The Coronavirus disease 2019 (COVID-19) pandemic is a devastating global pandemic affecting many countries worldwide. It has a huge impact on the country’s healthcare system as well as its socio-economic wellbeing. Majority of elective surgery was deferred in order to provide beds, resources and treat COVID-19 cases. Resumption of elective surgery requires a well-planned process and adherence to standard guidelines to protect both the healthcare providers and patients. Pre-operative COVID-19 screening will be one of the new norms for patients undergoing surgery. This study was aimed to evaluate the pre-operative COVID-19 screening for elective surgery among Otorhinolaryngology (ORL) patients in Hospital Ampang based on the current Malaysian guidelines for undertaking surgery during COVID-19 pandemic and highlight the screening protocols implemented by the Ministry of Health. This retrospective review was conducted in ORL Department, Hospital Ampang. We reviewed the surgical registry of 117 patients who underwent elective surgeries under general anaesthesia from June till September 2020. There were 62 patients (53%) below 18 years old and 55 patients (47%) above 18 years old. There were 76 cases (65%) involving aerosol-generating procedures. A total of 23 patients (19.7%) had COVID-19 screening done pre-operatively based on the Malaysian guidelines patient selection and all results were negative. None of the patients experienced any symptoms, complications or morbidities related to SARS-CoV-2 infection post-operatively. The Malaysian guideline on pre-operative screening for COVID-19 is applicable for institutions with low to moderate local transmission of SARS-CoV-2. Targeted group or risk-based protocols are beneficial for improving cost-effectiveness and reducing workload burden during the critical period. As the pandemic evolved, the guidelines have to be revised based on the prevailing situation to suit the best clinical practice for the benefit of patients and healthcare personnel without disrupting the surgical services.