PPE Hazard Assessment

• Prepared by

• Client / Site

• Location
  Address

• Personnel

• Conducted on

  Date

• Area evaluated

Eye Hazards: Any task that can cause injury training the eye including: working with chemicals or acids, UV lights, sanding or grinding, welding; and metal and wood working Check appropriate boxes for each hazards

• Chemical Exposure

• Dust/ Flying Debris

• Impact

• High Heat/ cold

• UV/IR Radiation

• Other.

• Description of Hazard(s)

Required PPE: chose appropriate PPE for task

• Safety Glasses

• Directionally Vented Googles

• Indirectly vented googles

• Face shield

• Welding helmet/ googles/ hood/ hand screens

• Other:

Head/Neck/Face Hazards: Tasks that can cause head/ neck/ face injury include: working elbow other workers who are using tools or materials that could fall and working in trenches or confined spaces

• Chemical Exposure

• Dust/ Flying Debris

• Impact

• UV/IR Radiation

• Electrical Shock

• Other

• Description of Hazard(s)

Required PPE: chose appropriate PPE for task

• Hard Hat

• Bump cap

• Face shield

• Welding helmet/ googles/ hood/ hand screens

• Other:

Foot Hazards: tasks that can cause foot injury: exposure to Chemicals or acids, welding or cutting , materials handling, renovation or construction, electrical work Check appropriate boxes for each Hazard

• Chemical Exposure

• High heat/cold

• Impact/compression

• Electrical

• Slippery/ wet surfaces

• Puncture

• Other:

• Description of Hazard(s)

Required PPE:

• Leather Work Boots

• Steel Toe Boot

• Composite Toe Boots

• Other:

Hand Hazards: Hand injury can be caused by: working with chemicals or acids, exposure to cut or abrasion Hazard ( for example, during demolition, renovation,woodworking), work with hot or cold objects or materials, exposure to sharps

• Check the appropriate box for each Hazard:

• Chemical Exposure

• High Heat/Cold

• UV/IR Radiation

• Electrical Shock

• Puncture

• Cuts/Abrasion

• Description of Hazard(s)

Required PPE: chose appropriate protection for the task

• Leather gloves

• Latex gloves

• Cotton gloves

• Other:

• Other:

Body Hazards: injury of the body (torso,arms,legs) can occur during: Exposure to Chemicals, acids,or other hazardous materials; abrasive blasting, welding,cutting,or brazing; chipping,sanding, or grinding: use of powered cutting tools, and work around electrical arcs.

• Check appropriate boxes for each Hazard

• Chemical Exposure

• High Heat/Cold

• Impact/ Compression

• Electrical Arc

• Cuts/Abrasions

• Other

• Description of Hazard(s)

Required PPE: select the appropriate boxes for the described hazard

• Long sleeve shirt

• Short sleeve shirt

• Long pants

• Chemical Overalls

• Welders coat

• Long gloves

• Arc flash PPE

• Other:

Fall Hazards: Personnel may be exposed to fall Hazards when performing work on surfaces with an unprotected side or edge this is 4 feet or more above a lower level, 10 feet or more on scaffolds. Fall protection may also be required when using vehicle man lifts,elevated platforms, roofs, or fixed ladders.

• Check the appropriate boxes for each Hazard

• Fall Hazard

• Description of Hazard(s)

Required PPE: choose appropriate protection for the described task

• Body Harness

• Life line

• Rope grab

• SRL

• Boatswains Chair

• LSS

• LFAS

• Lanyard

• Other:

Nose Hazards: personnel may be exposed to noise Hazards when working in mechanical rooms; machine;grinding; sanding; cage washing, working around pneumatic equipment, grounds equipment, generators, motors, saws,jackhammers,or similar equipment.

• Check the appropriate boxes for each Hazard

• Noise Hazard

• Description of Hazard(s)

• Winch

• Lanyard

Required PPE: choose the appropriate protection for the described task

• Earplugs

• Earmuffs

• Dual protection

• Other:

Respiratory Hazards: personnel may be exposed to respiratory hazards that require the use of respirators; during emergency response, when working with hazardous powders, when applying chemicals or paints in confined spaces, when welding, cutting or brazing on certain metals or materials, and when disturbing other particulate hazards

• Check appropriate boxes for each Hazard

• Chemical Exposure

• Particulate Exposure

• Other:

• Description of Hazard(s)

Required PPE for the described task

• Dust mask

• Full face respirator

• Half face respirator

• Other:

• I certify that the above Hazard Assessment was performed to the best of my knowledge and ability, based on the hazards present on this date:

• Select date

  Date

• Add signature

  Sign