Hand Protection - Gloves

Are gloves being used by employees where hand hazards exist?

Yes No N/A

Are gloves worn by employees suitable for hand hazards?

Yes No N/A

Are gloves free of damage or defects, and in clean/sanitary condition?

Yes No N/A

Are gloves stored properly when not in use?

Yes No N/A

Are gloves being properly disposed of when damaged or defective?

Yes No N/A

Protective Clothing

Is high visibility safety vest / shirt / jacket being worn?

Yes No N/A

Is protective clothing worn suitable for existing hazards?

Yes No N/A

Is protective clothing free of damage or defects?

Yes No N/A
 Does protective clothing fit properly?

Yes No N/A

Protective Footwear

Is protective footwear being used by employees where foot hazards exist?

Yes No N/A

Is protective footwear worn by employees suitable for hazard?

Yes No N/A

Is protective footwear properly fitted?

Yes No N/A

Is protective footwear free of damage or defects?

Yes No N/A

Head Protection - Hard Hats

Are hard hats being worn where head hazards exist?

Yes No N/A

Are hard hats properly fitted and worn properly?

Yes No N/A

Are hard hats free of damage or defects? (i.e. cracks, UV damage, chips, etc.)

Yes No N/A
 Are the hard hat suspension systems in good condition?

Yes No N/A

Hearing Protection

Is hearing protection being worn where noise hazards are above 90 dB?

Yes No N/A

Is hearing protection being used protect against present noise hazards?

Yes No N/A

Is hearing protection being worn properly?

Yes No N/A

Is hearing protection free of damage or defects?

Yes No N/A

Face/Eye Protection

Is face/eye protection being worn by employees where face/eye hazards exist?

Yes No N/A

Is face/eye protection suitable for hazards?

Yes No N/A

Is face/eye protection properly fitted and worn?

Yes No N/A
 Is face/eye protection free of damage or defects?

Yes No N/A

Respiratory Protection - Respirators

Are respirators being used where respiratory hazards exist?

Yes No N/A

Are respirators being used suitable for hazards present?

Yes No N/A

Are respirators fitted and worn properly?

Yes No N/A

Are respirators being stored properly when not in use?

Yes No N/A

Additional Comments

Additional safety concerns

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's
solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice.
You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should
independently determine whether the template is suitable for your circumstances.