FORM

Standard: Personal Protective Equipment

PERSONAL PROTECTIVE EQUIPMENT HAZARD ASSESSMENT

Task: Location:
Occupation: Department:
Evaluation Completed By: Date:

Eye and Face Protection

Type of Hazard Source of Hazard Description of Tasks, PPE

Engineering & Admin. Controls Required
In Place
Impact/Flying Working With, Near, or Around:
Objects/Dust Yes
Flying fragments, Chipping Buffing
Grinding Sanding No
objects, large chips,
particles, sand, dirt, Machining Woodworking
dust, etc. Drilling Powered
Chiseling Fastening
Riveting Masonry Work
Sawing Other:

Heat Working With, Near, or Around:

Burns Yes
Cutting Pouring Hot Metal
Welding Molten Metals No
Torching Other:
Hot Sparks

Chemical Liquids Working With, Near, or Around:

Chemical irritation or Yes
burns Pouring Mixing
No
Splash Hazards Irritating Mists
Washing/Cleaning Irritating Spray
Other:

Chemical Gases and Working With, Near, or Around:

Vapors Compressed Gas System Handling Yes
Chemical irritation or Other: No
burns

Light/Radiation Working With, Near, Or Around:

Poor vision; Damage to Yes
the eyes. Optical Radiation Torch Soldering
Cutting Torch Brazing No
Electric Arc Welding Glare
Gas Welding Other:

Biohazards Working With, Near, or Around:

Exposure to infectious First Aid/Emergency Care Treatment Yes
material Body Fluids No
Other:

Revision Date: 10/18/2012 Page 1 of 5

Copyright © 2012 The President and Fellows of Harvard College

Head Protection
Falling Objects Working Under:
Other workers using tools and materials Yes
that could fall No
Machinery or processes which might
cause materials or objects to fall
Warehouse racking where loose material
loads are handled or stored.
Other:

Overhead Object Interference Working Under or Near:

Conveyor belts carrying material Yes
Vertical lifts and other elevating work No
platforms
Other:

Foot Protection
Impact Hazards Working With:
Routine activities where Yes
objects heavier than 5 lb. Heavy Packages Heavy Parts/Equip.
Heavy Tools Other: No
could fall on feet
Heavy Objects

Compression Hazards Working With:

Roll-over hazards High Use of Carts or Pallet Trucks Yes
Handling Heavy Pipes or Logs No
Drum Handling
Other:

Puncture Protection Working Where There Is:

Puncture to shoe soles Yes
Nails Scrap Metal
Wire Screws No
Tacks Sharp Objects on
Glass Walking Surfaces
Large Staples Other:

Electrical Hazards Working With Or Near:

Electric shock or burns Exposed Electrical Conductors Yes
Energized Parts No
Electrical Switch Gear
Other Exposed Electrical Hazards:

Chemical Hazards Working With, Near, Or Around:

Irritation or burns Splash Hazards from Hot Or Corrosive Yes
Liquids No

Revision Date: 10/18/2012 Page 2 of 5

Copyright © 2012 The President and Fellows of Harvard College

Hand Protection
Chemical Hazards Working With or Handling:
Chemical irritation or burns Yes
Solvents Toxic Materials
Corrosives Other: No
Skin Irritants

Physical Hazards Working With Or Handling:

Cuts, punctures, abrasions, Sharp Objects Yes
rubbing/friction, or laceration. Sharp Tools No
Knives
Jagged Objects
Glass
Using, Cleaning or Dismantling
Equipment with Sharp Points Or Edges
Abrasive Materials (E.G. Sanders)
Other:

Thermal Hazards Working With Or Handling:

Burns Hot Material Yes
Molten Metal No
Hot Pipes, Steam, Or Liquids
Welding
Hot Work Activities
Other:

Cryogenic Hazards Working With Or In:

Frostbite Cold Materials Yes
Cold Weather No
Other:

Biohazards Contact During:

Exposure to infectious First Aid/Emergency Care Yes
material Custodial (Biological Response) No
Other:

Electrical Hazards Working on Or Near:

Electric shock or burn Energized Circuits of High Voltage (>600v) Yes
Other: No

Revision Date: 10/18/2012 Page 3 of 5

Copyright © 2012 The President and Fellows of Harvard College

Respiratory Protection
Inhalation Hazards Working With or Near:
Nuisance Dusts (Chemicals, Wood) Yes
Fibers (Asbestos, Etc.) No
Mists (Oils, Acids, Etc.)
Vapors (Solvents, Gases, Etc.)
Fumes (Torch Cutting, Welding,
Soldering)
Other:

Atmospheric Hazards Working In or Near:

Toxic Atmospheres Yes
Oxygen-Deficient Areas (Below 19.5% No
Oxygen)
Immediately Dangerous To Life Or Health
(IDLH)
Other:

Hearing Protection
Loud Noises Working in Area Exceeding 85 dBA:
Hearing loss Noise Level From Most Recent Noise Yes
Survey: No
Continuous Noise
Impact Noise
Intermittent Noise
Other:

Body Protection
Chemical Hazards Working With or Handling:
Chemical splash exposure Yes
Solvents Toxic by Skin
Corrosives Absorption No
Irritants Other:

Electrical Hazards Working With or Around:

Electric shock or burns High Voltage (>600v) Yes
Other: No

Fire Exposure Working With or Around:

Burns Fires Yes
Open Flames No
Other:

Fall Protection Working from unprotected heights

greater than 4 feet Yes
Other: No

Revision Date: 10/18/2012 Page 4 of 5

Copyright © 2012 The President and Fellows of Harvard College

 Personal Protective Equipment – Hazard Assessment Summary

Task: Location:
Occupation: Department:
Evaluation Completed By: Date:

PPE Category PPE Required for this Department

Eye and Face Protection Yes Safety Glasses w/ Side Face Shield Filtered Lenses
No Shields Welders Face Shield Impact Goggles
Chemical Goggles Welding Shields Other: ___________

Head Protection Yes Hard Hat-Class G (Proof Tested to 2,200 Volts)

No Hard Hat-Class E (Proof Tested to 20,000 Volts)
Hard Hat-Class C (No Electrical Protection)
Other: _______________

Foot Protection Yes Safety Shoes Electrical Hazard Soles: Material:

No Boots Leather Neoprene
Metatarsal Guards Rubber PVC
Boot Cover Other: ____________ Poly/Nylon

Hand Protection Yes Gloves: PVC Heat Resistant

No Wrist Length Nitrile Welding
Elbow Length PVA Cold Resistant
Shoulder Length Latex Electrical Resistant
Chemical Resistant Abrasion Resistant Anti-Static
Butyl Cut Resistant Other: ___________
Neoprene Puncture Resistant

Respiratory Protection Yes Air Purifying Airline Full-Face

No Dust PAPR Canister
Mist SCBA Cartridge
Fume Half-Face Other: ___________

Hearing Protection Yes Earmuffs Min. Noise Reduction Rating

No Earplugs Other: _______________

Body Protection Yes Apron Coveralls Insulating Covers

No Jacket/Coat Insulating Blankets Other: ___________
Long Sleeves

Fall Protection Yes

No

Comments:

_____________________ __________ __________________________ _________

Supervisor Date Environmental Safety Officer Date

Revision Date: 10/18/2012 Page 5 of 5

Copyright © 2012 The President and Fellows of Harvard College