Certificate of Hazard Assessment | Personal Protective Equipment
All managers and supervisors must survey the work areas and activities under their control to
determine where personal protective equipment, or PPE, may be required.
Instructions: Identify the workplace location. Conduct a walk through survey of the workplace
and list the task or job functions that require PPE. Ensure PPE has an acceptable ANSI rating
based on the chart provided on the back of this sheet. Conduct interviews with employees while
performing field observations when necessary and complete this form. Sign and date this
certificate. The completed certificate should remain on file in your area as well as additional
areas required by your department.
Please note:
When determining if a potential hazard exists, consideration should be given to the following:
• Employee’s perception of hazards.
• History of employee complaints or concerns.
• History of injuries or illnesses related to the workplace or job.
Location Department
