Checklist - Ppe Assessment: Suggested Questions Typical Operations of Concern Yes No

CHECKLIST – PPE ASSESSMENT
Suggested Questions Typical Operations of Yes No

Concern
EYES
Do your employees perform tasks, or Sawing, cutting, drilling, sanding, X
work near employees who perform grinding, hammering, chopping,
tasks, that might produce airborne abrasive blasting, etc.
dust or flying particles?
Do your employees handle, or work Pouring, mixing, painting, cleaning, X
near employees who handle, spraying, dispensing, and providing
hazardous liquid chemicals or first aid, etc.
encounter blood splashes?
Are your employees’ eyes exposed to Battery charging, installing fiberglass X
other potential physical or chemical insulation, compressed air or gas
hazards? operations, etc.
Are your employees exposed to Welding, cutting, etc. X
intense light?
FACE
Do your employees handle, or work Pouring, mixing, painting, cleaning, X
near employees who handle, providing first aid, etc.
hazardous liquid chemicals?
Are your employees’ faces exposed Welding, baking, cooking, drying, etc. X
to extreme heat?
Are your employees faces exposed Cutting, sanding, grinding, X

to other potential hazards? hammering, chopping, pouring,
mixing, painting, cleaning, dispensing,
etc.
HEAD
Could tools, tree limbs or other Work stations or traffic routes located X
objects fall from above and strike under catwalks, open sided floors,
your employees on the head? construction, trenching, utility work,
tree trimming, etc.
Are your employees’ heads near Construction, confined space X
exposed beams, machine parts, operations, building maintenance, etc.
pipes, etc. when they stand or bend,?
Do your employees work with or near Building maintenance; construction; X
exposed electrical wiring or wiring; work on or near
components? communications, computer, or other
high tech equipment; arc or
resistance welding; etc.

Concern
FEET
Could tools, heavy equipment, or Construction, plumbing, building X
other objects roll, fall onto, or strike maintenance, trenching, grass cutting,
your employees’ feet? etc.
Are your employees subject to Construction, machine shop X

walking on sharp objects? operations, building maintenance,
utility work, material handling, etc.
Do your employees work with or near Building maintenance; construction; X

exposed electrical wiring or wiring; work on or near
components? communications, computer, or other
Do your employees handle, or work Welding, etc. X
near employees who handle, molten
metal?
Do your employees work with Spray painting, abrasive blasting, work X
explosives or in explosive with highly flammable materials,
atmospheres? etc.
HANDS
Do your employees handle chemicals Pouring, mixing, painting, cleaning, X
that might irritate or damage skin, or providing first aid, etc.
come into contact with blood?
Do work procedures require your Welding, baking, cooking, drying, etc. X
employees to place their hands and
arms near extreme heat?
Are your employees’ hands and arms Building maintenance; construction; X
placed near exposed electrical wiring wiring; work on or near
or components? communications, computer, or other
Concern
BODY
Are your employees’ bodies exposed Pouring, mixing, painting, cleaning, X
to irritating dust or hazardous machining, sawing, battery charging,
chemical splashes, such as acids? installing fiberglass insulation,
compressed air or gas operations,
etc.
Are your employees’ bodies exposed Cutting, grinding, sanding, sawing, X
to sharp or rough surfaces? glazing, material handling, etc.
Are your employees’ bodies exposed Welding, baking, cooking, drying, etc. X
to extreme heat?
HEARING
Are your employees’ bodies exposed Machining, grinding, sanding, work X
to loud noise from machines, tools, near pneumatic equipment,
music systems, etc? generators, ventilation fans, motors,
brake presses, chainsaws, etc.
Form
Certification of Hazard Assessment for
PERSONAL PROTECTIVE EQUIPMENT
School Assessed: ________________________________________________
Department Assessed: ____________________________________________
Assessment Date: ________________________________________________
Person Completing Assessment: _____________________________________
 Gather, List, and Review Documentation. Include the following:
 Operating Procedures
 Workplace Practices
 Safety Procedures
 Material Safety Data Sheets
 Other Pertinent Information
________________________________________________________________
________________________________________________________________
 Walk through area being assessed.
In the documentation review and walk through, focus on the following:
 Motion hazards
 Impact
 Penetration (sharp objects)
 Compression (roll over)
 Falling (or potentially falling) objects
 Rolling or pinching objects
 Chemical exposures
 High (or low) temperatures (include possible effects of high
stress)
 Harmful dust
 Light (optical) radiation
 Workplace layout
 Location of co-workers
 Electrical hazards
 Data Analysis
 Estimate of potential for injuries
 Type of risk(s)
 Level of risk(s)
 Severity of potential injury
 Potential of simultaneous exposure to several hazards
 PPE Selected
Area Process
__________________________________ ________________________
__________________________________ ________________________
__________________________________ ________________________
__________________________________ ________________________
__________________________________ ________________________
__________________________________ ________________________
This document certifies that a hazard assessment for the selection of personal
protective equipment pursuant to 29 CFR 1910.132(d) was conducted.
Assessor Signature: ____________________________ Date: ___/___/___

Form
Certification of Training and Understanding
on
PERSONAL PROTECTIVE EQUIPMENT
School: _____________________________________________
Department: _________________________________________
 PPE Types:
__________________________________ ________________________
__________________________________ ________________________
__________________________________ ________________________
__________________________________ ________________________
__________________________________ ________________________
__________________________________ ________________________
 Training:
 When PPE is necessary

 What PPE is necessary
 How To properly inspect PPE for wear or damage
 How to properly put on, take off, adjust the fit, and wear PPE
 The limitations of PPE
 The proper care, maintenance, useful life and disposal of
PPE
 Each employee must demonstrate an understanding of the training

and the ability to use the PPE properly.
 Written certification for each affected employee.

This document certifies that the employees listed below have
received and demonstrated their understanding of the training in the
personal protective equipment necessary for their jobs pursuant to 29
CFR 1910.132 (f).
Employees Trained Date(s) of Training
__________________________________ ________________________
__________________________________ ________________________
__________________________________ ________________________
__________________________________ ________________________
__________________________________ ________________________
__________________________________ ________________________
Trainer:
Signature Printed Name
Date: ___/___/___

Checklist - Ppe Assessment: Suggested Questions Typical Operations of Concern Yes No

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Checklist - Ppe Assessment: Suggested Questions Typical Operations of Concern Yes No

Uploaded by

Copyright:

Available Formats

CHECKLIST – PPE ASSESSMENT

Suggested Questions Typical Operations of Yes No

Are your employees faces exposed Cutting, sanding, grinding, X

CHECKLIST – PPE ASSESSMENT

Are your employees subject to Construction, machine shop X

Do your employees work with or near Building maintenance; construction; X

School Assessed: ________________________________________________

Department Assessed: ____________________________________________

Assessment Date: ________________________________________________

Person Completing Assessment: _____________________________________

 Gather, List, and Review Documentation. Include the following:

 Walk through area being assessed.

In the documentation review and walk through, focus on the following:

Assessor Signature: __________________________ Date: _/_/_

 When PPE is necessary

 Each employee must demonstrate an understanding of the training

 Written certification for each affected employee.

Employees Trained Date(s) of Training

You might also like