PPE Doffing Procedure Checklist
Complete this checklist to document each step of the PPE doffing process. Ensure all required details are accurately recorded.
Date and Time of Doffing Event
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Full Name of Person Completing Checklist
*
First Name
Last Name
Location of Doffing
*
PPE Items Removed (select all that apply)
*
Gloves
Gown
Face Shield
Goggles
Mask/Respirator
Other
Order of PPE Removal
*
Were any contamination or exposure incidents observed?
*
No
Yes
Describe any contamination or exposure incidents (if applicable)
Hand hygiene completed after PPE removal?
*
Yes
No
Proper disposal or containment of used PPE confirmed?
*
Yes
No
Supervisor Verification (Full Name)
*
First Name
Last Name
Submit Checklist
Should be Empty: