Personal Protective Equipment Hazard Assessment Form Page 3
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1
2
3Respiratory
Is there any danger from the following hazards?
Yes
No
E, G
Identify Administrative or PPE Controls Needed
1- Painting with Solvent Based Paints containing Isocyanates _____
_____
______
Supplied Air w/ Full Hood
PAPR w/ Full Hood
2- Sanding
_____
_____
______
Dust Mask
3- Cleaning with Harmful Chemicals
_____
_____
______
Follow MSDS for Respiratory Controls
4- Vehicle Body Repairs with Fiberglass-Based Products
_____
_____
______
Follow MSDS for Respiratory Controls
5- Groundsckeeping using pesticides
_____
_____
______
Follow MSDS for Respiratory Controls
6- Brake Dust from Asbestos Containing Brake Pads
_____
_____
______
Negative Pressure HEPA Self Enclosed Vacuum System
Wet Down Method
Miscellaneous
Is there any danger from the following hazards?
Yes
No
E, G
Identify Administrative or PPE Controls Needed
1- Loud Noise (generator, fans, sanding, tool use)
_____
_____
______
Ear Plugs
Ear Muffs
Noise Encapsulation
1- Contact with Bodily Fluids
_____
_____
______
Cut Resistant Gloves when Reaching under Seats
Latex Gloves if involved in Emergency Response
2- Groundskeeping/Snow Removal
_____
_____
______
Guards on all equipment
Staff Trained in Equipment
Usage
4- Other____________________________________
_____
_____
______
Other________________________________________
Corrective Actions
If any hazards noted above could be eliminated, please note the action taken below.
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