Personal Protective Equipment

For: Date:      

Conducted by:      

YES NO N/A

Are you assessing the workplace to determine if hazards that require the use of personal
protective equipment (for example, head, eye, face, hand or foot protection) are present or are
likely to be present?

If hazards or the likelihood of hazards are found, are you selecting and having affected
employees use properly fitted personal protective equipment suitable for protection from these
hazards?

Has the employee been trained on PPE procedures, such as what PPE is necessary for a job
task, when they need it, and how to properly adjust it?

Are protective goggles or face shields provided and worn where there is any danger of flying
particles or corrosive materials?

Are approved safety glasses required to be worn at all times in areas where there is a risk of eye
injuries such as punctures, abrasions, contusions or burns?

Are employees who need corrective lenses (glasses or contacts) in working environments having
harmful exposures, required to wear only approved safety glasses, protective goggles, or use
other medically approved precautionary procedures?

Are protective gloves, aprons, shields, or other means provided and required where employees
could be cut or where there is reasonably anticipated exposure to corrosive liquids, chemicals,
blood, or other potentially infectious materials? See OSHA Standard 29 CFR 1910.1030(b) for
the definition of "other potentially infectious materials."

Are hard hats provided and worn where danger of falling objects exists?

Are hard hats inspected periodically for damage to the shell and suspension system?

Is appropriate foot protection required where there is the risk of foot injuries from hot, corrosive or
poisonous substances, falling objects, crushing or penetrating actions?

Are approved respirators provided for regular or emergency use where needed?

Is all protective equipment maintained in a sanitary condition and ready for use?

Do you have eyewash facilities and a quick drench shower within the work area where
employees are exposed to injurious corrosive materials? Where special equipment is needed for
electrical workers, is it available?

Where food or beverages are consumed on the premises, are they consumed in areas where
there is no exposure to toxic material, blood or other potentially infectious materials?

Is protection against the effects of occupational noise exposure provided when sound levels

Provided by: Horst Insurance

Design © 2005, 2012 Zywave, Inc. All rights reserved.
exceed those of the OSHA noise standard?

Are adequate work procedures, protective clothing and equipment provided and used when
cleaning up spilled toxic or otherwise hazardous materials or liquids?

Are there appropriate procedures in place for disposing of or decontaminating personal protective
equipment contaminated with, or reasonably anticipated to be contaminated with, blood or other
potentially infectious materials?
Source: OSHA

We can help! For additional information or assistance with your Personal Protective Equipment Program, contact
Horst Insurance at (800) 533-2011 for more information.

Design © 2005, 2012 Zywave, Inc. All rights reserved.