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Personal Protective Equipment (PPE) Competency Validation

1 NC SPICE; 9-2016 Type of Validation : Return demonstration Orientation Annual Other Employee Name: _____ Job Title: _____ Donning PPE Competent YES NO 1. Perform Hand Hygiene 2. Don Gown: Fully covering torso from neck to knees, arms to end of wrists 3. Tie/fasten in back of neck and waist 4. Don Mask/Respirator: Secure ties/elastic bands at middle of head & neck 5. Fit flexible band to nose bridge 6. Fit snug to face and below chin (Fit-check respirator if applicable) 7. Don Goggles or Face Shield: Place over face and eyes; adjust to fit 8.

Remove Mask/Respirator (respirator removed after exit room/closed door): Grasp bottom, then top ties or elastics and remove 21. Discard in waste container 22. Perform Hand Hygiene Personal Protective Equipment (PPE) Competency Validation Donning and Doffing Standard Precautions and Transmission Based Precautions .

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