Personal Protective Equipment (PPE) Hazard Assessment Form
Assess PPE-related hazards, required equipment, and training status for your work area or task. Complete all sections for a thorough assessment.
Work Area or Task Being Assessed
*
Type of Hazard Exposure Present
*
Chemical
Biological
Physical (e.g., noise, heat, radiation)
Mechanical (e.g., cuts, impact)
Electrical
Other
Required PPE for This Area/Task
*
Safety Glasses/Goggles
Face Shield
Gloves
Hearing Protection
Respirator/Mask
Protective Clothing
Safety Footwear
Hard Hat
Other
PPE Condition Assessment
*
Rows
In Good Condition
Needs Repair/Replacement
Not Applicable
Safety Glasses/Goggles
1
2
3
Face Shield
4
5
6
Gloves
7
8
9
Hearing Protection
10
11
12
Respirator/Mask
13
14
15
Protective Clothing
16
17
18
Safety Footwear
19
20
21
Hard Hat
22
23
24
Is required PPE available at the site?
*
Yes
No
Partial
Have all personnel received PPE training for this task?
*
Yes
No
Some/Partial
PPE Training Effectiveness
1
2
3
4
5
Additional Hazards or Comments
Assessor Name
*
First Name
Last Name
Assessment Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Should be Empty: