Section 1: Foot Protection
1. 1. Has the proper foot protection been selected and are employees required to use it when exposed to falling objects, punctures, crushing or rolling objects, stubbing, chemical or corrosive contact, electrical shock or burns, slips or falls?
Yes
No
N/A
2. 2. Is protective footwear sturdy with non-skid soles?
Yes
No
N/A
3. 3. Is steel-toed or non-metallic safety-toed footwear required to resist impact?
Yes
No
N/A
4. 4. In areas where there is risk for a puncture type injury, do shoes have flexible metal soles or inner shoes?
Yes
No
N/A
5. 5. Do employees wear the proper protective footwear when working in areas that have electrical hazards?
Yes
No
N/A
6. 6. Are employees wearing footwear with slip resistant soles when working in wet or slippery areas?
Yes
No
N/A
7. 7. Are employees who work in areas that have a risk of chemical or corrosive exposures wearing the appropriate chemical-resistant boots?
Yes
No
N/A
8. 8. Is damaged, defective or worn foot protection properly discarded and replaced?
Yes
No
N/A
Section 2: Hand Protection
1. 1. Has the proper hand protection been selected and are employees required to use it when exposed to harmful substances (skin contact), sever cuts/lacerations, severe abrasions, punctures, thermal and chemical burns, temperature extremes, corrosive liquids, blood and other potentially infectious materials?
Yes
No
N/A
2. 2. Have employees been trained on the differences in types of gloves and when and how to use them?
Yes
No
N/A
3. 3. When working with chemicals or corrosives, are employees using the proper type of glove as stated on the Safety Data Sheet (SDS)?
Yes
No
N/A
4. 4. Are the gloves maintained per manufacturer’s recommendations?
Yes
No
N/A
5. 5. Are employees who have allergies to certain gloves given alternative gloves?
Yes
No
N/A
6. 6. Do gloves fit properly and are they rated for the specific task being performed?
Yes
No
N/A
7. 7. Is damaged, defective or worn hand protection properly discarded and replaced?
Yes
No
N/A
Section 3: Hearing Protection
1. 1. Are there work areas in which employees are exposed to excessively loud noise?
Yes
No
N/A
2. 2. Has noise monitoring been conducted by an industrial hygienist or other qualified person?
Yes
No
N/A
3. 3. If one or more employees are exposed to sound levels greater than 85 dBA over an eight-hour period, has a written hearing conservation program compliant with 29 CFR 1910.95 been implemented?
Yes
No
N/A
4. 4. Have engineering and/or administrative controls been put in place prior to the use of PPE?
Yes
No
N/A
5. 5. Are noise hazard areas identified with signs?
Yes
No
N/A
6. 6. Are employees required to wear hearing protection in areas where sound levels exceed 85 dBA?
Yes
No
N/A
7. 7. Have employees been trained on the hearing conservation program and how to select, use, wear and care for the hearing protection?
Yes
No
N/A
8. 8. Does the hearing protection properly fit the employee?
Yes
No
N/A
9. 9. Is damaged, defective or worn hearing protection properly discarded and replaced?
Yes
No
N/A
Section 4: Protective Coats & Pants
1. 1. Have employees been trained on how to select, use, wear and care for the protective clothing?
Yes
No
N/A
2. 2. Does the clothing fit properly and overlap at least two inches?
Yes
No
N/A
3. 3. Is the clothing clean and free of any hazardous substances, chemicals, blood or bodily fluids?
Yes
No
N/A
4. 4. Does the clothing have any tears, cuts, holes or burns?
Yes
No
N/A
5. 5. Is damaged, defective or worn protective clothing properly disposed of and replaced?
Yes
No
N/A
Section 5: General PPE Requirements
1. 1. Has a hazard assessment to identify and control physical and health hazards been completed?
Yes
No
N/A
2. 2. Have engineering and/or administrative controls been applied prior to the use of PPE?
Yes
No
N/A
3. 3. Has appropriate PPE that matches the hazard been identified and provided to employees for use?
Yes
No
N/A
4. 4. Has the effectiveness of the PPE program been reviewed, updated and evaluated periodically?
Yes
No
N/A
5. 5. Have employees been trained on the use and care of the PPE?
Yes
No
N/A
6. 6. Have employees been trained on the limitations of the PPE?
Yes
No
N/A
7. 7. Is the PPE training documented and kept on file?
Yes
No
N/A
8. 8. Are supervisors enforcing the use of required PPE?
Yes
No
N/A
9. 9. Is PPE inspected regularly and properly maintained?
