Title Page

  • Site

  • Conducted on

  • Prepared by

  • Location

Personal Protective Equipment

  • P100 respirator <br>- Check latex straps for deterioration

  • Disposable coveralls<br> - Correct type for hazard, no holes, zipper functions

  • Inner gloves (rubber or vinyl) <br>- Correct type for hazard, no tears or deterioration

  • Outer gloves (rubber) <br>- Correct type for hazard, no tears or deterioration

  • Outer gloves (leather) <br> -Clean, no rips

  • Knee boots (rubber) <br>- Cleaned after last use, no deterioration or rips

  • Biohazard waste bag<br> - Clean, no rips

  • Antiseptic wipes <br> -Open one, check for moisture, replace wipe

  • Adhesive bandages<br> - Use once and dispose of

  • Safety glasses <br>-Clean, lenses undamaged, temple and hinges intact

  • Goggles, direct or indirect vent <br>- Check latex straps for deterioration, lenses intact and clear

  • Insect repellent (skin) <br>- DEET stored in overpack, container not leaking

  • Clothing: rain gear<br> - Clean, retreat water repellent coating annually

  • Clothing: work gloves<br> - Allows manual dexterity, fingertips intact, clean

  • Clothing: poly-cotton coveralls<br> -Clean, no rips, fits loose, zippers or buttons functional

  • Boots<br> - Broken in, covers above the ankle, clean, good repair

  • Flashlight <br>- UL Class 1 Div. 1 or 2; extra batteries and bulb; batteries stored outside of flashlight

  • Hard hat <br>- Shell intact, suspension intact, sized correctly

  • Ear plugs<br> -Clean, pair intact, extra pair(s)

  • Water bottles/bladders (2–4 quarts) <br> -Clean, no leaks; chlorine dioxide

  • Sanitizing hand wipes, 100/box <br>- Check wipes for dryness and adequate moisture; replace if needed or low in quantity .

  • Nitrile exam gloves, 100/box<br> - Check gloves for dryness, cracking, and adequate tear resistance; dispose of used gloves.

  • Nitrile gloves 11 mil, 13ʺ, pair <br>- Check gloves for dryness, cracking, and adequate tear resistance; dispose of torn gloves; clean gloves in 1:10 bleach solution 10 minutes and rinse.

  • Biohazard waste bags<br> - Dispose of used personal protective equipment (PPE) in bags; replace bags.

  • Disposable coverall<br> - Check for rips and tears, especially in armpits and crotch; check zipper function; replace used coveralls.

  • P100 respirator <br>- Check plastic headband attachment on side of respirator. These occasionally become unglued; reattach with Superglue. Check respirator elastic headband for cracked rubber components. Replace used or damaged respirators.

  • Poly/cotton twill coverall, navy blue <br>- Wash on sanitary or permanent press cycle with normal detergent, dry on low heat. Check zipper function; replace torn or damaged coveralls. If soiled with bloodborne pathogens (BBP),replace them.

  • Work gloves <br>- Check palms and fingertips for wear through leather or fabric. Replace damaged or contaminated gloves.

  • Clear or shaded safety glasses<br> - Check safety glasses sidepieces for proper function. -- Check lenses for excessive scratches. Replace damaged or worn glasses. Clean with isopropyl<br>alcohol, 10-minute soak in soapy water, or 1:10 bleach solution. Rinse and dry.

  • Safety goggles, indirect vent <br>- Check elastic headband for aged rubber bands, clean in soapy water, isopropyl alcohol, or 1:10 bleach solution. Rinse and dry.

  • Canteen, 1 quart, bisphenol A (BPA)-free <br>- Wash in dishwasher or soak 10 minutes in soapy dishwater followed by rinse and dry.

  • Headlamp, intrinsically safe<br> - Check switch function; approximately 1 percent of these lights are experiencing switch failure. Wipe with alcohol pad. Replace batteries.Check elastic headband for aged rubber components and proper function. Replace if necessary.

  • AAA alkaline batteries, 4 pack <br>- Replace used batteries.

  • Insect repellent/sunscreen wipes <br>- Replace dry or used wipes.

  • Trash bag <br>- Replace used trash bags.

  • Wood pencil <br>- Replace short pencils.

  • Pencil sharpener<br> - Wash in soapy water, rinse, and dry.

  • Duct tape, small roll <br>- Replace rolls when low on tape.

  • Water-resistant notebook <br>- Replace memo pads when low on paper.

  • Ear plugs, foam, pair<br> - Replace used ear plugs.

  • Adhesive strip bandage, 1ʺ x 3ʺ, 25/pack<br> - Replace dirty bandages or replace box when low in quantity.

  • Disposable poncho<br> - Replace when used. These are disposable to protect your personal clothing. They are not meant to be multiuse garments.

  • Rubber boots (steel toe and puncture-resistant) <br>- Check soles for delamination, tears, or damage.

  • Wash boots in soapy water or 1:10 bleach solution (10-minute soak).<br> - Rinse and dry.

  • Safety helmet with ratchet headband <br>- Check ratchet assembly for function. Wash in soapy water or 1:10 bleach solution (10-minute soak). Rinse and dry.

Sign Off

  • Prepared by

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.