Performance Checklist Gloving NOT Done 2 1 5 1 2 2

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PERFORMANCE CHECKLIST

GLOVING

PROCEDURE

DONE

1. Be sure that fingernails are short. Remove jewelries.


2. Wash and dry hands.
3. Maintain the sterility of the gloves during the entire
procedure.
4. Remove the package from the outer wrapper. Place the
package on a clean dry surface.
5. Open the package by pulling the corners of the wrapper.
6. Identify the right and left gloves. Glove dominant hand
first.
7. Get the first glove by grasping the folded cuff with the
thumb and first two fingers of the non-dominant hand,
touching only the cuff.
8. Slip in your dominant hand on the glove. Hold hand
above the waist level.
9. Using the gloved hand, slip your fingers under the cuff of
the other glove.
10. Slip the glove onto non-dominant hand.
11. Interlock the fingers of your gloved hand to fit the gloves
onto each finger.
12. If gloves are soiled, remove as follows: Using the fingers
of your dominant hand, grasp the outer part of the glove
at the wrist.
13. Pull the glove down to the fingers (glove to glove.)
14. Slip the ungloved fingers of your non-dominant hand
under the glove of your hand (skin to skin.)
15. Pull and remove the glove.
16. Dispose soiled gloves and wash hands.
TOTAL

SCORE

NOT
DONE

2
1
5
1
2
2
2
2
2
2
1
2
2
2
1
1
30

Name: ____________________

Score: _______________

Section: ___________________

Date: _______________

Instructor:__________________

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