HAZARD ASSESSMENT 
OF THE WORKPLACE

FOR

PERSONAL PROTECTIVE EQUIPMENT
(PPE)

1910.132

OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION

HAZARD ASSESSMENT FORM

Use this form as a guide to help identify the hazards in each work area.

Job Classification: ________________________________ Area: _________________________

Date: _____________________ Assessor: ___________________________________________

HEAD HAZARDS:	These can include working under machinery or processes that might cause materials or objects to fall, working below other workers, energized equipment and working with chemicals.

Circle which is appropriate	Description of Hazard: ____________________________________
for each hazard:			_______________________________________________________
Burn    	 	yes   no   	_______________________________________________________
Chemical Splash 	yes    no  	_______________________________________________________
Electrical Shock	yes    no   	_______________________________________________________
Impact		yes    no   	_______________________________________________________

EYE HAZARDS: These can include chipping, grinding, sanding, welding, woodworking, furnace operations, working with acids, or chemicals.

Circle which is appropriate		Description of Hazard: ______ _______________________
for each hazard:				________________________________________________
Light/radiation		yes   no   	________________________________________________
Chemicals		yes    no  	________________________________________________
Dust			yes   no   	________________________________________________
Heat			yes   no   	________________________________________________
Impact			yes   no   	________________________________________________

HAND HAZARDS: These can include working with chemicals, with hot objects, and cutting materials.

Circle which is appropriate		Description of Hazard: __________ ___________________
for each hazard:				________________________________________________
Puncture			yes   no   	________________________________________________
Burns			yes   no   	________________________________________________
Chemical Exposure	yes   no   	________________________________________________
Cuts/Abrasions		yes   no   	________________________________________________

FOOT HAZARDS: These can include handling//carrying materials that may be dropped, and working with chemicals.

Circle which is appropriate		Description of Hazard: _____________________________
for each hazard:			 	________________________________________________
Impact			yes   no   	________________________________________________
Compression		yes   no   	________________________________________________
Puncture			yes   no   	________________________________________________
Chemical Exposure	yes   no   	________________________________________________

It has been determined from the Personal Protective Equipment Assessment that the following personal protective

equipment (PPE) is required for: __________________________________.
									(Job Classification)

HEAD HAZARDS/PPE REQUIRED: ______________________________________________

EYE HAZARDS/PPE REQUIRED: ________________________________________________

HAND HAZARDS/PPE REQUIRED: ______________________________________________

FOOT HAZARDS/PPE REQUIRED: _______________________________________________

CERTIFICATION OF HAZARD ASSESSMENT

The workplace has been assessed for hazards which may be reduced through the use of selected Personal Protective Equipment. This assessment is in accordance with 29 CFR 1910.132 and its related standards, 29 CFR 1910.140. The attached survey form(s) serve as detail supporting the analysis as to the individual work area and possible hazards associated with each function.

Company surveyed: _____________________________________________________________

Surveyed by: __________________________________ Title: ___________________________

Certified by: __________________________________ Title: ____________________________

Date surveyed: _____________________________ Date certified: ________________________