PPE Inspection Checklist

• Audit Title

• Community

  Select City of Kaukauna Kaukauna Utilities Menasha Utilities Two Rivers City of Sturgeon Bay Sturgeon Bay Utilities New Holstein

  • City of Kaukauna
  • Kaukauna Utilities
  • Menasha Utilities
  • Two Rivers
  • City of Sturgeon Bay
  • Sturgeon Bay Utilities
  • New Holstein

• Department

  Select Cemetary City Hall DPW Finance Dept. Fire Dept. Police Dept. Library Parks Dept. Recreation Dept. Water Dept. Wastewater Dept. Electric Sewer Water Treatment Nature Center

  • Cemetary
  • City Hall
  • DPW
  • Finance Dept.
  • Fire Dept.
  • Police Dept.
  • Library
  • Parks Dept.
  • Recreation Dept.
  • Water Dept.
  • Wastewater Dept.
  • Electric
  • Sewer
  • Water Treatment
  • Nature Center

• Conducted on

  Date

• Prepared by

• Location
  Address

Hand Protection - Gloves

• Are gloves being used by employees where hand hazards exist?

  Yes

  No

  N/A

• Are gloves worn by employees suitable for hand hazards?

  Yes

  No

  N/A

• Are gloves free of damage or defects, and in clean/sanitary condition?

  Yes

  No

  N/A

• Are gloves stored properly when not in use?

  Yes

  No

  N/A

• Are gloves being properly disposed of when damaged or defective?

  Yes

  No

  N/A

Protective Clothing

• Is high visibility safety vest / shirt / jacket being worn?

  Yes

  No

  N/A

• Is protective clothing worn suitable for existing hazards?

  Yes

  No

  N/A

• Is protective clothing free of damage or defects?

  Yes

  No

  N/A

• Does protective clothing fit properly?

  Yes

  No

  N/A

Protective Footwear

• Is protective footwear being used by employees where foot hazards exist?

  Yes

  No

  N/A

• Is protective footwear worn by employees suitable for hazard?

  Yes

  No

  N/A

• Is protective footwear properly fitted?

  Yes

  No

  N/A

• Is protective footwear free of damage or defects?

  Yes

  No

  N/A

Head Protection - Hard Hats

• Are hard hats being worn where head hazards exist?

  Yes

  No

  N/A

• Are hard hats properly fitted and worn properly?

  Yes

  No

  N/A

• Are hard hats free of damage or defects? (i.e. cracks, UV damage, chips, etc.)

  Yes

  No

  N/A

• Are the hard hat suspension systems in good condition?

  Yes

  No

  N/A

Hearing Protection

• Is hearing protection being worn where noise hazards are above 90 dB?

  Yes

  No

  N/A

• Is hearing protection being used protect against present noise hazards?

  Yes

  No

  N/A

• Is hearing protection being worn properly?

  Yes

  No

  N/A

• Is hearing protection free of damage or defects?

  Yes

  No

  N/A

Face/Eye Protection

• Is face/eye protection being worn by employees where face/eye hazards exist?

  Yes

  No

  N/A

• Is face/eye protection suitable for hazards?

  Yes

  No

  N/A

• Is face/eye protection properly fitted and worn?

  Yes

  No

  N/A

• Is face/eye protection free of damage or defects?

  Yes

  No

  N/A

Respiratory Protection - Respirators

• Are respirators being used where respiratory hazards exist?

  Yes

  No

  N/A

• Are respirators being used suitable for hazards present?

  Yes

  No

  N/A

• Are respirators fitted and worn properly?

  Yes

  No

  N/A

• Are respirators being stored properly when not in use?

  Yes

  No

  N/A

Additional Comments

• Additional safety concerns