General PPE RequirementsHas a hazard assessment to identify and control physical and health hazards been completed Yes No N/A Have engineering and/or administrative controls been applied prior to the use of PPE Yes No N/A Has appropriate PPE that matches the hazard been identified and provided to employees for use Yes No N/A Has the effectiveness of the PPE program been reviewed, updated and evaluated periodically Yes No N/A Have employees been trained on the use and care of the PPE Yes No N/A Have employees been trained on the limitations of the PPE Yes No N/A ?Is the PPE training documented and kept on file Yes No N/A ?Are supervisors enforcing the use of required PPE Yes No N/A ?Is PPE inspected regularly and properly maintained Yes No N/A Is worn and damaged PPE removed from service and replaced Yes No N/A 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 If the employee provides his/her own PPE, is it adequate to protect the worker from hazards in the workplace Yes No N/A Eye And Face ProtectionDo employees perform hammering, cutting, grinding, sanding and/or masonry work that produces or could produce particles/dust or debris Yes No N/A Do employees handle chemicals that could splash into their eyes or face Yes No N/A ?Do employees work with wet or powdered cement Yes No N/A ?Do employees weld Yes No N/A ?Do employees work in dusty or windy conditions Yes No N/A 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 Do safety glasses have frames constructed of plastic or metal with impact-resistant lenses Yes No N/A ?Do safety glasses have side shields Yes No N/A Do safety glasses and goggles completely cover the eyes, eye socket and area surrounding the eyes Yes No N/A ?Are goggles tight-fitting Yes No N/A Are welding shields made of fiberglass or vulcanized fibre with a filtered lens Yes No N/A Do the filter lenses have the appropriate shade number to protect against specific hazards of the welding work being performed Yes No N/A Is damaged, defective or worn eye/face protection properly discarded and replaced Yes No N/A Dust Masks?Does the mask free of any holes in the filter Yes No N/A ?Is the metal nose clip undamaged Yes No N/A ?Do the face straps still have proper elasticity Yes No N/A RespiratorsIs there a written respiratory protection program in place that is compliant with 29 CFR 1910.134 Yes No N/A Have medical evaluations been conducted for employees required to wear a respirator Yes No N/A ?Have employees been fit-tested Yes No N/A Has air quality monitoring been conducted by a qualified industrial hygienist Yes No N/A Have employees been trained on the written program and how to use and care for the respirators Yes No N/A Have all training and fit test results been documented and kept on file Yes No N/A ?Is the face piece clean Yes No N/A Does the exhalation valve allow air to exit mask and not enter Yes No N/A ?Is the regulator functioning properly Yes No N/A ?Are the buckles, back plate and straps in good condition Yes No N/A ?Is the pressure hose in working order Yes No N/A Are the pressure cylinder, knobs and gauges in good condition and working properly Yes No N/A ?Are there any air leaks Yes No N/A Is there any visible damage to any part of the mask/respirator, hoses or cylinder Yes No N/A Is the filter or cartridge up-to-date, clean and free of any deterioration/damage Yes No N/A ?Is the air cylinder fully charged Yes No N/A Head ProtectionHave employees been trained on how to select, use, adjust, wear and care for their head protection Yes No N/A ?Is the head protection clean and in good condition Yes No N/A Is the head protection adjusted properly to fit the wearer’s head Yes No N/A ?Are worn straps replaced as needed Yes No N/A Are hard hats inspected daily for cracks or any other visible damage Yes No N/A Are hats discarded and replaced if they received a heavy blow, even if damage is not visible Yes No N/A Are hats kept out of direct sunlight or heat and cleaned only with hot, soapy water Yes No N/A ?Are Class A hats worn in manufacturing situations Yes No N/A ?Are Class B hats worn in situations with electrical hazards Yes No N/A Foot ProtectionHas 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 ?Is protective footwear sturdy with non-skid soles Yes No N/A Is steel-toed or non-metallic safety-toed footwear required to resist impact Yes No N/A In areas where there is risk for a puncture type injury, do shoes have flexible metal soles or inner shoes Yes No N/A Do employees wear the proper protective footwear when working in areas that have electrical hazards Yes No N/A Are employees wearing footwear with slip resistant soles when working in wet or slippery areas Yes No N/A 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 Is damaged, defective or worn foot protection properly discarded and replaced Yes No N/A Hand ProtectionHas 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 Have employees been trained on the differences in types of gloves and when and how to use them Yes No N/A 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 Are the gloves maintained per manufacturer’s recommendations Yes No N/A Are employees who have allergies to certain gloves given alternative gloves Yes No N/A Do gloves fit properly and are they rated for the specific task being performed Yes No N/A Is damaged, defective or worn hand protection properly discarded and replaced Yes No N/A Hearing ProtectionAre there work areas in which employees are exposed to excessively loud noise Yes No N/A Has noise monitoring been conducted by an industrial hygienist or other qualified person Yes No N/A 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 Have engineering and/or administrative controls been put in place prior to the use of PPE Yes No N/A ?Are noise hazard areas identified with signs Yes No N/A Are employees required to wear hearing protection in areas where sound levels exceed 85 dBA Yes No N/A 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 ?Does the hearing protection properly fit the employee Yes No N/A Is damaged, defective or worn hearing protection properly discarded and replaced Yes No N/A Protective Coats & PantsHave employees been trained on how to select, use, wear and care for the protective clothing Yes No N/A Does the clothing fit properly and overlap at least two inches Yes No N/A Is the clothing clean and free of any hazardous substances, chemicals, blood or bodily fluids Yes No N/A ?Does the clothing have any tears, cuts, holes or burns Yes No N/A Is damaged, defective or worn protective clothing properly disposed of and replaced Yes No N/A
