Personal Protective Equipment Hazard Assessment Form

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Personal Protective Equipment Hazard Assessment Form
Department/
Location:
Date:
Operation:
Assessment Conducted by:
Eye and Face Hazards
Chemical splashes
Welding operations
Grinding, buffing, polishing
Dusts
Lasers/Optical Radiation
Hot metal
Sanding
Biohazards
Flying particles
Spray painting/mists
Soldering Operations
Eye and Face Protection
Safety glasses or goggles
Yes
No
Splash goggles
Yes
No
Face Shield
Yes
No
Comments:
Foot Hazards
Heavy material handling
Slippery conditions
Construction / demolition
Sharp edges or points
Wet conditions
Exposed electrical wires
Hot metal
Chemical contact
Biohazards
Foot Protection - Safety Shoes With:
Toe protection
Yes
No
Metatarsal protection
Yes
No
Puncture resistant
Yes
No
Electrical insulation
Yes
No
Chemical resistance
Yes
No
Heat resistant spats
Yes
No
Comments:
Page 1 of 2
Personal Protective Equipment Hazard Assessment Form
Department/
Location:
Date:
Operation:
Assessment Conducted by:
Eye and Face Hazards
Chemical splashes
Welding operations
Grinding, buffing, polishing
Dusts
Lasers/Optical Radiation
Hot metal
Sanding
Biohazards
Flying particles
Spray painting/mists
Soldering Operations
Eye and Face Protection
Safety glasses or goggles
Yes
No
Splash goggles
Yes
No
Face Shield
Yes
No
Comments:
Foot Hazards
Heavy material handling
Slippery conditions
Construction / demolition
Sharp edges or points
Wet conditions
Exposed electrical wires
Hot metal
Chemical contact
Biohazards
Foot Protection - Safety Shoes With:
Toe protection
Yes
No
Metatarsal protection
Yes
No
Puncture resistant
Yes
No
Electrical insulation
Yes
No
Chemical resistance
Yes
No
Heat resistant spats
Yes
No
Comments:
Page 1 of 2
Overhead Hazards
Suspended loads
Energized wires/equipment
Sharp objects at head level
Overhead beams or loads
Elevated sites
Bump against
Head Protection
Bump Cap
Yes
No
Hard hat; type: ___________
Yes
No
Comments:
Hand Hazards
Caustic chemicals
Temperature extremes
Hand tools: pressure points
Chemical solvents
Biological agents
Hand tools: vibration
Sharp edges, splinters, burrs
Electrical hazards
Welding / torch operations
Hand Protection - Gloves
Glove description
Abrasion resistant
Yes
No
Chemical resistant
Yes
No
Temperature resistant
Yes
No
Pressure point / vibration protection
Yes
No
Electrical insulation
Yes
No
Biological resistant
Yes
No
Comments:
Legs, Upper Body and Arm Hazards
Caustic chemicals
Temperature extremes
Hand tools: pressure points
Chemical solvents
Biological agents
Hand tools: vibration
Sharp edges, splinters, burrs
Electrical hazards
Welding / torch operations
Foot Protection - Safety Shoes With:
Description
Abrasion resistant
Yes
No
Chemical resistant
Yes
No
Temperature resistant
Yes
No
Pressure point / vibration protection
Yes
No
Electrical insulation
Yes
No
Biological resistant
Yes
No
Comments:
Page 2 of 2

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