• Assessment conducted by:

  • Select date

  • Work Area

  • Add location

Head, Face and Eye Hazards

  • Select all hazards that apply

  • Select PPE for head, face and eye hazards identified

  • If other PPE was chosen list below

Hand Hazards

  • Select all Hazards that apply

  • Select PPE for hands

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

Body Hazards

  • Select all Hazards that apply

  • Select PPE for body

  • List materials of construction for selected body PPE

Foot Hazards

  • Select all Hazards that apply

  • Select PPE for feet

  • List other PPE selections for feet if selected

Respiratory Hazards

  • Select all Hazards that apply

  • Select PPE for Respiratory

  • List the type of respirator required

Noise Hazards

  • Are there noise hazards present

  • Add signature

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