Safety Feature Evaluation Form

Safety Gloves (Dental)

Date:_________ Department:________________ Occupation:________________

Product Evaluated:________________________ Number of times used:_________

Please circle the most appropriate answer for each question. A rating of One (1) indicates the highest level of agreement with the statement, five (5) the lowest. Not applicable (N/A) may be used if the question does not apply to this product.

agree..........disagree
1. The glove dispenses easily and quickly.	1	2	3	4	5	N/A
2. The gloves are not discolored upon removal from the box.	1	2	3	4	5	N/A
3. The glove does not have visible manufacturing defects (holes, etc.).	1	2	3	4	5	N/A
4. The glove is available for all hand sizes.	1	2	3	4	5	N/A
5. The size of the glove is easily determined after it has been removed from the box (e.g. sizes are color coded.)	1	2	3	4	5	N/A
6. The glove is easy to put on, even if hands are damp.	1	2	3	4	5	N/A
7. The glove retains appropriate sensitivity in the fingers.	1	2	3	4	5	N/A
8. The glove protects the wrist securely.	1	2	3	4	5	N/A
9. The glove is hypoallergenic.	1	2	3	4	5	N/A
10. No excess powder remains after removing the glove.	1	2	3	4	5	N/A
11. The glove is comfortable for extended use.	1	2	3	4	5	N/A
12. The glove is easily removed.	1	2	3	4	5	N/A
13. The glove allows the user to manipulate objects.	1	2	3	4	5	N/A
14. The glove does not tear when it contacts sharp edges of teeth, restorations, or ortho brackets.	1	2	3	4	5	N/A
15. The glove does not become slippery on contact with saliva.	1	2	3	4	5	N/A
16. Over gloves are easily donned removed.	1	2	3	4	5	N/A
17. The glove does not have an unusual taste or odor to which patients object.	1	2	3	4	5	N/A

TDICT Project

Trauma Foundation Bldg. #1, Rm. #300

San Francisco General Hospital

1001 Potrero Ave

San Francisco, CA 94110

info@tdict.org