Hazard Assessment

• Site conducted

  Select

• Person Responsible for area

• Conducted on

  Date

• Job or Equipment

  Date

• Prepared by

• Location
  Address

Eye and Face

• Flying particles

  Select Yes No

  • Yes
  • No

• Type of Protection

  Select Guarded PPE required

  • Guarded
  • PPE required

• Type of PPE

  Select Safety Glasses Faceshield Chemical Googles

  • Safety Glasses
  • Faceshield
  • Chemical Googles

• Molten Metal Flying particles Type of PPE

  Select Yes No

  • Yes
  • No

• Type of protection

  Select Guarded PPE required

  • Guarded
  • PPE required

• Type of PPE

  Select Safety Glasses Faceshield Chemical Googles

  • Safety Glasses
  • Faceshield
  • Chemical Googles

• Liquid Chemicals

  Select Yes No

  • Yes
  • No

• Type of PPE

  Safety Glasses

  Faceshield

  Chemical Googles

• Acids

  Select Yes No

  • Yes
  • No

• Type of Protection

  Guarded

  PPE required

• Type of PPE

  Safety Glasses

  Faceshield

  Chemical Googles

• Caustics

  Select Yes No

  • Yes
  • No

• Type of Protection

  Guarded

  PPE required

• Type of PPE

  Safety Glasses

  Faceshield

  Chemical Googles

• Chemical Gases or Vapors

  Select Yes No

  • Yes
  • No

• Type of Protection

  Guarded

  PPE required

• PPE

  Safety Glasses

  Chemical Googles

  Face Sheild

  Fullface facepeice (APR,SCBA)

• Light Radiation ( welding /lasers)

  Select Yes No

  • Yes
  • No

• Type of Protection

  Guarded

  PPE required

• PPE

  Safety Glasses

  Faceshield

  Chemical Googles

• Other

  Yes

  No

Body

• Flying particles

  Yes

  No

• Yes

  No