Donning and Doffing of PPE

• Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Select ✔ if steps were followed and X if not.

STEP 1: GOWN

• Fully cover torso from neck to knees, arms to end of wrists, and wrap around back

  ✔

  ✘

  N/A

• Fasten in back of neck and waist

  ✔

  ✘

  N/A

STEP 2: SHOE COVERS

• Pull shoe covers over shoes

  ✔

  ✘

  N/A

STEP 3: GLOVES

• Apply first layer of gloves (check for tears)

  ✔

  ✘

  N/A

• Cut hole in lab coat for thumb

  ✔

  ✘

  N/A

• Pull lab coat over hand putting thumb through hole

  ✔

  ✘

  N/A

• Apply second layer of gloves (extend to cover wrist)

  ✔

  ✘

  N/A

STEP 4: MASK OR RESPIRATOR

• Cup the respirator in your hand; nosepiece at fingertips

  ✔

  ✘

  N/A

• Position the respirator under your chin with nosepiece up

  ✔

  ✘

  N/A

• Pull top strap over head resting it at back of head

  ✔

  ✘

  N/A

• Pull bottom strap over head resting around neck below ears

  ✔

  ✘

  N/A

• Using two hands; mold nose

  ✔

  ✘

  N/A

• Place both hands over mask and exhale sharply

  ✔

  ✘

  N/A

• If air leaks out adjust mask

  ✔

  ✘

  N/A

STEP 5: GOGGLES OR FACE SHIELD (IF NEEDED)

• Place over face and eyes; adjust to fit

  ✔

  ✘

  N/A

STEP 1: GLOVES

• Grasp outside of glove with opposite gloved hand; peel off

  ✔

  ✘

  N/A

• Hold removed glove in gloved hand; peel glove off over first glove; discard in waste container

  ✔

  ✘

  N/A

• Leave inner layer of gloves on

  ✔

  ✘

  N/A

STEP 2: GOGGLES OR FACE SHIELD (IF USED)

• Handle by head band or ear pieces and place in designated receptacle

  ✔

  ✘

  N/A

STEP 3: GOWN

• Unfasten ties

  ✔

  ✘

  N/A

• Pull away from neck and shoulders, turning gown inside out

  ✔

  ✘

  N/A

• Fold or roll into a bundle and discard in waste container

  ✔

  ✘

  N/A

STEP 4: SHOE COVERS

• Touch highest part of shoe cover behind ankle only

  ✔

  ✘

  N/A

• Pull shoe cover off of first shoe; place foot in clean area

  ✔

  ✘

  N/A

• Pull shoe cover off of second shoe; place foot in clean area

  ✔

  ✘

  N/A

STEP 5: MASK OR RESPIRATOR

• Front of mask may be contaminated; touch only with gloved hands

  ✔

  ✘

  N/A

• Grasp side of mask with both hands

  ✔

  ✘

  N/A

• Gently pull off over face; discard in waste container

  ✔

  ✘

  N/A

STEP 6: INNER GLOVES

• Grasp outside of glove with opposite hand; peel off

  ✔

  ✘

  N/A

• Hold removed glove in opposite gloved hand

  ✔

  ✘

  N/A

• Slide fingers of ungloved hand under remaining glove at wrist

  ✔

  ✘

  N/A

• Peel glove off over first glove and discard

  ✔

  ✘

  N/A

STEP 7: WASH HANDS

• Wash hands thoroughly

  ✔

  ✘

  N/A

Completion

• Prepared by

  Sign