Hand Protection Assessment

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Initial Assessment Walk Through (Departments)

• Department

Department #

• What Department are you working in?

• What are the primary responsibilities for your particular job?

• Primary activities for department (image)

  Media

• What hand protection hazards exist within workplace department?

  Select (C) Cut (P) Puncture (T) Tear (A) Abrasion

  • (C) Cut
  • (P) Puncture
  • (T) Tear
  • (A) Abrasion

• What types of gloves are you currently using?

• Images of current gloves

  Media

• What feedback did this employee or department provide?

• Enter glove information

Glove #

• How long do the current hand protection products last? (Which glove)

  Select 1 day 2 days 3 days 4 days 5 days 6 days 7 days Month - Longer

  • 1 day
  • 2 days
  • 3 days
  • 4 days
  • 5 days
  • 6 days
  • 7 days
  • Month - Longer

• Image of current glove

  Media