These
“training” checklists are customizable versions of the MOHLTC
approved PDF versions that were developed by the PSHSA with input from
Infection Prevention and Control and Occupational Health and Safety experts
representing employer and labour associations in Acute Care and Emergency
Services. They reflect the PPE required in Directive 1 and 2 at the time of
publishing. Any modifications to the checklist should be done in consultation
with internal and external experts and your JHSC and are the sole responsibility
of the individual organization. Under no circumstances will the PSHSA be held
responsible for any damages or loss resulting from reliance upon revised
checklists or general information provided herein.
These can be used as “Observer” donning and doffing checklists by removing
the first columns of check boxes.
PRE-PLANNING ITEMS
Introduction
There are many factors that need to be considered before a worker dons or doffs personal protective
equipment (PPE). PPE is a last line of defense, and as such, to effectively control for the risk of
contracting Ebola in the workplace, the hierarchy of controls needs to be incorporated into decision
making. There should already be an Infection Prevention and Control (IPAC) and Occupational Health
and Safety (OHS) program in place. In addition organizations must always ensure compliance with the
Occupational Health and Safety Act (OHSA) and hospitals must comply with Health Care and Residential
Facilities Regulation (HCRFR) responsibilities; which include providing Health and Safety (H&S)
measures related to H&S/IPAC reviewed annually in consultation with the Joint Health and Safety
Committee (JHSC). Where appropriate the precautionary principle (section 21 guidance note) will also
need to be applied to ensure worker safety and health. Click on the following link to view Section 21
Guidance Notes for Workplace Parties: Application of Hazard Control Principles, including the
Precautionary Principle to Infectious Agents
As part of your pre-planning efforts to donning and doffing PPE for Ebola, a site-specific risk assessment
needs to be completed by qualified individuals. A useful resource titled “Protecting Health Care Workers
from Infectious Diseases: A self-assessment Tool” is available to help with conducting a general IPAC risk
assessment. It can be accessed using the following link: http://www.pshsa.ca/products/protecting-healthcare-workers-from-infectious-diseases-a-self-assessment-tool/.
It is also important to consider
establishing a working group composed of competent professionals to determine the appropriate level of
protection, PPE assembly based on regulatory requirements, a risk assessment, working conditions,
tasks, and accessibility to decontamination facilities. As with any use of PPE, there are no standardized
solutions, and proper selection and use is critical to protection.
See the list below for some additional free resources that may be of interest:
Cleaning and Disinfection of Environmental Surfaces:
http://www.pshsa.ca/wp-content/uploads/2013/03/Cleaning_And_Disinfection.pdf
Ebola Virus Disease – Staying Healthy & Safe at Work
http://www.pshsa.ca/wp-content/uploads/2014/09/PSHSA-Fast-Facts-Ebola-VirusDisease_updated-latest.pdf
10-Minute Health & Safety Program Check
http://www.pshsa.ca/wp-content/uploads/2013/07/LHSCHAEN0211-Ten-Minute-Health-SafetyProgram-Check.pdf
Health and Safety Management Systems
http://www.pshsa.ca/wp-content/uploads/2013/01/HSMS.pdf
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Key Areas to Address
There are key areas that may not be part of an organization’s regular IPAC program that need to be
considered specific to Ebola Virus Disease. Although the list that follows is not comprehensive, the items
have been identified by experts that formed various Ebola Committees and need to be considered prior to
donning and doffing PPE for EVD.
People
 Assignment of care providers and environmental services personnel (all persons entering the
contaminated environment must be trained)
 Workers must have received recent IPAC RPAP training/refresher training
 Include considerations for safety (heat stress, medically fit, hydration, slips and falls etc.) and
methods of communicating with persons outside of the isolation room (e.g. whiteboard or monitor)
 Trained Observer Role must be clearly defined including:
 The PPE required for this role
 Whether the observer or buddy will be assisting with the doffing process (i.e. unzipping
the coverall and removing it from the shoulder to reduce the risk of self contamination) or
if they will be limited to observing and instructing the worker on doffing through the use of
a checklist.
PPE and Other Supplies
PPE:
 Appropriate selection of PPE and donning/doffing sequencing all must meet the directives
 Consider anti-fog protection depending on the eyewear being used; footwear/coverings




that can be removed between hot and warm zones so regular footwear is not
contaminated; identification of what clothing will be worn under PPE including footwear
 Taping of PPE (e.g. Gloves to sleeves or foot covers to pant legs) should be decided
based on an understanding of the benefits versus the risks. Prudent use of taping can in
some circumstances increase the level of safety and health, however, some
organizations have found that taping may increase risk by making the doffing process
more difficult and cumbersome. As such, proper taping of PPE components requires the
right material be selected for use with properly sized PPE, the effective technique
determined, and adequate training and skill obtained
PPE must be properly used and maintained
Always follow user instructions from manufactures around donning and doffing, as well as
cleaning and disinfecting. (e.g. is the N95 respirator being used doffed with both straps at the
same time or is it the bottom strap and then the top one)
Ensure proper fit (e.g. once the gown is tied, is there a gap at the neck (too big) or can the worker
hug her/himself without the PPE straining (too small), etc.)
N95 respirators:
 MUST be individually fit tested. A seal check must be performed each time one is
donned
 Nothing can be allowed to interfere with the ability of an N-95 mask to seal properly and
there can be no layers between the mask (or any of its components) and the wearer
 Long hair should be restricted in such a way that it cannot shift the placement of the
elastic bands (like a braid, or a low ponytail that would be tied close to the neck)
 Inspected for damage or deterioration
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 Include direction/ processes on when to discard damaged PPE, according to the type of

