Personal Protective Equipment (PPE) Inventory Tool

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Personal Protective Equipment (PPE) Inventory Tool

Date Observed:__________ Observer:________________________________ Shift Observed: 1 2 3

Adequate Levels of PPE Maintained


Process Measures Observation Comment
On each shift a HCW is assigned to inventory and Yes No
restock PPE cart/caddy/cabinet
Supplies are inventoried and restocked at end of each Yes No
shift and as needed
Supplies are located on each nursing unit Yes No

Supplies are located in ancillary care areas such as Yes No


physical therapy
Supply cart, caddy, or storage cabinet prominently Yes No
labeled “PPE Supplies”
HCWs know location of supply cart/caddy/cabinet Yes No

Extra supplies are easily obtained from store room on Yes No


all shifts

Storage cart/caddy/cabinet contains only the following supplies

Par level
Supply (established Observation
by facility)
Gloves (small, medium, large): Yes No

Gowns (moisture repelling) Yes No

Gowns/aprons; may be plastic aprons or cloth gowns Yes No

Masks (surgical or procedure) Yes No

Goggles or face shield Yes No

Blood/body fluid spill containment kit Yes No

Alcohol-based hand hygiene refill dispensers Yes No

Environmental hygiene disinfectant wipes Yes No

NOTE: N-95 or higher level respiratory protection should be immediately available in storeroom in the event of a pandemic
influenza outbreak. Consult with local health department.

Data reported to Quality Improvement Committee: Yes No Date:


Recommended Actions:

UDOH
04/11

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