PANGASINAN STATE UNIVERSITY

Bayambang Campus
Institute of Nursing

PERSONAL PROTECTIVE EQUIPMENT COMPETENCY CHECKLIST

DONNING AND DOFFING

Donning and Doffing Standard Precautions and Transmission Based Precautions

Preparation Performed Comment/s

Assessment 5 4 3 2 1
1. Healthcare provider should ensure that clear space and appropriate
signage is assigned in separation between clean and potentially
contaminated areas:
 PPE Storage and Donning Area
 Patient Room
 PPE Removal Area
2. Gather Equipment:
 Single-use (disposable) PPE gown or coverall.
 Single-use (disposable) full face shield.
 Single-use (disposable) goggles.
 Single-use (disposable) N95 respirator.
 Single-use (disposable) surgical hood or head cap.
 Single-use (disposable) shoe covers.
 Two pairs of single-use (disposable) gloves with extended cuffs.
Procedure
DONNING PPE (DOUBLE GLOVES)
1. Engage Trained Observer: The donning process is conducted under the
guidance and supervision of a trained observer, who confirms visually that all
PPE is serviceable and has been donned successfully.
2. Remove Personal Clothing and Items: Change into surgical scrubs and
washable (plastic or rubber) footwear.
3. Inspect PPE Prior to Donning.
4. Perform Hand Hygiene and observe other appropriate infection
control procedures.
5. Put on First pair of Inner Gloves.
6. Put on Booties or Shoe Covers.
7. Put on PPE Gown or Coverall. Ensure cuffs of inner gloves are tucked
under the sleeve of the gown or coverall.
8. Put on Second pair of Outer Gloves. Ensure the cuffs are pulled over
the sleeves of the gown or coverall.
9. Put on N95 respirator. Complete a user seal check.
10. Put on Surgical Hood/ Head Cap. Over the N95 respirator, place a
surgical hood that covers all of the hair and the ears.
11. Put on Outer Apron (optional).
12. Put on Face Shield.
13. Verify: A trained observer should verify that a healthcare provider is
comfortable and able to extend the arms, bend at the waist, and go through
a range of motions while all areas of the body remain covered.
14. Disinfect Outer Gloves with EPA-registered disinfectant wipe or
ABHR.

Preparation Performed Comment/s

Assessment 5 4 3 2 1
1. Healthcare provider should ensure that clear space and appropriate
signage is assigned in separation between clean and potentially
contaminated areas:
 PPE Storage and Doffing Area
 Patient Room
2. Guarantee Available Equipment: (Anteroom)
a. Clean Section of PPE removal Area:
 Stock of disposable clean gloves.
 Stock of disposable surgical mask.
 Alcohol-based hands rub.
 PANGASINAN STATE UNIVERSITY
Bayambang Campus
Institute of Nursing

b. PPE removal Area:

 Leak-proof infectious waste containers for discarding used PPE.
 Shower room (if possible) available for use by healthcare workers
after doffing of PPE.
Procedure
DOFFING PPE
1. Engage Trained Observer: The doffing process is conducted under the
supervision of a trained observer who confirms visually that the PPE is
removed properly.
2. Inspect: Inspect the PPE to assess for visible contamination, cuts, or
tears before starting to remove.
3. Disinfect Outer Gloves with either EPA-registered disinfectant wipe
or ABHR.
4. Remove Apron (if used).
5. Disinfect Outer Gloves with either EPA-registered disinfectant wipe
or ABHR.
6. Remove Booties or Shoe Covers.
7. Disinfect Outer Gloves with either EPA-registered disinfectant wipe
or ABHR and Remove Outer Gloves (glove-to-glove technique).
8. Inspect and Disinfect Inner Gloves with either an EPA-registered
disinfectant wipe or ABHR.
9. Remove Face Shield and avoid touching the front surface of the face
shield.
10. Disinfect Inner Gloves with either an EPA-registered disinfectant
wipe or ABHR.
11. Remove Surgical Hood/ Head Cap.
12. Disinfect Inner Gloves with either an EPA-registered disinfectant
wipe or ABHR.
13. Remove Gown or Coverall. Pull gown away from body, rolling inside
out and touching only the inside of the gown.
14. Disinfect Inner Gloves with either an EPA-registered disinfectant
wipe or ABHR.
15. Remove N95 Respirator: By tilting the head slightly forward, grasping
first the bottom tie or elastic strap, then the top tie or elastic strap, and
remove without touching the front of the N95 respirator.
16. Disinfect Inner Gloves with either an EPA-registered disinfectant
wipe or ABHR and Remove Inner Gloves, taking care not to contaminate
bare hands during removal process.
17. Perform Hand Hygiene and observe other appropriate infection
control procedures.
18. Perform a final inspection. If contamination is identified, immediately
inform infection preventionist or occupational safety and health coordinator
before exiting PPE removal area.
19. Shower (if possible/available in the facility): is suggested for
healthcare providers spending extended periods of time in the isolation
room.

GRADE:

Remarks:

Performance Rating:
5 – Performed well without assistance (able to recite step by step).
4 – Performed with minimal assistance.
3 – Performed with assistance.
2 – Performed or able to recite but not done and explained (vice versa).
1 – Did not perform and recite.

Name: Date:

Year level/ Sec: Instructor:

Prepared by:
Sherlyn D. Platon, RN, MAN
PANGASINAN STATE UNIVERSITY
Bayambang Campus
Institute of Nursing