Personal Protective Equipment Hazard Assessment Form Page 2
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Hands/Arms
Is there any danger from the following hazards?
Yes
No
E, G
Identify Administrative or PPE Controls Needed
1- Losing Grip on Hand Tools (Cuts/Abrasions)
_____
_____
______
Tool guards, Blade guards, Torque Rods
2- Striking Against Sharp Part (Cuts/Abrasions)
_____
_____
______
Cut/Tear Resistant Gloves (i.e. Mechanix Gloves)
3- Punch Press, Shear, Lathe (Cuts)
_____
_____
______
Equipment Guards and Machine Controls
Cut Resistant Sleeves for Sheet Metal Work
4- Liquid Chemicals
_____
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______
Dust/Splash Tight Goggles
5- Thermal Burns (Hot Surfaces)
_____
_____
______
Heat Resistant Gloves, Wait for Engine Cooling
6- Electrical, Pneumatic, Hydraulic Hazards
_____
_____
______
Lock Out/Tag Out Procedure in Place
7- Computer Work
_____
_____
______
Ergonomic Positioning of Wrist/Arms
8- Caught Between Moving Objects
_____
_____
______
Other________________________________________
Feet/Legs
Is there any danger from the following hazards?
Yes
No
E, G
Identify Administrative or PPE Controls Needed
1- Falling or Rolling Objects on the Floor
_____
_____
______
Secure Equipment
Steel Toed Shoes, Shin Protectors
2- Objects on Floor Obstructing Walking/Working Surface
_____
_____
______
Improve Housekeeping
3- Objects Piercing the Shoe Sole
_____
_____
______
Appropriate Footwear for Job Task
Secure Sharp Parts
4- Wet or Slippery Floor Surfaces
_____
_____
______
Improve Floor Cleaning
Improve Drainage
Enforce Spill Clean-up
5- Carrying Heavy Objects
_____
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______
Steel Toed Shoes, Shin Protectors
6- Chemical/Thermal Burns
_____
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Other________________________________________
Body/Whole
Is there any danger from the following hazards?
Yes
No
E, G
Identify Administrative or PPE Controls Needed
1- Lifting Tires
_____
_____
______
Tire Lift
Tire Moving Device
Adjust Tire Process
2- Handling Transmissions, Engines, Other Heavy Parts
_____
_____
______
Use Mechanical Moving Devices (hoist ,forklift, cart, etc)
3- Struck by Moving Vehicle
_____
_____
______
Directional Traffic Patterns
Back-Up Policy
Reflective Vests
4- Acid Containing Products
_____
_____
______
Acid Protecting Splash Suits
5- Extreme Heat
_____
_____
______
Follow Company Heat Stress Plan
6- Work at Heights
_____
_____
______
Fall Protection
Appropriate Ladders/Scaffolding
8- Computer Work
_____
_____
______
Ergonomic Equipment__________________________
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Parent category: Business