PPE that the hospital has selected
Stored in a convenient, clean and sanitary location when not in use
Other Supplies:
 There must be access to a disinfectant that is capable of killing non-enveloped viruses
 A chair or bench to facilitate donning and doffing of foot coverings. Ensure it is disinfected
between use or when moving from the hot to warm zone
Donning and Doffing Environment
 The risk assessment must include the determination of patient placement. Whenever possible
use an airborne infection isolation room with anteroom and dedicated washrooms
 Regardless of the room used, organizations must delineate hot, warm, and cold (clean) zones,


with no possibility of anyone accidentally going into the warm/hot zones
 The delineation of hot/warm/cold must be such that there is no possibility of heavy
contamination in the clean zone
Donning must occur in a cold/clean zone, not in the ante room or hot zone
Doffing must occur in the hot or warm zone and far from the clean zone
 If possible, outer layers containing the heaviest contamination should be doffed in the hot
zone immediately before entering the warm zone, but only if there is no chance of further
contamination. If this cannot be achieved in the hot zone, then there needs to be an area
immediately inside the warm zone (but far from the clean zone), where the doffing of very
contaminated outer layers can be performed before proceeding forward in the warm zone
to do the rest of the doffing. Consider the use of doffing/ chemical mats or trays if feasible
 Once a piece of PPE has been removed in the warm zone, there should be no more
contact between that exposed area of the worker and the warm zone. i.e. if body covering
is removed, one can’t sit in a chair in the warm zone, if removing foot covering, do it in
mid-air before your foot then touches the clean side
Training
 Please refer to the Training section of the Ministry of Health and Long-Term Care (MOHLTC)
Directives and associated curriculum guide
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PARAMEDIC DOFFING TRAINING CHECKLIST
Suspected/Confirmed EVD Cases and/or Care Environment
Coverall with Integrated Hood and Separate Foot Covers
This checklist is designed to assist with training paramedics and first responders on the correct doffing of
personal protective equipment (PPE) for suspect/confirmed cases of EVD and their care environment.
Please Note: This is a sample checklist that may need to be adapted to meet relevant standards of
practice and/or specific manufacturer’s user instructions for variations of approved PPE. The tool can be
used to verify and document that all necessary doffing steps are performed and in the proper sequence.
Any errors or omissions identified during practice and skill proficiency demonstrations must be
communicated immediately, to ensure specific instructions are provided and so appropriate corrective
action are taken for the protection of the paramedic and/or first responder.
Note: Hand hygiene should be performed after removing PPE, before hands approach the face and any
time hand contamination is identified or suspected during the doffing process.
Before you begin, instruct paramedic(s) and/or first responder(s) that PPE must be removed
slowly and carefully and in the correct sequence to avoid self-and cross-contamination of the
workplace.
#
TRAIN.
PRAC.
PROF.
DOFFING PPE PROCEDURE
COMMENTS
(May include size of PPE)
Remove outer gloves:
 Remove outer gloves taking care not to
1



touch inner gloves or bare skin
 Dispose into designated waste container
 Inspect inner gloves for visible
contamination, cuts or tears
Remove face protection:
2



 Hold face shield by grasping band at

back of head, lifting gently over head
and away from face
Dispose into designated waste container
Remove hood/coverall:
 Trained observer may assist, but must

3





be donned in adequate PPE based on
risk
Unzip or unfasten coverall completely
before rolling down and turning inside
out. Avoid contact of inner clothing with
outer surface of coverall during removal,
touching inside of the coverall only
Take care not to slip and fall; sit on chair
as needed
Dispose into designated waste container
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Remove foot covers:
 Remove foot covers carefully to avoid
4





inadvertent contact and/or crosscontamination
Take care not to slip and fall; sit on chair
as needed
Dispose into designated waste container
Remove inner gloves:
 Inspect gloves for visible contamination,
5



cuts or tears before removing
 Take care to not touch the outside of the
gloves with bare skin
 Dispose into designated waste container
Perform hand hygiene:
6



 Use alcohol-based hand rub (ABHR) or

soap and water
Allow hands to dry completely
Remove eye protection (if applicable):
 Remove safety eyeware by grasping the
7




arms at the side or straps at the back of
head, leaning forward and lifting gently
away from face
Dispose into designated waste container
Perform hand hygiene:
8



 Use ABHR or soap and water
 Allow hands to dry completely
Remove N95 respirator:
9



 Grab bottom strap and lift over head
 Lean forward and grab top strap; gently


lift over head and away from face
Take care to not touch the front of the
respirator
Dispose into designated waste container
Perform hand hygiene:
10



 Use ABHR or soap and water
 Allow hands to dry completely
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Verify doffing PPE procedure:
11



 Visually confirm sequence has been
completed correctly and no
contamination has occurred
Note: TRAIN. (Trained); PRAC. (Practiced); PROF. (Proficient)
Name of
Trainer:
Name of
Worker:
Signature:
Date:
© 2015 Copyright for all original content is held by Public Services Health and Safety Association