Protective Eyewear Feature Evaluation Form

  • Download the Protective Eyewear Feature Evaluation Form as a PDF
  • Date Format: MM slash DD slash YYYY
  • This evaluation form should be completed by frontline non-managerial employees who are responsible for direct patient care, cleaning/disinfecting/sterilizing surfaces or devices, and laboratory personnel or anyone at risk of experiencing a splash of blood or body fluid. The completion of this evaluation and review is designed to assist employers with the requirements set forth in the OSHA Bloodborne Pathogens Standard (29 CFR 1910.1030(c)(1)(v)).

  • Please select the most appropriate answer for each question. Not applicable (N/A) may be used if the question does not apply to this particular product.
  • For the General Consideration of Protective Eyewear:
  • Strongly agreeAgreeNeutralDisagreeStrongly disagreeNA
    1. The product does not fog up when in use.
    2. The eyewear is comfortable enough to wear for extended periods of time.
    3. The product can be stored in a location that is readily accessible at the point of care/use (e.g., wall mount, caddy, etc.)
    4. The eyewear can be dispensed easily from its stored location.
    5. The eyewear does not distort vision or visibility.
    6. The eyewear is available in prescription offerings or can be used while wearing prescription glasses.
    7. The product is available in several sizes, fits, and styles.
    8. The product works well with a variety of head sizes and shapes.
    9. The product does not slide/slip on the nose or face when looking down, up, or side to side.
    10. The product has adequate physical coverage, including side, above, and below the eye.
    11. The product is suitable for a variety of types of procedures, patients, and exposure types.
  • Strongly agreeAgreeNeutralDisagreeStrongly disagreeNA
    12. If disposable, the product can easily be placed in the trash or if contaminated, in a red bag.
    13. If reusable, the product can be safely and adequately cleaned and disinfected without compromising its integrity (e.g., fit, vision, visibility).
    14. Product manufacturers have provided clear instructions for use, storage, disposal and/or reprocessing.
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