Guidance and Documentation Template for Work Place PPE Risk Assessments
Scope:
The purpose of this document is to give guidance on conducting PPE assessments and using the PPE assessment form. PPE assessments are needed to select proper PPE based on anticipated hazards. PPE assessments must be documented.
Guidance:
PPE assessments can be done for the work area in general to determine PPE that is required to be worn through the area at all times, (e.g. to determine need for safety glasses or safety shoes) or to designated additional PPE for a specific task (e.g. gloves while handling a chemical.)
1. To conduct a PPE assessment
Conduct a walk-through survey of the areas in question. During the survey, note potential hazards to workers. Basic hazard categories include, but are not limited to the following:
Impact / Falling Object Penetration Compression (roll-over) Pinch Points Chemical Exposure Heat Harmful dust Light (optical) radiation Material handling Energized equipment / Electrical
The attached questionnaire below is a list of specific items to consider and can be used as guidance during the walkthrough survey.
2. Complete the Worksheet
After the walkthrough survey is complete, use the information to document the real and potential hazards associated with each body part by checking the appropriate box(es) under Hazard on the PPE Risk Assessment Documentation Tool. (separate document).
3. Selection of Personal Protective Equipment (PPE) Once the hazards of the work place have been identified, PPE should be selected which provides the appropriate level of protection against the identified hazards. If a site has previously established PPE criteria for an area/task, the suitability of the PPE presently available must be determined.
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When selecting PPE, careful consideration must be given items such as comfort, fit, and dexterity requirements to ensure that it will be used.
The site PPE approval procedure must be followed when selecting new types of PPE.
4. Specialized PPE: Respiratory Protection, Hearing Protection, Electrical PPE, and Fall Protection
Specific requirements for respiratory protection and hearing protection are typically determined using industrial hygiene data collected through monitoring activities. If you are unfamiliar with using industrial hygiene data to select specialized PPE, please consult with your site or Regional Occupational Health Resource.
The appropriate fall protection may be determined and recorded using a specific assessment for elevated work by a knowledgeable resource.
Electrical PPE is often determined by arc flash analysis. An electrical safety resource must be involved in the selection of PPE to protect against electrical hazards.
The required PPE for these situations should be included in the PPE hazard assessment documentation.
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Personal Protective Equipment (PPE) Hazard Assessment Documentation Business: ______Assessment Date: _ Workplace & TASK Evaluated: ______
Chemical(s): Person(s) performing assessment: Title: ______
THE FOLLOWING HAZARDS HAVE BEEN EVALUATED Part of Body Hazard Required PPE References
Hands Penetration, laceration, abrasion, Leather Area/Site SHE or pinch points Cut resistant gloves procedures Chemicals- ______Chemical resistant gloves ______Type______Extreme heat or cold Bloodborne pathogens Cotton gloves Electrical shock/arc flash Insulated gloves Impact Heat/flame resistant gloves Dust Thin Nitrile gloves Vibration-power tools Double gloves Other ______Gauntlet style to cover forearms ______High voltage gloves ______Anti-vibration gloves Other ______
Head Site SHE Manual Impact from falling objects Hard Hat Procedure: Risk of falling from height Bump cap Electrical shock/arc flash Face shield/hood with hard hat Bump hazards Protective helmet Other______Other______
_
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Eyes and Face Impact-flying objects, Safety glasses with side shields Site SHE Manual chips, sand or dirt Vented Chemical splash Procedure: Chemical-splash, spray, or mist goggles Steam, water >60 deg. C Non-Vented Chemical Splash Area SHE Fumes, dusts Goggles Procedures Electrical shock/arc flash Face shield Flash fire hazard Face shield with side and chin Hot sparks-grinding protection (“nitrometer” style face Welding, cutting, brazing-UV shield) light/Radiant energy Full suit with hood Radiant Energy, Other Face shield with Hard hat Source: Nomex® hood Laser operations Welding helmet w/proper Laser Class(es): shade number Other ______Laser spectacles or goggles Other ______
Exposure to noise levels Ear plugs, Site SHE Manual Other ______Ear muffs Procedure: Ears Double protection (muffs & plugs) Other ______
Respiratory Hazardous atmospheres Cartridge Respirator (check one SHE Manual System Chemical vapors or both types and then type of Procedures Acid gases cartridges/filters Particulates/Dust/Mist Half mask Asbestos Full face NARFs PAPR Welding fumes Cartridge Types IDLH atmospheres Organic vapor Acid gas
Other______Organic vapor/ acid gas
Ammonia methylamine N95 filter P100 (HEPA) filter Combination: Note: Site respirator program Other ______administrator must be involved in Airline respirator respirator selection Airline respirator w/escape Escape only respirator SCBA NIOSH approved Respirator/chemical hood NIOSH approved Respirator/chemical suit Filtering facepiece respirator/ (“Disposable dust mask “) Other______
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Feet Impact-heavy objects Steel toe safety shoes SHE Manual Electrically classified area ESD safety shoes Procedures Chemical contact Chemical resistant boots- Area SHE Rules
Compression-rolling or pinching Leather boots or safety shoes objects/vehicles w/metatarsal guards Slippery surfaces Puncture Other______Other______
Body Flash fire hazard Flame-resistant clothing Site SHE Manual Electrical shock/arc flash Flame retardant overgarment Procedure Hot metal or sparks Electrical PPE Chemicals Chemical protective suit described below Low toxicity powders/solids Fully encapsulated suit Steam, or liquids >60 deg. C Uncoated Tyvek® coverall Heat stress Apron Cold stress Lab coat Sleeves Heights-fall hazard Body cooling device Low visibility Cold weather garments Body harness and lanyard Other______Other______
CERTIFICATION: I certify that the above Hazard Assessment was performed on the date indicated.
Signed by: ______Date: ______
Additional comments, notes, drawings (use other side if needed):
Reviewed January 23, 2018