Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • **INSTRUCTIONS**
    Review the following audit to identify and evaluate need for Personal Protective Equipment in a given workplace.
    Answer "SAFE" if employee is not likely to be exposed to work condition listed below.
    Answer "AT RISK" if employee may be exposed to work condition

EYES

  • Eye and Protection Criteria
    * Protect against specific hazard(s) encountered by employees
    * Comfortable to wear
    * Must not restrict vision or movement
    * Durable and easy to clean and disinfect
    * Must not interfere with the function of other required PPE
    * Meets requirements of ANSI Z87.1-1989 for devices purchased after July 5, 1992 and ANSI Z87.1-1968for devices purchased before that date

  • Employees Perform tasks, or work near employees that perform tasks, that might produce airborne dust or flying particles

  • Employees handle, or work near employees who handle hazardous liquid chemicals or encounter blood splashes

  • Employees' eyes exposed to other potential physical or chemical irritants

  • Employee exposed to intense light or lasers

FACE

  • Eye and Protection Criteria
    * Protect against specific hazard(s) encountered by employees
    * Comfortable to wear
    * Must not restrict vision or movement
    * Durable and easy to clean and disinfect
    * Must not interfere with the function of other required PPE
    * Meets requirements of ANSI Z87.1-1989 for devices purchased after July 5, 1992 and ANSI Z87.1-1968for devices purchased before that date

  • Employee handles or works near employees who handle hazardous liquid chemicals

  • Employees' faces are exposed to extreme heat

  • Employees' faces are exposed to other potential irritants

HEAD

  • Tools or other objects may potentially fall from above and strike your employee on the head

  • Employees' heads, when they stand or bend, are near exposed beams, machine parts, pipes, etc.?

  • Employees work with or are in close proximity to electrical wiring or components of electrical wiring

FEET

  • Tools, heavy equipment or other objects may potentially roll, fall onto or strike employees' feet

  • Employees work with or are near exposed electrical wiring or electrical wiring components

  • Employees handle or work with those who handle molten metal

  • Employees work with explosives or are in an explosive atmosphere

HANDS

  • Employees' hands may come into contact with tools or materials that might scrape, bruise or cut

  • Employees handle chemicals that might irritate skin or come into contact with blood

  • Employees place their hands and arms near extreme heat

  • Employees' hands and arms are placed ear exposed electrical wiring or components

BODY

  • Employees' bodies exposed to irritating dust or chemical splashes

  • Employees' bodies exposed to sharp or rough surfaces

  • Employees' bodies exposed to extreme heat

  • Employees' bodies exposed to acids or other hazardous substances

HEARING

  • Employees are exposed to loud noise from machines, tools, music systems, etc.

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.