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Workplace Hazard Assessment & Personal Protective Equipment (Ppe) Certification - Maine Safety And Environmental Management Department

Department:

The University of Maine Safety and Environmental Management Department

Page 1 of 2

Document:

Workplace Hazard Assessment & PPE Certification

MF08011, 07/20/03, Rev 3

Workplace Hazard Assessment &

Personal Protective Equipment (PPE) Certification

Date of Assessment:

Department:

Location:

This Hazard Assessment has been completed by:

Signature:

(print name and title)

Job Task(s)

Potential Hazard

PPE Required

Describe the task that the worker will be

Indicate the potential hazards associated with that

List the PPE required to protect the employee

performing. For instance; bench grinding,

task

while performing the task.

charging batteries; handling liquid chemicals, etc.

Note: If hearing protection or respiratory

Note: Similar job tasks may be grouped together

protection is necessary, additional guidance,

on one form.

training, and fit testing will be required.

Required training for all PPE users:

Personal Protective Equipment (PPE) training is to be performed upon initial job assignment, or when deemed necessary by the workers

supervisor. When training employees on proper maintenance, use, and disposal of PPE please cover the following topics:

___ What PPE is necessary

___ When PPE shall be used.

___ How to put on, take off, adjust, and otherwise wear PPE (per manufacturer recommendations).

___ Limitations and useful life of the PPE (per manufacturer recommendations).

___ Proper care, maintenance, replacement, and disposal of PPE (per manufacturer recommendations).

___ Other, please specify:_______________________________

Supervisors providing the required training for use and care of PPE must create a certification of training that contains the trained

individual’s name, ID#, and the date on which the training was performed. Training certifications are to be maintained by the department

having jurisdiction over the trained individual(s). If you need help establishing a training program, please contact SEM at 581-4055.

Workplace Hazard Assessment & Personal Protective Equipment (Ppe) Certification - Maine Safety And Environmental Management Department