Name: _______________________________ Section: __________________

MASKING
DEFINITION
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PURPOSE
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EQUIPMENT

Considerations before the procedure:

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Things to follow up after the procedure:

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Things that need to be documented:

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Things to remember to maintain safety:

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PERFORMANCE INDICATORS:
C –The step was correctly performed
X- The step was not performed
N- The execution of the step needs improvement
R- The step was correctly performed after remediation

PROCEDURE RATIONALE C X N R

1. With clean hands take a mask from the supply

of clean mask.
2. Handle the mask only by the strings, thereby
keeping the facial area of a fresh mask clean
 and the hands uncontaminated by a soiled
mask. Do not handle the mask excessively.
3. Mask should cover the nose and mouth and
conforms to facial contours. Upper strings are
tied at the back of the head; lower strings are
tied behind the back (see Fig. 2).

Figure 1

4. Never lower the mask to hang loosely around

the neck. Never place the mask on top of the
head, and never place the mask in a pocket.
5. Remove mask, touching only the strings upon
leaving the unit, after taking off gown and
washing hands.
6. Drop mask into proper container or discard at
once if disposable.
Ability to answer questions

Date of
Completed YES NO Signature
Compilation

Remarks:
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