Title Page
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Date of Audit
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Name of Auditor
Personal protective equipment audit (donning and doffing)
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Name of staff member being observed
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Is the staff member 'bare below the elbows'?
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Staff member can risk assess and identify the appropriate PPE to be worn?
- 1) When there is a risk of contact with blood and/or body fluids (apron, gloves, and facial protection if there is risk of splashing)
- 2) When the resident has a confirmed or suspected infection (apron, gloves, and facial protection if droplet or airborne transmission)
- 3) When handling used and infected linen (apron, gloves, if the risk of exposure to blood and/or body fluid or the resident has a confirmed or suspected infection, and facial protection if the risk of splashing)
- 4) When cleaning a commode and/or commode pan (apron, gloves, and facial protection if risk of splashing)
- 5) None of the above
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Staff members can demonstrate or describe the correct procedure and order for donning PPE?
- 1) Wash hands or apply alcohol handrub
- 2) Apply apron
- 3) Apply face mask (if required)
- 4) Apply eye protection (if required)
- 5) Apply gloves
- 6) None of the above
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Staff members can demonstrate or describe the correct prodocure and order for doffing PPE?
- 1) Remove gloves
- 2) Remove apron
- 3) Remove eye protection
- 4) Remove face mask
- 5) Clean hands
- 6) None of the above
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Staff uniform/work clothing is clean and fit for purpose.
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Footwear is well maintained, visibly clean, non-slip and supports and covers the entire foot to avoid contamination.
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Did the staff member pass or fail the audit? (Failing any question is a fail, pass rate is 100%)
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Signature
