Instructions: Check "yes" if the task was performed correctly; check "no" if the task was not performed correctly or was not performed.
Note: For the purpose of this activity, it is not necessary to perform all of the tasks that are not directly involved in putting on or removing gloves (e.g., performing surgical scrub, placing the used gloves in decontamination solution). Check "yes" if the the task is mentioned at the appropriate moment, even if it is not performed.
1. Prepares a large, clean, dry area for opening the package of gloves.
___ Yes | No ___
2. Opens the outer glove pack and performs surgical scrub, or performs surgical
scrub and then has someone else open the pack.
___ Yes | No ___
3. Opens the inner glove wrapper, exposing the cuffed gloves with the palms up.
___ Yes | No ___
4. Picks up the first glove by the cuff, touching only the inside portion of the cuff.
___ Yes | No ___
5. With the fingers of the glove pointing down, holds the cuff in one hand while slipping the other
hand into the glove.
___ Yes | No ___
6. Waits to make any adjustment to the first glove until the second glove is on.
___ Yes | No ___
7. Picks up the second glove by sliding the fingers of the gloved hand under the cuff
of the second glove.
___ Yes | No ___
8. Puts the second glove on the ungloved hand by maintaining a steady pull through the
cuff.
___ Yes | No ___
9. Does not attempt to adjust the cuffs once the gloves are on.
___ Yes | No ___
10. Adjusts the position of the glove fingers until the gloves fit comfortably.
___ Yes | No ___
1. Rinses gloved hands in a basin of decontamination solution.
___ Yes | No ___
2. Grasps one of the gloves near the cuff and pulls it part-way off.
___ Yes | No ___
3. Leaving the first glove over the fingers, grasps the second glove near the cuff and
pulls it off.
___ Yes | No ___
4. Pulls off the first glove, being careful to touch only the inside surface with the bare
hand.
___ Yes | No ___
5. Removes the second glove.
___ Yes | No ___
6. If the gloves are intact and are to be reused, places them in a container of decontamination solution. If
they are disposable or not intact, disposes of them properly.
___ Yes | No ___
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