PERSONAL PROTECTIVE EQUIPMENT HAZARD ASSESSMENT

Company:                                                          Date of Assessment:                                                    

Location:                                                            Assessment Prepared By:                                           

Job Task:                                                                                                                                                 

POTENTIAL
Does the job present 
an occupational exposure to:

Eye Hazards		Yes	No		Hazard Description		Recommended PPE

Chemicals		___	___		                                		                                 

Dust			___	___               	                                		                                 

Heat			___	___      		________________		_________________
                     
Impact			___	___		_________________		_________________

Light/Radiation		___	___		_________________		_________________

Head & Face Hazards

Burn			___	___		_________________		_________________

Chemical Splash	___	___		_________________		_________________

Electric Shock		___	___		_________________		_________________
			
Impact			___	___		_________________		_________________

Hand Hazards

Burns/Cold		___	___		_________________		_________________

Cuts/Abrasions		___	___		_________________		_________________

Punctures		___	___		_________________		_________________

Chemicals 		___	___		_________________		_________________

Repetitive Trauma	___	___		_________________		_________________

Electric Shock		___	___		_________________		_________________

POTENTIAL

Does the job present 
an occupational exposure to:

Foot Hazards		Yes	No		Hazard Description		Recommended PPE

Impact			___	___		_________________		_________________

Puncture		___	___		_________________		_________________

Chemicals		___	___		_________________		_________________

Electric-shock		___	___		_________________		_________________

Electro-static buildup	___	___		_________________		_________________

Compression		___	___		_________________		_________________

Respiratory Hazards

Fumes			___	___		_________________		_________________

Mists			___	___		_________________		_________________

Dusts			___	___		_________________		_________________
	
Vapors			___	___		_________________		_________________

Noise Hazards

Impact noise 					
>140 decibels		___	___		_________________		_________________

Continuous noise 				
>85 decibels		___	___		_________________		_________________