PPE Hazard Assessment Survey

• Document No.

• Audit Title

• Customer Name / Site

• OH&S Site Contact / Phone / Email

• Conducted on

  Date

• Prepared by Protector Alsafe Account Manager

• Location
  Address

• Customer Site Key Contact

• The purpose of the survey is to identify sources of hazards to workers and co-workers. Observe the following: layout of the workplace, location of the workers, work operations, hazards and places where PPE is currently used including the device and reason for use.
  Consideration should be given to the following basic hazard categories:
  1. Impact (falling/flying objects)
  2. Penetration (sharp objects piercing foot/hand)
  3. Compression (roll-over or pinching objects)
  4. Chemical exposure (inhalation, ingestion, skin contact, eye contact or injection)
  5. Heat
  6. Dust
  7. Light (optical) radiation (welding, brazing, cutting, furnaces, etc.)
  8. Respiratory System
  9. Extreme Cold
  10. Noise
  11. Water (potential for drowning or fungal infections caused by wetness)
  12. Vibration
  13. Electrical
  

DEPARTMENT / WORK PROCESS DESCRIPTION

• Work Area or Department

• Work Process

HAZARD ASSESSMENT

• EYE & FACE PROTECTION

  Off

  On

• Airborne Dust

  Yes

  No

  N/A

• UV/IR Light from Welding Sources

  Yes

  No

  N/A

• Flying Particles/Objects

  Yes

  No

  N/A

• Blood Splashes

  Yes

  No

  N/A

• Hazardous Liquid Chemicals Mists

  Yes

  No

  N/A

• Chemical Splashes

  Yes

  No

  N/A

• Molten Metal Splashes

  Yes

  No

  N/A

• Glare/High Intensity Lights

  Yes

  No

  N/A

• Laser Operations

  Yes

  No

  N/A

• Outdoor Sunlight

  Yes

  No

  N/A

• Hot Sparks

  Yes

  No

  N/A

• Fogging

  Yes

  No

  N/A

• HEAD PROTECTION

  Off

  On

• Beams and or Pipes

  Yes

  No

  N/A

• Exposed Electrical Wiring or Components

  Yes

  No

  N/A

• Falling Objects

  Yes

  No

  N/A

• Fixed Object

  Yes

  No

  N/A

• Machine Parts

  Yes

  No

  N/A

• HAND / ARMS PROTECTION

  Off

  On

• Blood

  Yes

  No

  N/A

• Irritating Chemicals

  Yes

  No

  N/A

• Tools or Materials that could Scrape, Bruise, or Cut

  Yes

  No

  N/A

• Level of Risk: Low = 0, Medium = 3, High = 5

• Extreme Heat

  Yes

  No

  N/A

• Extreme Cold

  Yes

  No

  N/A

• Electric Shock

  Yes

  No

  N/A

• Vibration

  Yes

  No

  N/A

• Back of Hand Impact

  Yes

  No

  N/A

• Non-Irritating Chemicals

  Yes

  No

  N/A

• HEARING / NOISE

  Off

  On

• Loud Noises

  Yes

  No

  N/A

• Noise Level dB

• Loud Work Environment

  Yes

  No

  N/A

• Noise Level dB

• Noisy Machines/Tools

  Yes

  No

  N/A

• Noise Level