Information
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Audit Title
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Client / Site
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Document No.
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Conducted on
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Prepared by
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Location
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Personnel
Protection Protective Equipment - Eyes/Face
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Department
Department
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Department Name
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Job Title
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Shift Length
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Describe Job Duties
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Photo of Work Area
Chemical Hazards
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Potential Chemical Hazards
- Fumes
- Mist
- None
- Particulate Cloud
- Splash
- Spray
- Vapors
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Photo of Potential Hazards
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Tasks
- Acids
- Battery Acids
- Bloodborne Pathogens
- Chrome
- Cleaning Agents
- Degreaser
- None
- Plating
- Paint
- Thinners
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Suggested Type of PPE
- Filter Lense Safety Spectacles
- Heat Reflective Window Face Shield
- None Required
- Plastic Window Face Shield
- Safety Goggles
- Safety Spectacles
- Welding Goggles
- Welding Hood
- Wire Screen Face Shield
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Does PPE Create an Additional Hazard
Dust Hazards Hazards
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Potential Dust Hazards
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Photo of Potential Hazards
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Tasks
- Blowing
- Brushing
- Buffing
- Dusting
- Grinding
- Mixing
- None
- Potential for Wind Gusts
- Sanding
- Sawing
- Wiping
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Suggested Type of PPE
- Filter Lense Safety Spectacles
- Heat Reflective Window Face Shield
- None Required
- Plastic Window Face Shield
- Safety Goggles
- Safety Spectacles
- Welding Goggles
- Welding Hood
- Wire Screen Face Shield
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Does PPE Create an Additional Hazard
Flying Impact
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Potential Flying Impact Hazards
- Chipping Hazard
- Dirt
- Dust
- Fire Proofing
- Flying Projectiles (Nail gun)
- Fragraments
- Insulation Fibers
- Particles
- Sand
- Saw Dust
- None
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Photo of Potential Hazards
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Tasks
- Blowing
- Chipping
- Chiseling
- Cutting
- Drilling
- Grinding
- Hammering
- Machining
- Masonry Work
- None
- Power Fastening
- Riveting
- Sanding
- Sawing
- Wood Working
- Wiping
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Suggested Type of PPE
- Filter Lense Safety Spectacles
- Heat Reflective Window Face Shield
- None Required
- Plastic Window Face Shield
- Safety Goggles
- Safety Spectacles
- Welding Goggles
- Welding Hood
- Wire Screen Face Shield
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Does PPE Create an Additional Hazard
Heat Hazards
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Potential Heat Hazards
- Anything Emitting Extreme Heat
- None
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Photo of Potential Hazards
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Tasks
- Brazing
- Casting
- Cutting
- Dryer
- Furnace Operations
- Hot Dipping
- None
- Pouring
- Soldering
- Welding
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Suggested Type of PPE
- Filter Lense Safety Spectacles
- Heat Reflective Window Face Shield
- None Required
- Plastic Window Face Shield
- Safety Goggles
- Safety Spectacles
- Welding Goggles
- Welding Hood
- Wire Screen Face Shield
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Does PPE Create an Additional Hazard
Optic Radiation Hazard
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Potential Optical Radiation Hazards
- Flash
- Glare
- Intense Light
- None
- Radiant Energy
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Photo of Potential Hazards
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Tasks
- Brazing
- Laser Work
- None
- Soldering
- Torch Cutting
- Welding
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Suggested Type of PPE
- Filter Lense Safety Spectacles
- Heat Reflective Window Face Shield
- None Required
- Plastic Window Face Shield
- Safety Goggles
- Safety Spectacles
- Welding Goggles
- Welding Hood
- Wire Screen Face Shield
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Does PPE Create an Additional Hazard
Determination Of PPE (Personal Protective Equipment) To Use
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Suggested Type of PPE
- Filter Lense Safety Spectacles
- Heat Reflective Window Face Shield
- None Required
- Plastic Window Face Shield
- Safety Goggles
- Safety Spectacles
- Welding Goggles
- Welding Hood
- Wire Screen Face Shield
Additional Hazards/Concerns or Safe Behaviors
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Hazard/Concern or Safe Behavior
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Hazard/Concern or Safe Behavior:
Sign Off
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Marsh & McLennan Loss Control Representative's Signature:
