PPE Hazard Assessment Worksheet Assessment conducted by (Print and Sign): Task or Work Area: Date: Work Unit and Department: Campus location: Job title of personnel conducting work: Use a separate sheet for each task or work area EYES Task or Work Area, such as: HAZARD(s): Can hazard be eliminated without the use of abrasive blasting airborne dust PPE? sanding flying particles Yes No chopping blood or other potentially infectious If no, use: sawing material splashes Safety glasses cutting hazardous chemicals Safety goggles grinding intense light (ex. Lasers, welding) Laser safety glasses drilling cryogenic liquids Welding shield/helmet (shade #_______) see hammering pesticide use appendix F welding Name other hazard: Name other PPE: lab work __________________________ _________________________________ press operations No PPE Required yard work machining laser use Name task or work area:________________ FACE Task or Work Area, such as: HAZARD(s): Can hazard be eliminated without the use of cleaning hazardous chemicals PPE? lab work extreme heat/cold Yes No welding potential irritants If no, use: furnace operations flying particles Face shield mixing Name other hazard: Welding shield/helmet (shade #_______) see yard work _________________________ appendix F painting Name other PPE: ______________________ pouring molten metal No PPE Required dip tank operations Name task or work area:________________
PPE Hazard Assessment Worksheet Assessment conducted by (Print and Sign): Task or Work Area: Date: Work Unit and Department: Campus location: Job title of personnel conducting work: Use a separate sheet for each task or work area EYES Task or Work Area, such as: abrasive blasting sanding chopping sawing cutting grinding drilling hammering welding lab work press operations yard work machining laser use Name task or work area:________________ HAZARD(s): airborne dust flying particles blood or other potentially infectious material splashes hazardous chemicals intense light (ex. Lasers, welding) cryogenic liquids pesticide use Name other hazard: __________________________ Can hazard be eliminated without the use of PPE? Yes No If no, use: Safety glasses Safety goggles Laser safety glasses Welding shield/helmet (shade #_______) see appendix F Name other PPE: _________________________________ No PPE Required FACE Task or Work Area, such as: cleaning lab work welding furnace operations mixing yard work painting pouring molten metal dip tank operations Name task or work area:________________ HAZARD(s): hazardous chemicals extreme heat/cold potential irritants flying particles Name other hazard: _________________________ Can hazard be eliminated without the use of PPE? Yes No If no, use: Face shield Welding shield/helmet (shade #_______) see appendix F Name other PPE: ______________________ No PPE Required
personal_protective_equipment_program_revision_7_2015.docx