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SELF-AUDIT REVIEW FORM - COVID-19 GUIDANCE DOCUMENT
RCDSO
REQUIREMENT YES NO N/A NOTES
Aerosol generating procedures (AGPs)
when the patient has screened negative for
COVID-19
• N95 respirator (t-tested, seal-checked),
or the Health Canada approved equivalent,
OR ASTM level 2 or 3 procedure/surgical
mask
• Gloves
• Eye protection AND/OR face shield
• Protective gown (optional)
Y
N
N/A
Aerosol generating procedures (AGPs) when
the patient has screened positive for COVID-19
• N95 respirator (t-tested, seal-checked), or
the Health Canada approved equivalent
• Gloves
• Eye protection AND face shield
• Protective gown
Y
N
N/A
Cleaning and disinfection of operatory or
other treatment area
• ASTM level 1 procedure mask
• Gloves
• Eye protection
Y
N
N/A
Reprocessing of reusable instruments
• ASTM level 2 or 3 procedure/ surgical mask
• Heavy duty utility-gloves
• Eye protection or face shield
• Protective gown
Y
N
N/A
Ensure staff are trained in and use proper
donning and dofng procedures for PPE.
Y
N
N/A
Fallow Time (Patients who have Screened Negative for COVID-19)
15 to 30 minutes following an aerosol-
generating procedure.
Fallow period begins after completion
of clinical care but before cleaning and
disinfection.
Y
N
N/A
End of Day Sanitation
Clean and disinfect high touch surfaces at least
twice a day (i.e. door knobs, plexiglass barriers,
hand rails, counters, and the arms of chairs).
Y
N
N/A