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