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PPE Evaluation Form

Use this template to evaluate which types of PPE are required to perform the task safely. There are endless onsite hazards that could damage a worker’s health. Ensuring that these risks are mitigated with the proper PPE is of utmost importance to stay in compliance with the occupational safety and health act.

Streamline PPE Selection with our Evaluation Form

Personal Protective Equipment (PPE) is essential for protecting workers from hazards, but selecting the right PPE can be a daunting task. Our PPE Evaluation Form simplifies the process by allowing you to assess the effectiveness of different PPE options.

The form includes sections for assessing the type of hazard, the level of protection needed, and any specific requirements for the job. It also includes a section for evaluating the comfort and fit of the PPE, as these factors can affect worker compliance.

By using our PPE Evaluation Form, you can ensure that the PPE selected meets the needs of the job, while also providing the necessary level of protection. It also helps to ensure that workers are comfortable and will be more likely to wear the PPE as required.

Protect your workforce by using our PPE Evaluation Form to select the right PPE for the job.

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PPE Evaluation Form

INSTRUCTIONS 1. Answer the following questions by typing in your answers in the text field. 2. On the dropdown list, select the items that apply to each hazard. 3. Indicate the description of the hazard and the required PPE. 4. Complete audit by providing digital signature

EYE HAZARDS

Handling/dispensing chemicals and ingredients; working around UV lights; chipping, sanding, grinding, welding, metal working; tasks that generate dust

Select all that apply for each hazard from the drop down list.

Description of Hazard

Required PPE

HEAD/NECK/FACE HAZARDS

Handling/dispensing chemicals and ingredients, chipping, sanding or grinding metal or wood; working below others, working on energized equipment, working in confined spaces

Select all that apply for each hazard from the drop down list.

Description of Hazard

Required PPE

FOOT HAZARDS

Exposure to chemicals; wet environments; welding and cutting; material handling; uneven walking/working surfaces

Select all that apply for each hazard from the drop down list.

Description of Hazard

Required PPE

HAND HAZARDS

Handling/dispensing chemicals and ingredients; exposure to abrasive materials; using knives or other sharp objects; working with hot or cold materials; food service prep

Select all that apply for each hazard from the drop down list.

Description of Hazard

Required PPE

BODY/TORSO HAZARDS

Handling/dispensing chemicals or ingredients; exposure to abrasive materials; cutting, brazing, welding, chipping or sanding; working around electrical panels

Select all that apply for each hazard from the drop down list.

Description of Hazard

Required PPE

FALL HAZARDS

Working on raised surfaces of 4 feet or morel; ladder use

Select all that apply for each hazard from the drop down list.

Description of Hazard

Required PPE

NOISE HAZARDS

Noise levels above 85 dBA; working around pneumatic equipment; using powered hand tools

Select all that apply for each hazard from the drop down list.

Description of Hazard

Required PPE

RESPIRATORY HAZARDS

Handling/using highly hazardous chemicals; tasks that generate dust and/or fumes; cutting, brazing on certain metals (stainless steel);

Select all that apply for each hazard from the drop down list.

Description of Hazard

Required PPE

Auditor's Signature

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This template, developed by Lumiform employees, serves as a starting point for businesses using the Lumiform platform and is intended as a hypothetical example only. It does not replace professional advice. Companies should consult qualified professionals to assess the suitability and legality of using this template in their specific workplace or jurisdiction. Lumiform is not liable for any errors or omissions in this template or for any actions taken based on its content.