Personal Protective Equipment Assessment Template Page 2
Download a blank fillable Personal Protective Equipment Assessment Template in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Personal Protective Equipment Assessment Template with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3
4IMPACT
1.
Are there sources of motion which expose employees to impact hazards such as chipping, grinding,
masonry work, woodworking, sawing, drilling, chiseling, power fastening, riveting, sanding, etc. in this
work area? ___Yes___No
2.
Do employees work around/under conveyor belts that carry equipment or machinery? ___Yes___ No
3.
Is there a possibility of an employee being struck by a falling object? ___ Yes___ No
4.
What personal protective equipment is recommended?
___ Gloves ___ Foot Protection ___ Hard Hat
___ Safety Glasses with side shields
___ Goggles ___ Face Shield ___ Other(s) ____________________________________
P E N ET R A TIO N
1.
Are employees exposed to any sources of penetration such as needles, pipettes, syringes,
sharp objects, etc.? ___Yes___ No
2.
Do employees perform any activities where there is a chance of the hands getting cut?
___ Yes___ No
3.
Are there any scrap metals, nails, wires, screws, tacks, or large staples being used by an employee?
___Yes___ No
4.
Is there any area where an employee walks where sharp objects may pierce the feet?
___ Yes___ No
5.
What personal protective equipment is recommended?
___ Gloves ___ Safety glasses ___ Goggles ___ Foot Protection
___ Face Shield ___ Other(s) _____________________________________
H E A T
1.
Are there any sources of high temperature in the work area such as boilers, furnace operations, glass
making, cutting, welding, or casting? ___Yes___ No
2.
Are there any sources of extreme cold temperatures in the work area such as cryogenic gases, dry ice,
etc.? ___ Yes___ No
3.
What personal protective equipment is recommended?
___ Gloves ___ Face Shields ___ Safety Glasses ___ Goggles
___ Other(s) ______________________________________
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business