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General • Inspections

PPE Hazard Assessment Certification

Selection of PPE must be based upon the protection needed - For the tasks to be performed - Conditions present - Duration of us - Identified hazards
Ergon - Lubbock 14842
03/29/2023

PPE Hazard Assessment Certification

Selection of PPE must be based upon the protection needed - For the tasks to be performed - Conditions present - Duration of us - Identified hazards

    Facility

    Work Area

    Name

    Body (Torso) Hazards

    Asphalt/Chemical splash

    • Yes
    • No
    • N / A

    If "yes", describe specific hazards

    Burn

    • Yes
    • No
    • N / A

    If "yes", describe specific hazards

    Harmful dust

    • Yes
    • No
    • N / A

    If "yes", describe specific hazards

    Flash fires

    • Yes
    • No
    • N / A

    If "yes", describe specific hazards

    Working over/near water

    • Yes
    • No
    • N / A

    If "yes", describe specific hazards

    Identify PPE required to address hazards

    Eye & Face Hazards

    Asphalt/Chemical splash

    • Yes
    • No
    • N / A

    If "yes", describe specific hazards

    Burn

    • Yes
    • No
    • N / A

    If "yes", describe specific hazards

    Harmful dust

    • Yes
    • No
    • N / A

    If "yes", describe specific hazards

    Flash fires

    • Yes
    • No
    • N / A

    If "yes", describe specific hazards

    Working over/near water

    • Yes
    • No
    • N / A

    If "yes", describe specific hazards

    Identify PPE required to address hazards

    Head Hazards

    Asphalt/Chemical splash

    • Yes
    • No
    • N / A

    If "yes", describe specific hazards

    Burn

    • Yes
    • No
    • N / A

    If "yes", describe specific hazards

    Harmful dust

    • Yes
    • No
    • N / A

    If "yes", describe specific hazards

    Flash fires

    • Yes
    • No
    • N / A

    If "yes", describe specific hazards

    Working over/near water

    • Yes
    • No
    • N / A

    If "yes", describe specific hazards

    Identify PPE required to address hazards

    Foot Hazards

    Asphalt/Chemical splash

    • Yes
    • No
    • N / A

    If "yes", describe specific hazards

    Burn

    • Yes
    • No
    • N / A

    If "yes", describe specific hazards

    Harmful dust

    • Yes
    • No
    • N / A

    If "yes", describe specific hazards

    Flash fires

    • Yes
    • No
    • N / A

    If "yes", describe specific hazards

    Working over/near water

    • Yes
    • No
    • N / A

    If "yes", describe specific hazards

    Identify PPE required to address hazards

    Hand Hazards

    Asphalt/Chemical splash

    • Yes
    • No
    • N / A

    If "yes", describe specific hazards

    Burn

    • Yes
    • No
    • N / A

    If "yes", describe specific hazards

    Harmful dust

    • Yes
    • No
    • N / A

    If "yes", describe specific hazards

    Flash fires

    • Yes
    • No
    • N / A

    If "yes", describe specific hazards

    Working over/near water

    • Yes
    • No
    • N / A

    If "yes", describe specific hazards

    Identify PPE required to address hazards

    Other Hazards

    Describe other hazards if necessary and any PPE to address those hazards

Source: Ergon - Lubbock 14842 (Community Member)

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