1. PERSONAL PROTECTIVE
EQUIPMENT
HAZARD ASSESSMENT
DEPARTMENT: DATE:
JOB DESCRIPTION: EVALUATOR:
EYE AND FACE
Is there danger from: NO YES LIST SPECIFICPPE
 Flying Particles
 Liquid Chemicals
 Acids
 Chemical Gases or Vapors
 Light Radiation
 Other:
HEAD
Is there danger from: NO YES LIST SPECIFICPPE
 Falling or Flying Objects
 Work Being Performed
Overhead
 Elevated Conveyors
 Striking Against A Fixed
Object
 Forklift Hazards
 Exposed Electrical
Conductors
 Other:
FOOT
Is there danger from: NO YES LIST SPECIFICPPE
 Falling and Rolling Objects
 Objects Piercing Sole

2.  Electrical Hazards
 Wet or Slippery Surfaces
 Chemical Exposure
 Other:
HAND
Is there danger from: NO YES LIST SPECIFICPPE
 Skin Absorption
 Cuts or Lacerations
 Abrasions
 Punctures
 Chemical Burns
 Thermal Burns
 Harmful Temperature
Extremes
 Other:
TORSO
Is there danger from: NO YES LIST SPECIFICPPE
 Hot Metals
 Cuts
 Acids
 Radiation
 Other:
RESPIRATORY
Is there danger from: NO YES LIST SPECIFICPPE
 Harmful Dusts
 Fogs
 Fumes
 Mists
 Smokes
 Sprays
 Vapors
 Other:
MISC.
Is there danger from: NO YES LIST SPECIFICPPE
 Lifting
 Blood-Borne Pathogens
 Noise/Sound

3.  Traffic./Cargo Handling
Equipment
 Other: