Workplace Hand Safety Assessment Form
Use this form to evaluate hand-safety conditions and practices in your workplace. The "Workplace Hand Safety Assessment Form" ensures a structured review for improved safety.
Assessor's Full Name
*
First Name
Last Name
Department or Work Area
*
Date of Assessment
*
-
Month
-
Day
Year
Date
Are appropriate hand protection (e.g., gloves) available and in use?
*
Yes
No
Not Applicable
Rate the overall condition of hand protection equipment.
*
1
2
3
4
5
Are hand-related hazards clearly identified in the work area?
*
Yes
No
Partially
Hand Safety Practices Matrix
*
Rows
Yes
No
Needs Improvement
Proper glove use
1
2
3
Hands kept away from moving parts
4
5
6
Regular hand safety training
7
8
9
Immediate reporting of hand injuries
10
11
12
Have there been any recent hand injuries or near-misses in this area?
*
Yes
No
If yes, please describe the incident(s) and any corrective actions taken.
Additional comments or suggestions to improve hand safety
Submit Assessment
Should be Empty: