Personal Protective Equipment (PPE)

Hazard Assessment Checklist

Reviewer (Print) ID No. Division/Section Date

Building, Department, Work Area or Employee:

Hazard Hazard Present Description of Hazard

Foot
Falling Objects Yes No

Sole Punctures Yes No

Compression Yes No
Head
Falling Objects Yes No

Bump Hazards Yes No

Penetration Falling Objects Yes No

Electric Shock Yes No

Eye/Face
Impact, Flying Objects Yes No

Heat, Hot sparks Yes No

Splash From Molten Metal Yes No
High Temperature Exposure Yes No

Chemical Splash Yes No

Chemical, Irritating Mist Yes No
Nuisance Dust Yes No

Light Radiation, Welding Yes No

Light Radiation, Glare Yes No
Radiation, Non-Ionizing Yes No

Hand
Cuts Yes No
Abrasions Yes No
Chemicals Yes No
Temperature Extremes Yes No
Other

The signature on this document certifies that a hazard assessment required by OSHA 29 CFR 1910.132, has been
performed of the above identified building, department, work area or employee.
Signature of Reviewer: Date:

Fermilab ES&H Manual    Form 5101.03 ‐ 1  
    Rev. 07/2008 
WARNING. This paper copy may be obsolete soon after it is printed. The current version of this FESHM Chapter is found at
http://www-esh.fnal.gov/pls/default/esh_manuals.html.