Background: Appropriate utilization and compliance of Surgical Safety Checklist reduces occurrence of perioperative surgical complications and improve patient outcomes. However, data on compliance of surgical checklists are scarce in the study area. Therefore, the aim of this study was to evaluate compliance of checklist completionat ayder comprehensive specialized hospital, mekelle, Ethiopia. Methods: Institutional based cross sectionalstudy was conducted among 132 patients undergoing elective and emergency surgery from April to June 2017. Compliance and completeness rate with implementation of Sign-in, Time-out, and Sign-out domains was computed with SPSS 20 package. Results: A total of 132 operations were performed and checklists were utilized in 69.7 % (92/132) of cases. Among these, most checklists were employed during emergency procedures (72 %) and in plastic and neurology surgical specialty were (100) completed. The overall compliance and completeness rate were 69.7% and 2.2 % respectively. The sign-in, time-out and sign-out completeness rate were in 60.9% (56/92), 8.9% (8/92) and 7.6 % (7/92) respectively. Conclusions and recommendations: The compliance rate was satisfactory but the overall completeness rate was low. Moreover, frequent use of the checklist during emergency cases has been deemed to be of value by clinicians. Supplementary training and attention to actual checklist use would be indicated to ensure that this valuable tool could be used more routinely and improve communication. Conducting regular audit of checklist utilization is also recommended.