases and was fully completed in 26.7%. Factors influencing the time-out adherence included overall staff presence and the involvement of the primary surgeon during the time-out phase (p < 0.001). Absence of some staff members was significantly associated with a higher rate of time-out noncompliance (OR = 0.04; 95%; CI = 0.01, 0.21; p < 0.001).  There was no significant association between time-out and the time of the day that the surgery was performed (p = 0.83), nor the number of surgeries performed in the day. Overall, time-out compliance was suboptimal in this study. Time-out was conducted at a similar rate throughout the day, regardless of the surgical load and the length of the pre-incision period.