Personal Protective Equipment (PPE) Donning and doffing assessment tool

Site: __________________________________

Healthcare worker name: ____________________________Date: ______________

Assessor: _________________________________________

Donning

Profession/job role Add abbreviationN=nurse, Care worker=CW, D=doctor, AH=Allied Health, C=Cleaner, SN=Student nurse, O=other

Equipment Yes No CommentPPE & Alcohol based hand rub (ABHR) available and easily accessible

Clearly identifies the PPE that is required i.e. correct glove size

Donning Criteria Yes No CommentPerforms hand hygiene correctly

Dons gown – opening at the back & tied in a bow, not a knot. Waist strap tied at the side or back

Dons surgical mask or respirator

Ensures mask is fitted snug to the face, over the nose and below the chin.

If P2/N95 – fit check is conducted if appropriate

Dons protective eyewear/face shield over eyes/face & adjusts to fit

Dons gloves – extend to cover the wrists of the gown

Doffing

Equipment & waste Yes No CommentABHR easily accessible

Waste disposal available

Doffing criteriaDoffs gloves, peels off without contaminating hands and into waste container.

Performs hand hygiene correctly.

Releases ties (side and neck). Inserts hands into the internal surface of the gown and the back of the neck. Slowly removes gown touching internal surfaces only rolling in to a contained package before disposal directly into waste container.

Performs hand hygiene correctly

Doffs protective eyewear & disposes.

health.wa.gov.au

(Clean if reusable with detergent & disinfectant. Single person use only)

Performs hand hygiene correctly

Doffs mask by straps/ear loops – pulls away from the face while not touching the mask & disposes directly in waste container.

Performs hand hygiene correctly

Score out of 16 = _________

16/16 indicates competency with PPE donning and doffing sequence.

Acknowledgements

This resource has been adapted from ‘How to put on (don) and take off (doff) your personal protective equipment (PPE)’, Victoria, Department of Health & Human Services 2020, www.dhhs.vic.gov.au/coronavirus

Last updated 12 October 2020This document can be made available in alternative formats on request for a person with disability.

© Department of Health 2020

health.wa.gov.au

Comments or follow up actions if 16/16 not achieved: