PPE Evaluation Form

Nature of work

Identify potential hazards at work (select all that apply)
EYE HAZARDS

Handling/dispensing chemicals and ingredients; working around UV lights; chipping, sanding, grinding, welding, metal working; tasks that generate dust

Select all that apply for each hazard from the drop down list.

Description of Hazard

Required PPE

Does the equipment undergo testing and in a good condition?

Take a photo

Does the equipment fit perfectly?

Take a photo
HEAD/NECK/FACE HAZARDS

Handling/dispensing chemicals and ingredients, chipping, sanding or grinding metal or wood; working below others, working on energized equipment, working in confined spaces

Select all that apply for each hazard from the drop down list.

Description of Hazard

Required PPE

Does the equipment undergo testing and in a good condition?

Take a photo

Does the equipment fit perfectly?

Take a photo
FOOT HAZARDS

Exposure to chemicals; wet environments; welding and cutting; material handling; uneven walking/working surfaces

Select all that apply for each hazard from the drop down list.

Description of Hazard

Required PPE

Does the equipment undergo testing and in a good condition?

Take a photo

Does the equipment fit perfectly?

Take a photo
HAND HAZARDS

Handling/dispensing chemicals and ingredients; exposure to abrasive materials; using knives or other sharp objects; working with hot or cold materials; food service prep

Select all that apply for each hazard from the drop down list.

Description of Hazard

Required PPE

Does the equipment undergo testing and in a good condition?

Take a photo

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]

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Does the equipment fit perfectly?

Take a photo
BODY/TORSO HAZARDS

Handling/dispensing chemicals or ingredients; exposure to abrasive materials; cutting, brazing, welding, chipping or sanding; working around electrical panels

Select all that apply for each hazard from the drop down list.

Description of Hazard

Required PPE

Does the equipment undergo testing and in a good condition?

Take a photo

Does the equipment fit perfectly?

Take a photo
FALL HAZARDS

Working on raised surfaces of 4 feet or morel; ladder use

Select all that apply for each hazard from the drop down list.

Description of Hazard

Required PPE

Does the equipment undergo testing and in a good condition?

Take a photo

Does the equipment fit perfectly?

Take a photo
NOISE HAZARDS

Noise levels above 85 dBA; working around pneumatic equipment; using powered hand tools

Select all that apply for each hazard from the drop down list.

Description of Hazard

Required PPE

Does the equipment undergo testing and in a good condition?

Take a photo

Does the equipment fit perfectly?

Take a photo
RESPIRATORY HAZARDS

Handling/using highly hazardous chemicals; tasks that generate dust and/or fumes; cutting, brazing on certain metals (stainless steel);

Select all that apply for each hazard from the drop down list.

Description of Hazard

Required PPE

Does the equipment undergo testing and in a good condition?

Take a photo

Does the equipment fit perfectly?

Take a photo
RECOMMENDATION

State recommendations here

COMPLETION
Auditor's Full Name and Signature