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Hazard Assessment Form

Quick Tips #192
Instructions

Print this Hazard Assessment Form and use it as a guide for your walk-through survey. It helps identify the hazards in each work area. Once you've completed the Hazard Assessment Form, review the Guidelines for Selecting Personal Protective Equipment.

Head Hazards

Tasks that can cause head hazards include working below other workers who use tools and materials which could fall, working on energized electrical equipment, working with chemicals and working under machinery or processes which might cause materials or objects to fall.

Check the appropriate box for each hazard:

       
Description of hazards: 
Head Hazards
Burn Yes No  
Chemical Splash Yes No  
Electrical Shock Yes No  
Impact Yes No  

 

Eye & Face Hazards

Tasks that can cause eye or face hazards include working with acids and chemicals, chipping, grinding, furnace operations, sanding, welding and woodworking.

Check the appropriate box for each hazard:

       
Description of hazards:


Eye Hazards
Chemicals Yes No  
Dust Yes No  
Heat Yes No  
Impact Yes No  
Light/Radiation Yes No  
Grinding Yes No  

 

Respiratory Hazards

Respirators should not be the first choice for respiratory protection in the workplace. Only use respirators when engineering or administrative controls are not technically feasible, while engineering controls are being installed and/or repaired or when emergencies or other temporary situations arise.

Check the appropriate box for each hazard:

       
Description of hazards: 


Respiratory Hazards
Toxic Gases or Vapors Yes No  
Chemicals Yes No  
Dust or Particulate Yes No  
Fumes Yes No  
Oxygen Deficiency Yes No  
Other Yes No  

 

Hearing Hazards

Tasks that can cause hearing hazards include working with or around loud machinery or tools.

Check the appropriate box for each hazard:

       
Description of hazards: 
Hearing Hazards
Loud Noise Yes No  
Impact Noise Yes No  
Loud Machinery Yes No  
Other Yes No  

 

Hand Hazards

Tasks that can cause hand hazards include cutting material, working with chemicals and working with hot objects.

Check the appropriate box for each hazard:

       
Description of hazards: 
Hand Hazards
Burns Yes No  
Chemical Exposure Yes No  
Cuts/Abrasion Yes No  
Puncture Yes No  

 

Foot Hazards

Tasks that can cause foot hazards include carrying or handling materials that could be dropped, performing manual material handling and working with chemicals.

Check the appropriate box for each hazard:

       
Description of hazards: 
Foot Hazards
Chemical Exposure Yes No  
Compression Yes No  
Impact Yes No  
Puncture Yes No  

 

Other Required PPE

Do hazards exist that require PPE for the Body? Chemical splash hazards, electrical arc hazards and bloodborne pathogens are some examples of hazards that can affect the body and may require PPE to protect clothing and skin from harm or contamination.

Check the appropriate box for each hazard:

       
Description of hazards: 

Body Hazards
Chemical Yes No  
Heat/Arc Yes No  
Hazardous Particulate ie. asbestos/lead Yes No  
Non-Hazardous Particulate Yes No  

 

Guidelines for Selecting Personal Protective Equipment (PPE)

Note: Personal protective equipment alone should not be relied on to provide protection against hazards, but should be used in conjunction with guards, engineering controls and sound manufacturing practices.

  1. Familiarize yourself with the potential hazards in the area and the types of PPE that are available.
  2. Consider the hazards associated with the environment (impact velocities, masses, projectable shape, radiation intensities, etc.).
  3. Select PPE that ensures a greater level of protection than the minimum required to protect workers from the hazards.
  4. Fit the worker with the PPE and give instructions on its use and care. It is very important that workers be made aware of all warning labels for and limitations of their PPE.

Based on the hazard assessment for ______________________________ (Job Classification), the following PPE is required:

Head Hazard Job PPE
     
     
     
     

 

 

Eye & Face Hazard Job PPE
     
     
     
     

 

Respiratory Hazard Job PPE
     
     
     
     

 

Hearing Hazard Job PPE
     
     
     
     

 

Hand Hazard Job PPE
     
     
     
     

 

Foot Hazard Job PPE
     
     
     
     

 

Other Hazard Job PPE
     
     
     
     

Sources

OSHA Title 29 1910.132

(Rev. 6/2014)


Find even more information you can use to help make informed decisions about the regulatory issues you face in your workplace every day. View all Quick Tips Technical Resources at www.grainger.com/quicktips.

Think Safety. Think Grainger.®
Grainger has the products, services and resources to help keep employees safe and healthy while operating safer facilities. You’ll also find a network of safety resources that help you stay in compliance and protect employees from hazardous situations. Count on Grainger for lockout tagout, fall protection equipment, confined space products, safety signs, personal protective equipment (PPE), emergency response and so much more!

Please Note:
The content in this newsletter is intended for general information purposes only. This publication is not a substitute for review of the applicable government regulations and standards, and should not be construed as legal advice or opinion. Readers with specific compliance questions should refer to the cited regulation or consult with an attorney.


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