PPE Assessment-Terex Utilities

• Document No.

• PPE Assessment

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Assessment conducted by:

• Select date

  Date

• Work Area

• Add location
  Address

Head, Face and Eye Hazards

• Select all hazards that apply

  Select Splash Flying Objects Light/Radiation Hazard Vapor Overhead Falling Objects Dust

  • Splash
  • Flying Objects
  • Light/Radiation Hazard
  • Vapor
  • Overhead Falling Objects
  • Dust

• Select PPE for head, face and eye hazards identified

  Select Safety Glasses Goggles(splash) Goggles(chip or welders) Face Shield Laser Goggles Arc Welding Helmet Hard Hat Other

  • Safety Glasses
  • Goggles(splash)
  • Goggles(chip or welders)
  • Face Shield
  • Laser Goggles
  • Arc Welding Helmet
  • Hard Hat
  • Other

• If other PPE was chosen list below

Hand Hazards

• Select all Hazards that apply

  Select Chemical Exposure Thermal(Contact with heat or cold) Cuts/Abrasions Puncture Moving parts(no gloves recommended)

  • Chemical Exposure
  • Thermal(Contact with heat or cold)
  • Cuts/Abrasions
  • Puncture
  • Moving parts(no gloves recommended)

• Select PPE for hands

  Select Chemical Resistant Gloves Guantlets Leather/Kevlar Gloves Other

  • Chemical Resistant Gloves
  • Guantlets
  • Leather/Kevlar Gloves
  • Other

• List types of Gloves to be used for PPE selected above

Body Hazards

• Select all Hazards that apply

  Select Chemical Splash Thermal(contact with heat or cold) Chemical Exposure Hot or Cold Environment

  • Chemical Splash
  • Thermal(contact with heat or cold)
  • Chemical Exposure
  • Hot or Cold Environment

• Select PPE for body

  Select Apron Lab Coat/Coveralls Protective Suit Other

  • Apron
  • Lab Coat/Coveralls
  • Protective Suit
  • Other

• List materials of construction for selected body PPE

Foot Hazards

• Select all Hazards that apply

  Select Chemical Exposure Falling Objects Tripping and Twisting

  • Chemical Exposure
  • Falling Objects
  • Tripping and Twisting

• Select PPE for feet

  Select Chemical Resistant Boots Steel/Composite Toe Boots Other

  • Chemical Resistant Boots
  • Steel/Composite Toe Boots
  • Other

• List other PPE selections for feet if selected

Respiratory Hazards

• Select all Hazards that apply

  Select Dusts Mists Fumes

  • Dusts
  • Mists
  • Fumes

• Select PPE for Respiratory

  Select Respirator

  • Respirator

• List the type of respirator required

Noise Hazards

• Are there noise hazards present

  Yes

  No

• Add signature

  Sign