Title Page

  • Date of audit

  • Name of auditor

Questions

  • Name of staff member being audited

  • Is the staff member 'bare below the elbows'?

  • Staff member can risk assess and identify the appropriate PPE to be worn:

  • When there is a risk of contact with blood and/or body fluids (apron, gloves, eye/face protection if risk of splashing).

  • When the resident has a known or suspected infection (apron, gloves).

  • When handling used soiled, fouled or infected linen (apron, gloves).

  • When cleaning a commode and/or commode pan (apron, gloves, eye/face protection if risk of splashing).

  • Donning: Staff member can demonstrate or describe the correct procedure and order for putting on PPE after risk assessing the task.

  • 1. Washing hands or apply alcohol hand rub.

  • 2. Apply apron.

  • 3. Apply face mask if required.

  • 4. Apply eye/face protection if required.

  • 5. Apply gloves.

  • Doffing: Staff member can demonstrate or describe the correct procedure and order for removing PPE.

  • 1. Remove gloves.

  • 2. Clean hands.

  • 3. Remove apron.

  • 4. Clean hands.

  • 5. Remove eye/face protection.

  • 6. Clean hands.

  • 7. Remove face mask.

  • 8. Wash hands.

  • Staff uniform/work clothing is clean and fit for purpose.

  • Footwear is well maintained, visibly clean, non-slip and supports and covers the entire foot to avoid contamination.

Sign off

  • Signature of auditor

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.