PPE Evaluation Form
Nature of work
- Eye
- Head/Neck/Face
- Foot
- Hand
- Body/Torso
- Fall
- Noise
- Respiratory
Handling/dispensing chemicals and ingredients; working around UV lights; chipping, sanding, grinding, welding, metal working; tasks that generate dust
- Chemical Exposure
- Cut/Abrasions
- Dust/Flying Debris
- Dust Particulates
- Electrical Arc
- Electrical Shock
- Fall Hazard
- High Heat/COld
- Impact
- Impact/Compression
- UV/IR Radiation
- Noise Hazard
- Puncture
- Slippery/Wet Surfaces
- Other
Description of Hazard
Required PPE
Does the equipment undergo testing and in a good condition?
Does the equipment fit perfectly?
Handling/dispensing chemicals and ingredients, chipping, sanding or grinding metal or wood; working below others, working on energized equipment, working in confined spaces
- Chemical Exposure
- Cut/Abrasions
- Dust/Flying Debris
- Dust Particulates
- Electrical Arc
- Electrical Shock
- Fall Hazard
- High Heat/COld
- Impact
- Impact/Compression
- UV/IR Radiation
- Noise Hazard
- Puncture
- Slippery/Wet Surfaces
- Other
Description of Hazard
Required PPE
Does the equipment undergo testing and in a good condition?
Does the equipment fit perfectly?
Exposure to chemicals; wet environments; welding and cutting; material handling; uneven walking/working surfaces
- Chemical Exposure
- Cut/Abrasions
- Dust/Flying Debris
- Dust Particulates
- Electrical Arc
- Electrical Shock
- Fall Hazard
- High Heat/COld
- Impact
- Impact/Compression
- UV/IR Radiation
- Noise Hazard
- Puncture
- Slippery/Wet Surfaces
- Other
Description of Hazard
Required PPE
Does the equipment undergo testing and in a good condition?
Does the equipment fit perfectly?
Handling/dispensing chemicals and ingredients; exposure to abrasive materials; using knives or other sharp objects; working with hot or cold materials; food service prep
- Chemical Exposure
- Cut/Abrasions
- Dust/Flying Debris
- Dust Particulates
- Electrical Arc
- Electrical Shock
- Fall Hazard
- High Heat/COld
- Impact
- Impact/Compression
- UV/IR Radiation
- Noise Hazard
- Puncture
- Slippery/Wet Surfaces
- Other
Description of Hazard
Required PPE
Does the equipment undergo testing and in a good condition?
REFERENCE: Gloves are resistant to chemicals
[This is an example of how you can use iAuditor to include best practice reference images in your templates to assist with inspections]
Does the equipment fit perfectly?
Handling/dispensing chemicals or ingredients; exposure to abrasive materials; cutting, brazing, welding, chipping or sanding; working around electrical panels
- Chemical Exposure
- Cut/Abrasions
- Dust/Flying Debris
- Dust Particulates
- Electrical Arc
- Electrical Shock
- Fall Hazard
- High Heat/COld
- Impact
- Impact/Compression
- UV/IR Radiation
- Noise Hazard
- Puncture
- Slippery/Wet Surfaces
- Other
Description of Hazard
Required PPE
Does the equipment undergo testing and in a good condition?
Does the equipment fit perfectly?
Working on raised surfaces of 4 feet or morel; ladder use
- Chemical Exposure
- Cut/Abrasions
- Dust/Flying Debris
- Dust Particulates
- Electrical Arc
- Electrical Shock
- Fall Hazard
- High Heat/COld
- Impact
- Impact/Compression
- UV/IR Radiation
- Noise Hazard
- Puncture
- Slippery/Wet Surfaces
- Other
Description of Hazard
Required PPE
Does the equipment undergo testing and in a good condition?
Does the equipment fit perfectly?
Noise levels above 85 dBA; working around pneumatic equipment; using powered hand tools
- Chemical Exposure
- Cut/Abrasions
- Dust/Flying Debris
- Dust Particulates
- Electrical Arc
- Electrical Shock
- Fall Hazard
- High Heat/COld
- Impact
- Impact/Compression
- UV/IR Radiation
- Noise Hazard
- Puncture
- Slippery/Wet Surfaces
- Other
Description of Hazard
Required PPE
Does the equipment undergo testing and in a good condition?
Does the equipment fit perfectly?
Handling/using highly hazardous chemicals; tasks that generate dust and/or fumes; cutting, brazing on certain metals (stainless steel);
- Chemical Exposure
- Cut/Abrasions
- Dust/Flying Debris
- Dust Particulates
- Electrical Arc
- Electrical Shock
- Fall Hazard
- High Heat/COld
- Impact
- Impact/Compression
- UV/IR Radiation
- Noise Hazard
- Puncture
- Slippery/Wet Surfaces
- Other
Description of Hazard
Required PPE
Does the equipment undergo testing and in a good condition?
Does the equipment fit perfectly?
State recommendations here