Max Katz Bag Ppe Hazard Assessment Form Page 3
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3Max Katz Bag Co. Inc.
PPE Hazard Assessment Form
Check the appropriate box for each hazard:
Description of Hazard(s)
Required PPE
Fall Hazard
❏
❏
Other
Fall Hazards:
Check the appropriate box for each hazard:
Description of Hazard(s)
Required PPE
❏
Chemical Exposure
❏
High Heat / Cold
Impact / Compression
❏
❏
Electrical Arc
❏
Cuts / Abrasion
Other
❏
Body Hazards:
Check the appropriate box for each hazard:
Description of Hazard(s)
Required PPE
Chemical Exposure
❏
❏
Particulate Exposure
❏
Other
Respiratory Hazards:
I certify that the above hazard assessment was performed to the best of my knowledge and ability, based on the hazards present
on this date.
Printed Name:___________________________ Signature:_______________________________
Date: _____/_____/_____
_
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