HEAD Task or Work Area, such as: HAZARD(s): Can hazard be eliminated without the use of building maintenance overhead beams PPE? confined space operations overhead pipes Yes No construction exposed electrical wiring or If no, use: electrical wiring components Protective Helmet walking/working under crane loads falling objects Type E (up to 2,200 volts) utility work machine parts (ex. Entanglement) Type G (up to 20,000 volts) Name task or work area:________________ Name other hazard: _____________ Type C (no electrical protection) Bump cap (not ANSI-approved) Hair net or soft cap Name other PPE: ______________________ No PPE Required HANDS/ARMS Task or Work Area, such as: HAZARD(s): Can hazard be eliminated without the use of animal handling blood or other potentially infectious PPE? material handling material Yes No cooking hazardous chemicals If no, use: sanding tools or materials that could scrape, Gloves grinding bruise, cut or puncture Chemical resistance sawing extreme heat/cold Liquid/leak resistance welding electricity Temperature resistance hammering Name other hazard: _____________ Abrasion/cut resistance working with glass Slip resistance yard work Voltage rated using knives Protective sleeves health care services Long sleeve shirt Name task or work area:________________ Name other PPE: ______________________ No PPE Required FEET/LEGS Task or Work Area, such as: HAZARD(s): Can hazard be eliminated without the use of building maintenance objects that can roll over feet PPE? construction hazardous chemicals Yes No demolition material handling
HEAD Task or Work Area, such as: building maintenance confined space operations construction electrical wiring walking/working under crane loads utility work Name task or work area:________________ HAZARD(s): overhead beams overhead pipes exposed electrical wiring or components falling objects machine parts (ex. Entanglement) Name other hazard: _____________ Can hazard be eliminated without the use of PPE? Yes No If no, use: Protective Helmet Type E (up to 2,200 volts) Type G (up to 20,000 volts) Type C (no electrical protection) Bump cap (not ANSI-approved) Hair net or soft cap Name other PPE: ______________________ No PPE Required HANDS/ARMS Task or Work Area, such as: animal handling material handling cooking sanding grinding sawing welding hammering working with glass yard work using knives health care services Name task or work area:________________ HAZARD(s): blood or other potentially infectious material hazardous chemicals tools or materials that could scrape, bruise, cut or puncture extreme heat/cold electricity Name other hazard: _____________ Can hazard be eliminated without the use of PPE? Yes No If no, use: Gloves Chemical resistance Liquid/leak resistance Temperature resistance Abrasion/cut resistance Slip resistance Voltage rated Protective sleeves Long sleeve shirt Name other PPE: ______________________ No PPE Required FEET/LEGS Task or Work Area, such as: building maintenance construction demolition HAZARD(s): objects that can roll over feet hazardous chemicals material handling Can hazard be eliminated without the use of PPE? Yes No