Personal Protective Equipment (PPE)

Hazard Assessment Checklist

Assessor’s Name: _____________________________________________________________________________________________ Date of Assessment: _____/_____/_____

HOW TO USE THIS CHECKLIST

Begin your PPE hazard assessment by reviewing OSHA 300 logs, insurance loss runs, first aid logs and similar documents, as these may indicate
hazards in the work area that caused previous injuries. Following that review, conduct a walkthrough survey to identify and assess potential hazards.
Also, be sure to consider non-routine or infrequent tasks that may not be noted during the walkthrough, but that may require PPE when performed.

PPE HAZARD ASSESSMENT CHECKLIST

HAZARD TO EYES/FACE YES NO DESCRIBE HAZARDS NOTED PPE REQUIRED
Flying particles/dust
Chemicals
Blood
Light/radiation

HAZARD TO EARS (NOISE) YES NO DESCRIBE HAZARDS NOTED PPE REQUIRED

Impact noise >140 dB
Continuous noise >85 dB

HAZARD TO LUNGS YES NO DESCRIBE HAZARDS NOTED PPE REQUIRED

Fumes
Mists
Dusts
Vapors

HAZARD TO HEAD YES NO DESCRIBE HAZARDS NOTED PPE REQUIRED

Falling objects
Electrical shock
Low pipe/beams/etc.

Continued >>
Loss Control Services
PPE Hazard Assessment Checklist

PPE HAZARD ASSESSMENT CHECKLIST

HAZARD TO HANDS YES NO DESCRIBE HAZARDS NOTED PPE REQUIRED
Cuts/scrapes/bruises
Hot/cold temperatures
Chemicals
Blood
Electrical shock

HAZARD TO FEET YES NO DESCRIBE HAZARDS NOTED PPE REQUIRED

Falling/dropped objects
Electrical shock
Molten metal/burns
Puncture
Chemicals
Electrostatic discharge

HAZARD TO BODY YES NO DESCRIBE HAZARDS NOTED PPE REQUIRED

Chemicals
Hot/cold temperatures
Dusts
Sunlight/UV exposure

Providing solutions
Learn more about PPE Loss Control Services
Personal Protective Equipment to help our members
program best practices. Help workers stay safe with the right manage risk.®
personal protective equipment.
According to the U.S. Bureau of Labor Statistics, more than 2.8 million
Tools for introducing nonfatal workplace injuries occurred in 2017, including nearly 883,000

For more information about PPE

PPE in your workplace. involving days away from work.1 Many of these injuries — such as cuts,
objects in the eye and inhalation of hazardous material — could have
Nationwide Loss Control been prevented with proper personal protective equipment, or PPE.
Services offers additional Such items include gloves, safety glasses, goggles, masks, steel-toed
documents to assist boots, earplugs / earmuffs, hard hats, respirators and full body suits.

programs and their role in helping

with your PPE hazard
assessment. Ask your agent Before PPE is considered, however, you should first explore other

For your risk management

or Nationwide representative methods of minimizing employees’ exposure to workplace hazards.
for our PPE Hazard See p. 4 for a discussion of several options available to you.

workers avoid workplace injuries,

Assessment Checklist
(CMO-0919AO) and Job Conduct a PPE hazard assessment.
Hazard Analysis technical
brochure (CMO-0395AO).

and safety needs, contact

The first step in developing a PPE program is to identify hazards in
the workplace, a process known as PPE hazard assessment. Potential

ask your agent or Nationwide Loss

Equipment
(PPE) hazards are often physical, such as moving objects, fluctuating
Personal Protective Checklist
Hazard Assessment _____________________
Date of Assessment:
_____/_____/_____ temperatures, high intensity lighting, rolling or pinching objects,
electrical connections and sharp edges. You should also consider health
____________________________________
indicate
as these may hazards.
Name: ____________________________________ documents,
Assessor’s and similar assess potential
first aid logs identify and when performed.
loss runs, survey to require PPE
USE THIS
CHECKLIST logs, insurance conduct a walkthrough but that may
HOW TO OSHA 300 that review,
by reviewing the walkthrough,
assessment Following noted during
PPE hazard previous injuries. may not be

hazards such as overexposure to harmful dusts, chemicals or radiation.

