JOB HAZARD ANALYSIS/PPE CERTIFICATION

FACILITY: MACHINE/EQUIPMENT I.D.: ANALYSIS BY: Gloves - Chemical Resistant Gloves - Cut Resistant Gloves - Cotton Gloves - Leather Gloves - Steel Mesh DEPARTMENT: TOOLS/EQUIPMENT USED:

JHA NO.

ORIGINAL JHA DATE: REVISION DATE: PAGE_ 1__OF __

APPROVED BY (Business Unit Leader): Name: Required Personal Protective Equipment Hard Hat Forearm Guard Other: Face Shield Stomach Guard Other: Goggles Rubber Boots - steel toed Other: Safety Glasses Suit (Pants, Jacket) Chemical Resistant Other: Ear Plugs Sleeves - Chemical Resistant Other:

REVIEWED BY (Resource):

Date:

NOTE TO EMPLOYEES: CONDUCT A PRE-OPERATION SAFETY INSPECTION OF WORKSTATION, TOOLS, EQUIPMENT/MACHINERY, PPE, AND WORK ENVIRONMENT BEFORE PERFORMING THE JOB! REPORT OBSERVED DEFICIENCIES IMMEDIATELY! TASKS, PROCESSES, CONTRIBUTING FACTORS. POTENTIAL HAZARDS EXISTING CONTROLS RISK ASSESSMENT SEVERITY