We note with interest the correspondence from Jennings and Bhatt [1] regarding their application of a warning sticker to the surgical assistant’s forehead to assist in the prevention of a retained throat pack. In April 2009 the National Patient Safety Agency (NPSA) issued a Safer Practice Notice relating to the safe use of throat packs in clinical practice [2].  The NPSA guidance recommends that both a visual and a document-based check should be employed every time a throat pack is used. Before issuing the guidance, the NPSA working party conducted a risk assessment of the reported methods for minimising the risk of retention of throat packs. This assessment identified certain actions that need to be taken with each of the methods. When using a label as the visual check, if a site other than the patient’s head is to be used then the choice of alternative site should be based on local risk assessment. The NPSA also specifically states that it does not endorse labelling of the anaesthetic machine - it is not specific to individual patients and the patient is able to leave theatre, without the label, regardless of whether the throat pack remains in place. We feel that the application of the throat pack label to the surgical assistant’s head is similarly flawed and that formal risk assessment of this alternative site will result in a high risk ranking.