Personal Protective Equipment Hazard Assessment Form
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1
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3Personal Protective Equipment
Hazard Assessment Form
Location________________________________________________Department____________________________________________
Job Task_______________________________Assessment Conducted By___________________________________Date__________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
Eye and Face
(E= Eliminated Hazard, G= Hazard Already Guarded)
Is there any danger from the following hazards?
Yes
No
E, G
Identify Administrative or PPE Controls Needed
1- Flying Particles
_____
_____
______
Safety Glasses _____ w/ side shields
2- Liquid Chemicals
_____
_____
______
Splash-tight Goggles
3- Losing Grip on Hand Tools
_____
_____
______
Cut/Tear Resistant Gloves (i.e. Mechanix Gloves)
4- Cutting, Drilling, Grinding, Chipping, Hammering
_____
_____
______
Impact Goggles or Face Shield
5- Welding, Soldering
_____
_____
______
Welding Helmet
6- Sanding
_____
_____
______
Dust-tight Goggles
7- Painting
_____
_____
______
Face Shield
8- Computer Work
_____
_____
______
Glare Screen/ Position of Monitor
Other_____________________________________
Head
Is there any danger from the following hazards?
Yes
No
E, G
Identify Administrative or PPE Controls Needed
1- Falling Objects from Above (shelving, lifts, etc)
_____
_____
______
Protective Helmet, Hard Hat
2- Flying Particles
_____
_____
______
Organized Shelving w/ Edge Guard or Chain
3- Moving Objects via Hoist, Forklift (above head)
_____
_____
______
4 Sided Materials Basket, Encapsulated Load on Forklift
4- Working Under Vehicle
_____
_____
______
Lift Safety Controls Engaged At All Times
5- Strike Against Fixed Object
_____
_____
______
Other_____________________________________
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Parent category: Business