PERSONAL PROTECTIVE EQUIPMENT CERTIFICATE

• Document No.

• PERSONAL PROTECTIVE EQUIPMENT CERTIFICATION

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel attending audit.

• Material from this audit is an interpretation of proper personal equipment required for general warehouse use per OSHA regulations. The checklist was modeled from industry guidelines
  https://www.osha.gov/dte/library/ppe_assessment/ppe_assessment.html

• Answer "SAFE" if employees will not be exposed to conditions listed
  Answer "AT RISK" if employees may be exposed to conditions listed

EYES

• Eye and Protection Criteria
  * Protect against specific hazard(s) encountered by employees
  * Comfortable to wear
  * Must not restrict vision or movement
  * Durable and easy to clean and disinfect
  * Must not interfere with the function of other required PPE
  * Meets requirements of ANSI Z87.1-1989

• Employees Perform tasks, or work near employees that perform tasks, that might produce airborne dust or flying particles

  Safe

  At Risk

  N/A

• Employees handle, or work near employees who handle hazardous liquid chemicals or encounter blood splashes

  Safe

  At Risk

  N/A

• Employees' eyes exposed to other potential physical or chemical irritants

  Safe

  At Risk

  N/A

• Employee exposed to intense light or lasers

  Safe

  At Risk

  N/A

• Special eyewear required?

  yes

  no

• Section notes.

FACE

• Eye and Protection Criteria
  * Protect against specific hazard(s) encountered by employees
  * Comfortable to wear
  * Must not restrict vision or movement
  * Durable and easy to clean and disinfect
  * Must not interfere with the function of other required PPE
  * Meets requirements of ANSI Z87.1-1989

• Employee handles or works near employees who handle hazardous liquid chemicals

  Safe

  At Risk

  N/A

• Employees' faces are exposed to other potential irritants

  Safe

  At Risk

  N/A

• Employees are required to wear:

  safety glases

  goggles

  full face mask

  no eye protection required

• Section notes.

HEAD

• Objects may potentially fall from above and strike your employee on the head

  Safe

  At Risk

  N/A

• Employees are required to wear:

  HARD HAT

  BUMP CAP

  no special head protection

• Section notes.

FEET

• Tools, heavy equipment or other objects may potentially roll, fall onto or strike employees' feet

  Safe

  At Risk

  N/A

• Employees are required to wear:

  Select WORK TYPE SHOES WORK TYPE BOOTS SAFETY TOE SHOES SLIP RESISTANT SHOES INSULATED BOOTS no special foot wear required

  • WORK TYPE SHOES
  • WORK TYPE BOOTS
  • SAFETY TOE SHOES
  • SLIP RESISTANT SHOES
  • INSULATED BOOTS
  • no special foot wear required

• Section notes.

HANDS

• Employees' hands may come into contact with tools or materials that might scrape, bruise or cut

  Safe

  At Risk

  N/A

• Employees handle chemicals that might irritate skin or come into contact with blood

  Safe

  At Risk

  N/A

• employees must wear gloves?

  yes

  no

• Section notes.

BODY

• Hiviz vests or shirts are:

  required

  not required but worn

  not required

• Employees' bodies exposed to irritating dust or chemical splashes

  Safe

  At Risk

  N/A

• Employees' bodies exposed to sharp or rough surfaces

  Safe

  At Risk

  N/A

• Employees' bodies exposed to acids or other hazardous substances

  Safe

  At Risk

  N/A

• Section notes.

HEARING

• Employees are exposed to loud noise from machines, tools, music systems, etc.

  Safe

  At Risk

  N/A

• Are employees required to use hearing protection?

  yes

  no

• Section notes.

FORKLIFT, REACH TRUCK OR ORDER PICKER OPERATOR

• OPERATORS HAVE PROPER POWERED INDUSTRIAL TRUCK TRAINING.

  Yes

  No

  N/A

• Employees trained to be aware and stay clear of all lift trucks.

  Yes

  No

  N/A

• Employees use proper fall restraint and harness when using order picker

  Safe

  At Risk

  N/A

• All trailers [or container wheels are chocked and a support stand placed at front of trailer before entering with fork lift.

  Yes

  No

  N/A

• Operators complete a safety check list for each machine at start of every shift.

  Yes

  No

  N/A

• Section notes.

THIS CERTIFIES THAT THE ABOVE NAMED FACILITY MEETS ALL REQUIRED PERSONAL PROTECTIVE EQUIPMENT USE CRITERIA AS OF THE TIME OF THE AUDIT

• General notes and restrictions if any.

• AUDITOR:

  Sign