Ppe Checklist

Name ______________________________________________________ Date _____________________
School ______________________________________________________
Instructor ___________________________________________________
Course _____________________________________________________
PPE - (DONING)
Able to
Assessment Able to Unable to Initials and
Perform with
*Available trained observer is necessary to verify compliance Perform Perform Date
Assistance
with all steps.
1. Ensure all needed supplies are available.
2. Prepare for donning of PPE
a. (Remove watch, jewelry and other contents of the
pockets)
b. Hair is secured -especially for those with long hair.
3. Inspect PPE items before putting on.
a. Check for the sizes. All should be in good condition.
4. Put on boot covers.
5. Perform hand hygiene
6. Put on inner gloves.
7. Put on cover-all/gown.
a. Make sure all are tucked. Cuffs onf inner gloves are
tucked under sleeves of the coverall. Zip up coverall.
8. Make thumb holes at the border of cuff and sleeves.
9. Put on N95 Respirator.
a. Cup the respirator in your hand with the nosepiece
at your fingertips.
b. Position the respirator under your chin with the
nosepiece up.
c. Pull the top strap over your head resting it high at
the back of your head.
d. Pull the bottom strap over your head resting it high
at the back of your head.
e. Pull the bottom strap over your head and position it
around the neck, below the ears.
f. Mold the nosepiece using two fingers of each hand
to the shape of your nose. (Pinching the nosepiece
using one hand may compromise the respirator
performance.)
10. Perform seal check.
a. Inhale deeply
b. Exhale sharply
11. Put on hood. (Make sure that the hood covers all of hair,
ears, and neck with no skin exposed. )
a. Put on outer apron. (Tie the apron with a simple
knot for easy removal.
b. Put on outer gloves. (Ensure the cuffs are pulled
over the sleeves of the gown/cover-all.
c. Put on face shield or goggles.
Checking:
● Make sure that all parts of skin are covered.

● All areas of the body should be covered during the
range of movement.
● The healthcare worker should be able to extend his/her
arms, bend at the waist and do range of motions.
PPE DOFFING
Able to
Assessment Able to Unable to Initials and
Perform with
Inspect PPE for visible contamination, cuts or tears before Perform Perform Date
Assistance
starting to remove.
1. Always remove PPE under the guidance and supervision of a
trained observer (colleague). Ensure that infectious waste
containers are available in the doffing area for safe disposal of
PPE. Separate containers should be available for reusable items.
2. Perform hand hygiene on gloved hands.
3. Remove apron leaning forward and taking care to avoid
contaminating your hands.
( When removing disposable apron, tear it off at the neck and roll it
down without touching the front area. Then untie the back and roll
the apron forward.) After inspect PPE again for contamination or
cuts.
5. Remove head and neck covering taking care to avoid
contaminating your face by starting from the bottom of the
hood in the back and rolling from back to front and from inside
to outside, and dispose of it safely.
7. Remove coverall and outer pair of gloves:
Ideally, in front of a mirror, tilt head back to reach zipper, unzip
completely without touching any skin or scrubs, and start
removing coverall from top to bottom. After freeing shoulders,
remove the outer gloves while pulling the arms out of the
sleeves. With inner gloves roll the coverall, from the waist down
and from the inside of the coverall, down to the top of the
boots. Use one boot to pull off coverall from other boot and
vice versa, then step away from the coverall and dispose of it
safely.
9. Remove eye protection by pulling the string from behind the
head and dispose of it safely.
11. Remove the mask from behind the head by first untying the
bottom string above the head and leaving it hanging in front;
and then the top string next from behind head and dispose of it
safely.
13. Remove rubber boots without touching them (or overshoes if
wearing shoes). If the same boots are to be used outside of the
high-risk zone, keep them on but clean and decontaminate
appropriately before leaving the doffing area.
15. Remove gloves carefully with appropriate technique and dispose
of them safely.
16. Perform hand hygiene.
source: DOH guideline and WHO
COMMENTS: GRADE:
Rating Scale:
Excellent : 96 – 100%
Very satisfactory : 90 – 95%
Very Good : 85 – 89%
Good : 80 – 84%
Fair : 75 – 79%
Poor : 74 & below
_______________________________ ____________________________
Clinical Instructor Student’s Signature

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Name __________________________________ Date _

● Make sure that all parts of skin are covered.

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