Borden Perlman Loss Control - Personal Protective Equipment Assessment - Eyes

• Audit Title

• Client / Site

• Document No.

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Protection Protective Equipment - Eyes/Face

Department

Department

• Department Name

• Job Title

• Shift Length

• Describe Job Duties

• Photo of Work Area

  Media

Chemical Hazards

• Potential Chemical Hazards

  Select Fumes Mist None Particulate Cloud Splash Spray Vapors

  • Fumes
  • Mist
  • None
  • Particulate Cloud
  • Splash
  • Spray
  • Vapors

• Photo of Potential Hazards

  Media

• Tasks

  Select Acids Battery Acids Bloodborne Pathogens Chrome Cleaning Agents Degreaser None Plating Paint Thinners

  • Acids
  • Battery Acids
  • Bloodborne Pathogens
  • Chrome
  • Cleaning Agents
  • Degreaser
  • None
  • Plating
  • Paint
  • Thinners

• Suggested Type of PPE

  Select Filter Lense Safety Spectacles Heat Reflective Window Face Shield None Required Plastic Window Face Shield Safety Goggles Safety Spectacles Welding Goggles Welding Hood Wire Screen Face Shield

  • Filter Lense Safety Spectacles
  • Heat Reflective Window Face Shield
  • None Required
  • Plastic Window Face Shield
  • Safety Goggles
  • Safety Spectacles
  • Welding Goggles
  • Welding Hood
  • Wire Screen Face Shield

• Does PPE Create an Additional Hazard

  Yes

  No

Dust Hazards Hazards

• Potential Dust Hazards

  Harmful Dust

  None

• Photo of Potential Hazards

  Media

• Tasks

  Select Blowing Brushing Buffing Dusting Grinding Mixing None Potential for Wind Gusts Sanding Sawing Wiping

  • Blowing
  • Brushing
  • Buffing
  • Dusting
  • Grinding
  • Mixing
  • None
  • Potential for Wind Gusts
  • Sanding
  • Sawing
  • Wiping

• Suggested Type of PPE

  Select Filter Lense Safety Spectacles Heat Reflective Window Face Shield None Required Plastic Window Face Shield Safety Goggles Safety Spectacles Welding Goggles Welding Hood Wire Screen Face Shield

  • Filter Lense Safety Spectacles
  • Heat Reflective Window Face Shield
  • None Required
  • Plastic Window Face Shield
  • Safety Goggles
  • Safety Spectacles
  • Welding Goggles
  • Welding Hood
  • Wire Screen Face Shield

• Does PPE Create an Additional Hazard

  Yes

  No

Flying Impact

• Potential Flying Impact Hazards

  Select Chipping Hazard Dirt Dust Fire Proofing Flying Projectiles (Nail gun) Fragraments Insulation Fibers Particles Sand Saw Dust None

  • Chipping Hazard
  • Dirt
  • Dust
  • Fire Proofing
  • Flying Projectiles (Nail gun)
  • Fragraments
  • Insulation Fibers
  • Particles
  • Sand
  • Saw Dust
  • None

• Photo of Potential Hazards

  Media

• Tasks

  Select Blowing Chipping Chiseling Cutting Drilling Grinding Hammering Machining Masonry Work None Power Fastening Riveting Sanding Sawing Wood Working Wiping

  • Blowing
  • Chipping
  • Chiseling
  • Cutting
  • Drilling
  • Grinding
  • Hammering
  • Machining
  • Masonry Work
  • None
  • Power Fastening
  • Riveting
  • Sanding
  • Sawing
  • Wood Working
  • Wiping

• Suggested Type of PPE

  Select Filter Lense Safety Spectacles Heat Reflective Window Face Shield None Required Plastic Window Face Shield Safety Goggles Safety Spectacles Welding Goggles Welding Hood Wire Screen Face Shield

  • Filter Lense Safety Spectacles
  • Heat Reflective Window Face Shield
  • None Required
  • Plastic Window Face Shield
  • Safety Goggles
  • Safety Spectacles
  • Welding Goggles
  • Welding Hood
  • Wire Screen Face Shield

• Does PPE Create an Additional Hazard

  Yes

  No

Heat Hazards

• Potential Heat Hazards

  Select Anything Emitting Extreme Heat None

  • Anything Emitting Extreme Heat
  • None

• Photo of Potential Hazards

  Media

• Tasks

  Select Brazing Casting Cutting Dryer Furnace Operations Hot Dipping None Pouring Soldering Welding

  • Brazing
  • Casting
  • Cutting
  • Dryer
  • Furnace Operations
  • Hot Dipping
  • None
  • Pouring
  • Soldering
  • Welding

• Suggested Type of PPE

  Select Filter Lense Safety Spectacles Heat Reflective Window Face Shield None Required Plastic Window Face Shield Safety Goggles Safety Spectacles Welding Goggles Welding Hood Wire Screen Face Shield

  • Filter Lense Safety Spectacles
  • Heat Reflective Window Face Shield
  • None Required
  • Plastic Window Face Shield
  • Safety Goggles
  • Safety Spectacles
  • Welding Goggles
  • Welding Hood
  • Wire Screen Face Shield

• Does PPE Create an Additional Hazard

  Yes

  No

Optic Radiation Hazard

• Potential Optical Radiation Hazards

  Select Flash Glare Intense Light None Radiant Energy

  • Flash
  • Glare
  • Intense Light
  • None
  • Radiant Energy

• Photo of Potential Hazards

  Media

• Tasks

  Select Brazing Laser Work None Soldering Torch Cutting Welding

  • Brazing
  • Laser Work
  • None
  • Soldering
  • Torch Cutting
  • Welding

• Suggested Type of PPE

  Select Filter Lense Safety Spectacles Heat Reflective Window Face Shield None Required Plastic Window Face Shield Safety Goggles Safety Spectacles Welding Goggles Welding Hood Wire Screen Face Shield

  • Filter Lense Safety Spectacles
  • Heat Reflective Window Face Shield
  • None Required
  • Plastic Window Face Shield
  • Safety Goggles
  • Safety Spectacles
  • Welding Goggles
  • Welding Hood
  • Wire Screen Face Shield

• Does PPE Create an Additional Hazard

  Yes

  No

Determination Of PPE (Personal Protective Equipment) To Use

• Suggested Type of PPE

  Select Filter Lense Safety Spectacles Heat Reflective Window Face Shield None Required Plastic Window Face Shield Safety Goggles Safety Spectacles Welding Goggles Welding Hood Wire Screen Face Shield

  • Filter Lense Safety Spectacles
  • Heat Reflective Window Face Shield
  • None Required
  • Plastic Window Face Shield
  • Safety Goggles
  • Safety Spectacles
  • Welding Goggles
  • Welding Hood
  • Wire Screen Face Shield

Additional Hazards/Concerns or Safe Behaviors

Hazard/Concern or Safe Behavior

• Hazard/Concern or Safe Behavior:

  Safe

  At Risk

  N/A

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• Marsh & McLennan Loss Control Representative's Signature:

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