Auditor Name

Gloves are readily available?

Comply with current standards and suitable for purpose?

Gloves appropriate for activity?

Hand Hygiene prior to application of gloves

Gloves removed appropriately and hand hygiene performed directly after removal?

Gloves are patient and procedure specific? ie gloves changed between patients and after every episode of individual patient care.

Protective Eyewear

Protective eyewear readily available?

Comply with current standards and is optically clear, anti fog, distortion free and provides close fitting shields at the sides?

Protective Eyewear it utilised by the healthcare worker when there is a risk of a splash or spray of bodily fluid?

Protective Mask

Surgical masks are readily available?

Surgical mask is worn and fitted according to manufacture instructions?

Surgical mask is immediately disposed after use?

Surgical mask apply with current standards and are appropriate for use in the operating theatre, ie cover nose and mouth and are water resistance/reflective, P2 masks for bronchoscopy?


Gowns/Apron are readily available?

Gown/Apron appropriate for activity?

Gown/Apron comply with standards and are suitable for purpose?

Gown removed appropriately?

Gowns/Aprons are worn when the is a risk of a splash or spray of bodily fluids?

Gowns/Aprons are changed after every pt procedure or episode of pt care and when visibly soiled/wet. They are removed in the area where care takes placed.


Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.