Yes
No
N/A
10. 10. Is worn and damaged PPE removed from service and replaced?
Yes
No
N/A
11. 11. When the following type of PPE is necessary, is the employer providing and paying for the PPE as stated by the OSHA standard 1910.132?
Yes
No
N/A
12. 12. If the employee provides his/her own PPE, is it adequate to protect the worker from hazards in the workplace?
Yes
No
N/A
Section 6: Eye And Face Protection
1. 1. Do employees perform hammering, cutting, grinding, sanding and/or masonry work that produces or could produce particles/dust or debris?
Yes
No
N/A
2. 2. Do employees handle chemicals that could splash into their eyes or face?
Yes
No
N/A
3. 3. Do employees work with wet or powdered cement?
Yes
No
N/A
4. 4. Do employees weld?
Yes
No
N/A
5. 5. Do employees work in dusty or windy conditions?
Yes
No
N/A
6. 6. If “yes” in response to any of the above eye and face protection questions, are the employees using appropriate PPE as applicable (i.e., safety glasses, goggles, welding shields, face shields, etc.)?
Yes
No
N/A
7. 7. Do safety glasses have frames constructed of plastic or metal with impact-resistant lenses?
Yes
No
N/A
8. 8. Do safety glasses have side shields?
Yes
No
N/A
9. 9. Do safety glasses and goggles completely cover the eyes, eye socket and area surrounding the eyes?
Yes
No
N/A
10. 10. Are goggles tight-fitting?
Yes
No
N/A
11. 11. Are welding shields made of fiberglass or vulcanized fibre with a filtered lens?
Yes
No
N/A
12. 12. Do the filter lenses have the appropriate shade number to protect against specific hazards of the welding work being performed?
Yes
No
N/A
13. 13. Is damaged, defective or worn eye/face protection properly discarded and replaced?
Yes
No
N/A
Section 7: Dust Masks
1. 1. Does the mask free of any holes in the filter?
Yes
No
N/A
2. 2. Is the metal nose clip undamaged?
Yes
No
N/A
3. 3. Do the face straps still have proper elasticity?
Yes
No
N/A
Section 8: Respirators
1. 1. Is there a written respiratory protection program in place that is compliant with 29 CFR 1910.134?
Yes
No
N/A
2. 2. Have medical evaluations been conducted for employees required to wear a respirator?
Yes
No
N/A
3. 3. Have employees been fit-tested?
Yes
No
N/A
4. 4. Has air quality monitoring been conducted by a qualified industrial hygienist?
Yes
No
N/A
5. 5. Have employees been trained on the written program and how to use and care for the respirators?
Yes
No
N/A
6. 6. Have all training and fit test results been documented and kept on file?
Yes
No
N/A
7. 7. Is the face piece clean?
Yes
No
N/A
8. 8. Does the exhalation valve allow air to exit mask and not enter?
Yes
No
N/A
9. 9. Is the regulator functioning properly?
Yes
No
N/A
10. 10. Are the buckles, back plate and straps in good condition?
Yes
No
N/A
11. 11. Is the pressure hose in working order?
Yes
No
N/A
12. 12. Are the pressure cylinder, knobs and gauges in good condition and working properly?
Yes
No
N/A
13. 13. Are there any air leaks?
Yes
No
N/A
14. 14. Is there any visible damage to any part of the mask/respirator, hoses or cylinder?
Yes
No
N/A
15. 15. Is the filter or cartridge up-to-date, clean and free of any deterioration/damage?
Yes
No
N/A
16. 16. Is the air cylinder fully charged?
Yes
No
N/A
Section 9: Head Protection
1. 1. Have employees been trained on how to select, use, adjust, wear and care for their head protection?
Yes
No
N/A
2. 2. Is the head protection clean and in good condition?
Yes
No
N/A
3. 3. Is the head protection adjusted properly to fit the wearer’s head?
Yes
No
N/A
4. 4. Are worn straps replaced as needed?
Yes
No
N/A
5. 5. Are hard hats inspected daily for cracks or any other visible damage?
Yes
No
N/A
6. 6. Are hats discarded and replaced if they received a heavy blow, even if damage is not visible?
Yes
No
N/A
7. 7. Are hats kept out of direct sunlight or heat and cleaned only with hot, soapy water?
Yes
No
N/A
8. 8. Are Class A hats worn in manufacturing situations?
Yes
No
N/A
9. 9. Are Class B hats worn in situations with electrical hazards?
Yes
No
N/A