food processing exposed electrical wiring or If no, use: animal handling components Safety shoes or boots logging (ex. chainsaw) heavy equipment (ex. Forklift, pallet Toe protection plumbing jack) Metatarsal protection trenching slippery surfaces Electrical protection welding tools Heat/cold protection Name task or work area:________________ Name other hazard: __________ Puncture resistance Chemical resistance Anti-slip soles Leggings or chaps Long pants Closed toe shoe Name other PPE: ______________________ No PPE Required BODY Task or Work Area, such as: HAZARD(s): Can hazard be eliminated without the use of baking or frying chemical splashes PPE? building maintenance extreme heat/cold Yes No battery charging sharp or rough edges If no, use: construction exposed electrical wiring or High Visibility Clothing dip tank operations components Fluorescent orange vest & cap utility work height of more than 10 feet on Flame Retardant Clothing fiberglass installation scaffold Coveralls, Body suit scaffold use height of 6 feet during Chemical resistant suit irritating chemicals maintenance/construction activities Arc Flash PPE aerial lift use contact with motor vehicle Fall arrest/restraint equipment sawing hunting / gun fire Apron working near water Name other hazard: _________ Personal Floatation Device item under pressure Welding leathers live electrical work Abrasion/cut resistance use of highly flammable materials Name other PPE: _____________________ Working on/near roadway No PPE Required Name task or work area:________________ LUNGS/RESPIRATORY Task or Work Area, such as: HAZARD(s): Can hazard be eliminated without the use of cleaning irritating dust or particulate PPE?
food processing animal handling logging (ex. chainsaw) plumbing trenching welding Name task or work area:________________ exposed electrical wiring or components heavy equipment (ex. Forklift, pallet jack) slippery surfaces tools Name other hazard: __________ If no, use: Safety shoes or boots Toe protection Metatarsal protection Electrical protection Heat/cold protection Puncture resistance Chemical resistance Anti-slip soles Leggings or chaps Long pants Closed toe shoe Name other PPE: ______________________ No PPE Required BODY Task or Work Area, such as: baking or frying building maintenance battery charging construction dip tank operations utility work fiberglass installation scaffold use irritating chemicals aerial lift use sawing working near water item under pressure live electrical work use of highly flammable materials Working on/near roadway Name task or work area:________________ HAZARD(s): chemical splashes extreme heat/cold sharp or rough edges exposed electrical wiring or components height of more than 10 feet on scaffold height of 6 feet during maintenance/construction activities contact with motor vehicle hunting / gun fire Name other hazard: _________ Can hazard be eliminated without the use of PPE? Yes No If no, use: High Visibility Clothing Fluorescent orange vest & cap Flame Retardant Clothing Coveralls, Body suit Chemical resistant suit Arc Flash PPE Fall arrest/restraint equipment Apron Personal Floatation Device Welding leathers Abrasion/cut resistance Name other PPE: _____________________ No PPE Required LUNGS/RESPIRATORY Task or Work Area, such as: cleaning HAZARD(s): irritating dust or particulate Can hazard be eliminated without the use of PPE?
personal_protective_equipment_program_revision_7_2015.docx