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

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