Fillable Personal Protective Equipment Hazard Assessment Certification

Fill Online, Printable, Fillable, Blank Personal Protective Equipment Hazard Assessment Certification Form

Use Fill to complete blank online CITY OF BANGOR (ME) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Personal Protective Equipment Hazard Assessment Certification

On average this form takes 15 minutes to complete

The Personal Protective Equipment Hazard Assessment Certification form is 1 page long and contains:

  • 0 signatures
  • 93 check-boxes
  • 18 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of Bangor

BROWSE CITY OF BANGOR (ME) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
PPE Hazard Assessment Certification
Department of Safety and Environmental Management
Created: 10/15/17
Revision: New 1 | Page
Complete this form for each task within your department that requires the use of Personal Protective Equipment
to protect the employee from the hazard(s) associated with the task. The information gathered on this form will
be used to train affected employees on the required PPE for task listed below. If feasible, departments should try
to implement engineering or administrative controls to eliminate the hazards before assigning the required PPE.
Completed By:
Date:
Department:
Can the hazard(s) be eliminated without the use
of PPE? Yes No
Task:
Eye/Face:
PPE Required:
Flying particles
Airborne dust
Safety goggles
Chemical splash
UV light (i.e. welding)
Welding shield
Blood or OPIM
Molten metal splashes
Other: __________________________________
Other: ___________________________________________
Ears:
PPE Required:
Loud Noises
Crowd Noises
Ear muffs
Other: ___________________________________________
Other: ___________________________________
Head:
PPE Required:
Falling objects
Low overhead objects
Type II hard hat
Side impacts
Electrical hazards
Class G (2.2K volts)
Other: ___________________________________________
Other: ___________________________________
Hands:
PPE Required:
Chemical hazards
Blood or OPIM
Cut-resistant gloves
Cuts/sharp edges
Extreme heat/cold
Welding Gloves
Electrical
Vibrating tool/equipment
Chemical resistant
Other: __________________________________________
Cryogenic Gloves
Other: ___________________________________
Feet/Legs:
PPE Required:
Heavy falling objects
Heavy rolling objects
Leather boot
Large/heavy equipment
Electrical hazards
Slip-resistant sole
Slippery/wet surfaces
Chemical hazards
Non-conductive
Chainsaw
Puncture sharp objects
Cut resistant boots
Other: ___________________________________________
Other: ___________________________________
Lungs:
PPE Required:
Dust or particulates
Welding fume
N95 Respirator
Pesticide
Chemical hazard
Full-face respirator
Oxygen deficiency
Fibers (i.e. asbestos)
SCBA
Other: ___________________________________________
Other: _____________________________
Whole Body:
PPE Required:
Vehicle Traffic
Working on or near water
PFD
Chemical hazard
Electrical
Welding leathers
Welding sparks/hot metal
Unprotected heights/falls
Arc flash clothing
Other: ___________________________________________
Other: ____________________________________
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Personal Protective Equipment Hazard Assessment Certification

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 11 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document