Background: In 2019, Ontario Health (Cancer Care Ontario) published 54 standards to ensure high quality and safe delivery of systemic treatment (ST) in Ontario, along with 16 recommendations for take-home cancer drugs (THCD). The standards/recommendations focused on 7 domains for the delivery of ST delivery and 8 domains for THCD. These domains varied between the two documents but also overlapped on issues including prescribing, patient care, patient education and training and education for providers. The standards for ST delivery were also prioritized according to Very High, High or Medium priority with regards to implementation expectations. The objective of this project was to obtain a baseline assessment of alignment with the standards/recommendations for all ST sites within Ontario. Methods: A validated electronic survey that linked to all standards/recommendations was distributed to 75 ST sites in August 2019. Sites had 8 weeks to complete the survey with their multi-disciplinary teams. Data was analyzed centrally using quantitative analysis methods by region as well as by site level. Results: The response rate was 100%. Overall, alignment in all domains was higher for intravenous cancer drug (IVCD) delivery as compared to THCD delivery. Important areas of gaps include CPOE/PPO use (75% for both IVCD and THCD); appropriate drug labels (90% for IVCD versus 52% for THCD); prescribing/dispensing independent double checks (IDC) (95% for IVCD versus 38% for THCD); pump independent double check (83% of sites); continuous ST with central line (86% of sites); standardized tool for THCD education (40%); and oncology training/education (96% of RNs versus 20% of pharmacists). Conclusions: The main gaps that were identified through the current state assessment were related to THCD, as opposed to IVCD. To ensure alignment with the standards/recommendations, these gaps should continue to be an area of focus for quality improvement. The survey was instrumental in informing provincial, regional, and local strategies to address these gaps and to ensure high quality, safe practices are embedded in ST delivery as outlined in the published best practice documents.