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Example Checklist PPE

This document is a personal protective equipment hazard assessment checklist. It lists various hazards for different body parts including the feet, head, eyes/face, and hands. For each listed hazard, the reviewer indicates whether the hazard is present or not in the building, department, work area, or for the specific employee. The checklist is to be signed and dated by the reviewer to certify that an OSHA-required hazard assessment has been performed.

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2K views1 page

Example Checklist PPE

This document is a personal protective equipment hazard assessment checklist. It lists various hazards for different body parts including the feet, head, eyes/face, and hands. For each listed hazard, the reviewer indicates whether the hazard is present or not in the building, department, work area, or for the specific employee. The checklist is to be signed and dated by the reviewer to certify that an OSHA-required hazard assessment has been performed.

Uploaded by

Gerald Here
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Personal Protective Equipment (PPE)

Hazard Assessment Checklist


Reviewer (Print) ID No. Division/Section Date

Building, Department, Work Area or Employee:

Hazard Hazard Present Description of Hazard


Foot
Falling Objects Yes No

Sole Punctures Yes No


Compression Yes No
Head
Falling Objects Yes No

Bump Hazards Yes No

Penetration Falling Objects Yes No

Electric Shock Yes No

Eye/Face
Impact, Flying Objects Yes No

Heat, Hot sparks Yes No


Splash From Molten Metal Yes No
High Temperature Exposure Yes No

Chemical Splash Yes No


Chemical, Irritating Mist Yes No
Nuisance Dust Yes No

Light Radiation, Welding Yes No


Light Radiation, Glare Yes No
Radiation, Non-Ionizing Yes No

Hand
Cuts Yes No
Abrasions Yes No
Chemicals Yes No
Temperature Extremes Yes No
Other

The signature on this document certifies that a hazard assessment required by OSHA 29 CFR 1910.132, has been
performed of the above identified building, department, work area or employee.
Signature of Reviewer: Date:

Fermilab ES&H Manual    Form 5101.03 ‐ 1  
    Rev. 07/2008 
WARNING. This paper copy may be obsolete soon after it is printed. The current version of this FESHM Chapter is found at
[Link]

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