Personal Protective Equipment Safety Checklist

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

A. Personal Protective Equipment (PPE) Program

• 1. Hazard Assessment complete and documented

  Yes

  No

  N/A

• 2. PPE selection based upon Hazard Assessment

  Yes

  No

  N/A

• 4. Defective or damaged PPE not used

  Yes

  No

  N/A

• 5. Training complete and documented

  Yes

  No

  N/A

B. Eye and Face Protection

• 1. Eye and Face Protection appropriate to the hazard used

  Yes

  No

  N/A

• 2. Side Protectors used where flying objects hazards are found

  Yes

  No

  N/A

• 3. Eye protection incorporates prescription or can be worn without disturbing proper position of prescription lenses

  Yes

  No

  N/A

• 5. Maintained per manufacturers recommendations

  Yes

  No

  N/A

C. Head Protection

• 1. Hard hats used where there is the potential for head injury from falling objects

  Yes

  No

  N/A

• 4. Maintained per manufacturers recommendations

  Yes

  No

  N/A

D. Foot Protection

• 1. Appropriate for protection from falling or rolling objects

  Yes

  No

  N/A

• 2. Appropriate for protection from objects piercing the sole

  Yes

  No

  N/A

• 4. Maintained per manufacturers recommendations

  Yes

  No

  N/A

E. Hand Protection

• 1. Hand protection appropriate to the hazard

  Yes

  No

  N/A

• 2. Maintained per manufacturers recommendations

  Yes

  No

  N/A

F. Other Related Issues

• 1. Appropriate PPE available for hot work (e.g., cutting, welding, brazing)

  Yes

  No

  N/A

• 2. Clothing and shoes worn appropriate for tasks being performed

  Yes

  No

  N/A

• 3. Reflective vests used when working near vehicles

  Yes

  No

  N/A

• 4. Barricades used where appropriate

  Yes

  No

  N/A

• Summary of Findings

• Please sign upon audit completion

  Sign