Begin your that caused tasks that PPE REQUIRED
the work area or infrequent
hazards in non-routine
to consider NOTED
Also, be sure HAZARDS
DESCRIBE

Nationwide Loss Control

NO
YES Loss Control
TO EYES/FACE Services
HAZARD Job Hazard
Analysis
Flying particles/dust
PPE REQUIRED

Control Services representative

Chemicals
NOTED
Blood HAZARDS
DESCRIBE
NO

A process
Light/radiation YES
(NOISE) PPE REQUIRED
TO EARS

Using a checklist such as the one featured in the box to the left, begin
HAZARD

in the way for uncoverin

>140 dB NOTED
Impact noise HAZARDS
dB DESCRIBE
noise >85 NO

your businessg hazards

Continuous YES
TO LUNGS
HAZARD
Fumes
works.
PPE REQUIRED

the assessment with a review of OSHA 300 logs, insurance loss runs,
Mists A job hazard
NOTED that may analysis
Dusts HAZARDS
DESCRIBE be present (JHA) is a
NO The job in the way procedure
Vapors YES being evaluated
steps employees work gets used to identify
TO HEAD can be
HAZARD the process take anything done in your flaws
manufactures. workers while changing from the organization.
combination
Falling objects use to
JHA is produce a flat tire on
prevent the finished a fleet vehicle,of

first aid logs and similar documents, as these may indicate hazards that
Electrical
shock accidental a self-inspection
and those >> goods
Continued
yet to be
losses,
and tool created a businessto
Low pipe/beams/etc. introduced.it can be applied to help
both to businesses
A systematic existing
jobs
review
Finding of all your
an unsuspected
The challenge jobs.

have caused previous injuries and merit extra attention. Following the
can help is to find hazard after
your business and control an accident
of all jobs.
The goal accomplish hazards beforetakes place is
the planning/design is to identify that through a loss occurs.easy.
modifications phase, unexpected a systematic JHAs
or that
raw materials, in work processes, slip in as hazards overlooked review
interim as site layout, a result of subsequentin
changes well as any intermediate equipment
ways. When can increase

historical injury review, conduct a walkthrough survey to identify and

and final and tools,

for a copy of this document:

recommendations hazards the
are identified,job hazard products.
the hazard for exposure These
the

Services: 1-866-808-2101
can becomeeffective controls JHA shifts in unexpected
The JHA an accident. that can gears to developing
process be implemented
corresponding focuses before
negative on the following
Job hazard n Physical consequences factors
associated and the

assess potential hazards. When conducting the walkthrough, consider

analysis associated
hazards — Slips,
is a self-inspection with a
job
falls, burns, with them:
n Hazardous sprains,
strains
and cuts
tool created exposures materials and/or
to help or hazardous to harmful energies — Short
environments,
businesses energies
(electricity, toxic substances
and long-term
prevent n Ergonomic
heat, radiation, (chemicals)

unseen tasks that are non-routine or infrequent, but that require PPE
accidental repetitive risk — Hazardous noise) and/
or forceful
losses. n Work actions
motions,
awkward
or tasks,
poorly
rule or
procedure-related focused postures, highly
defined impacts
unnecessary, rules or risks — Worker and vibration
personal outdated the implementation confusion
preferences or incorrect; of procedures due to
that alter and practices also, employee
the way that are

when performed. The following sources can also help point to the
a job is
n Special done and passed on from shortcuts, habits,
aptitudes, lead to other workers
for a particular knowledge, injury or
property
knowledge job — Danger skills and/or damage
opportunities and skill to workers physical
set to perform who lack requirements
redesigning by management jobs competently, the correct
danger a job to recognize
of harm so a larger number or
a preferable missed

need for PPE:

of workers option
can handle of
it without

Continued
>>

n Safety data sheets (SDS) describe chemical hazards and

or LCS@nationwide.com.
suggested PPE.

n Equipment and operator manuals describe manufacturer’s

recommendations for PPE.

Personal Protective Equipment n Supervisors and employees performing the job every day often have
a wealth of information about hazards, especially for non-routine
tasks that can’t be directly observed during the walkthrough.

Tech Brochure (CMO-0918AO) n Job hazard analyses, which document all hazards of a job, often
identify PPE needs as part of the analysis.
1
“Employer-Related Workplace Injuries and Illnesses, 2017,” press release, Bureau of Labor
Statistics, Nov. 8, 2018).

Continued >>

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