PERSONAL
PROTECTIVE EQUIPMENT HAZARD REVIEW
Date
of Review ___________________ Name of Reviewer
_________________
Location
of personnel involved in review __________________________________
List
Job Tasks or Work Areas Observed:
HAZARD
INDEX
In
all cases, engineering modifications are strongly
recommended. Personal protective equipment (PPE)
cannot be used in lieu of feasible engineering
controls.
1.
PPE is required.
2.
PPE is strongly recommended.
3.
PPE may not be necessary.
| |
HAZARD
SEVERITY
|
|
HAZARD PROBABILITY
|
CRITICAL
May
cause severe injury
|
MARGINAL
May
cause minor injury
|
NEGLIGIBLE
Probably
would not affect personnel or may cause
first aid visit
|
|
A - Likely to occur
immediately or within a short period of
time
|
1
|
1
|
2
|
|
B - Probably will
occur in time
|
1
|
2
|
2
|
|
C - May occur in time
|
2
|
2
|
3
|
|
D - Unlikely to occur
|
2
|
3
|
3
|
|
PERSONAL
PROTECTIVE EQUIPMENT REVIEW
|
|
ITEM
|
YES/NO
|
HAZARD
SOURCE
|
HAZARD
SEVERITY
|
HAZARD
PROBABILITY
|
HAZARD
INDEX
|
FREQUENCY
|
APPROPRIATE
PPE
|
COMMENTS
(Identify Hazard & Job Step)
|
|
EYE &
FACE PROTECTION
Employees
are exposed to flying particles, molten
metal, liquid chemicals, acids, caustic
liquids, chemical gases or vapors, or
potentially harmful light radiation.
|
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HEAD PROTECTION
The employee
works in an area where there is a potential
for injury to the head from a falling
object.
The employee
works in an area near exposed electrical
conductors which could contact the head.
The employee
works in an area where a "caught on" hazard
exists for hair.
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FOOT PROTECTION
The employee
works in an area where there is potential
exposure to foot injury due to falling
or rolling objects.
The employee
works in an area where there is potential
exposure to foot injury due to an object
piercing the sole of the shoe.
Employees
are working in an area where floor surfaces
are such that they may create a slip hazard.
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PERSONAL
PROTECTIVE EQUIPMENT REVIEW
|
|
ITEM
|
YES/NO
|
HAZARD
SOURCE
|
HAZARD
SEVERITY
|
HAZARD
PROBABILITY
|
HAZARD
INDEX
|
FREQUENCY
|
APPROPRIATE
PPE
|
COMMENTS
(Identify Hazard & Job Step)
|
|
HAND PROTECTION
The employee's
hands are exposed to hazards such as those
from skin absorption of harmful substances,
severe cuts or lacerations, severe abrasions,
punctures, chemical burns, or harmful
temperature extremes.
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FALL PROTECTION
Employees
are working at an elevated work area where
a slip or fall to a lower level is a potential
hazard.
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CLOTHING
PROTECTION
Employees
are exposed to harmful materials, chemicals,
temperature extremes, or source of cuts,
lacerations or punctures.
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Section: Training Records
