Bretford - PPE Evaluation

• Department / Area / Machine #

• Document No.

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

(PPE) Personal Protective Equipment

• PPE Pics

  Media

• Describe the type of work activity being performed by the employee.

• Employees wearing safety glasses at all times?

  Safe

  PPE on, but not worn correctly

  At Risk

  Multiple employees at Risk

  N/A

• Employees wearing gloves when exposed to cuts, scrapes, burns or chemical hazards?

  Safe

  PPE on, but not worn correctly

  At Risk

  Multiple employees at Risk

  N/A

• Arm/wrist protectors worn as required?

  Safe

  PPE on, but not worn correctly

  At Risk

  Multiple employees at Risk

  N/A

• Employees wearing hard hat or bump cap as required?

  Safe

  PPE on, but not worn correctly

  At Risk

  Multiple employees at Risk

  N/A

• Employees wearing steel toed shoes or safety shoes as required?

  Safe

  PPE on, but not worn correctly

  At Risk

  Multiple employees at Risk

  N/A

• Employee has long hair tied up, covered or capped as required?

  Safe

  PPE on, but not worn correctly

  At Risk

  Multiple employees at Risk

  N/A

• Employees wearing face shield during grinding, sanding or other operations when required?

  Safe

  PPE on, but not worn correctly

  At Risk

  Multiple employees at Risk

  N/A

• Face shield or splash goggles worn during chemical operations? (Splash Hazard into eyes)

  Safe

  PPE on, but not worn correctly

  At Risk

  Multiple employees at Risk

  N/A

• Hearing Protection worn properly by employees when required?

  Safe

  PPE on, but not worn correctly

  At Risk

  Multiple employees at Risk

  N/A

• Respiratory Hazard - Respirator or dust mask worn when required?

  Safe

  PPE on, but not worn correctly

  At Risk

  Multiple employees at Risk

  N/A

• FR (Flame Resistant) clothing worn where required?

  Safe

  PPE on, but not worn correctly

  At Risk

  Multiple employees at Risk

  N/A

• Condition of PPE? (Clean & sanitary condition)

  Safe

  At Risk

  N/A

• PPE properly stored when not being used?

  Safe

  At Risk

  N/A

Unsafe acts observed?

• Unsafe Acts?

  Not wearing PPE

  Not following Policy/Procedure

  No unsafe acts noticed during this inspections

• Other?

• Other?

Review

• Overall review?

  Great Job! keep up the good work.

  OK, but still needs improvement

  Below Average, or Trending Downward

  Poor, needs immediate attention

• Supervisor or Lead signature

  Sign

• EHS Manager signature

  Sign