Personal Protective Equipment (PPE) Analysis Worksheet

Department
________________________
Job Title
________________________
Location of Job Duties
________________________
Analysis Done By

Hazard Key
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.

Cut
Abrasion
Burn
Fall
Falling objects
Noise
Flying particles
Inhalation
Bump
Slip
Splash
Other

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Body Part Key

13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.

Head
Face
Eye(s)
Ear(s)
Respiratory System
Trunk
Arm(s)
Hand(s)
Finger(s)
Leg(s)
Foot/Feet
Toe(s)
Other

Date

PPE Required Key

A. Hard hat
B. Chemical goggles
C. Safety glasses
D. Ear plugs
E. Ear muffs
F. Body harness
G. Gloves (list type)
________________________
H. Shoes/boots (list type)
________________________
I. Respirator
J. Other ________________

________________________

Activities/Tasks

Potential Hazards

Body Part(s)

PPE Required