Personal Protective Equipment (PPE) Hazard Assessment Survey and Certification Department:_____________________________________ Location: _________________________ Job Classification: _____________________________ Operation/Process: _______________________ Hazard Assessor (print): _____________________________ Title:________________________ Part of Body Hazard Required PPE Notes objects Leather/cut resistant gloves Penetration-animal bites Leather/cut resistant gloves Hands objects General purpose work gloves Chemical(s) __________ Chemical resistant gloves; ____________________ Type _________________ Extreme cold Insulated gloves Extreme heat Heat/flame resistant gloves Blood Latex or nitrile gloves Electrical shock Insulated rubber gloves; Type _____________ Vibration-power tools Cotton, leather or anti-vibration gloves Other ______________ __________________ Impact-flying objects, Safety glasses w/side shields chips, sand or dirt Glasses/goggles w/face shield Eyes and Face Nuisance dust Impact goggles UV light-welding, cutting, Welding goggles torch brazing or soldering Welding helmet/shield w/safety Chemical-splashing liquid glasses & side shields Chemical-irritating mists Chemical goggles/ face shield
Personal Protective Equipment (PPE) Hazard Assessment Survey and Certification Department:_____________________________________ Location: _________________________ Job Classification: _____________________________ Operation/Process: _______________________ Hazard Assessor (print): _____________________________ Title:________________________ Part of Body Hazard Required PPE Notes Hands objects Penetration-animal bites objects Chemical(s) __________ ____________________ Extreme cold Extreme heat Blood Electrical shock Vibration-power tools Other ______________ Leather/cut resistant gloves Leather/cut resistant gloves General purpose work gloves Chemical resistant gloves; Type _________________ Insulated gloves Heat/flame resistant gloves Latex or nitrile gloves Insulated rubber gloves; Type _____________ Cotton, leather or anti-vibration gloves __________________ Eyes and Face Impact-flying objects, chips, sand or dirt Nuisance dust UV light-welding, cutting, torch brazing or soldering Chemical-splashing liquid Chemical-irritating mists Safety glasses w/side shields Glasses/goggles w/face shield Impact goggles Welding goggles Welding helmet/shield w/safety glasses & side shields Chemical goggles/ face shield
safetymanual_ch21a.docx