3/2/23, 10:35 AM PPE Checklist - SafetyCulture

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Title Page

Company Name

Client / Site

Conducted on 

Prepared by

Location 

PPE Evaluation Form

Nature of work

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Identify potential hazards at work (select all that apply)

Eye Head/Neck/Face Foot Hand Body/Torso Fall Noise Respiratory

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.

Dust Fall
Chemical Cut/Abrasions Dust/Flying Particulates Electrical Electrical Hazard He
Exposure Debris Arc Shock

Description of Hazard

Required PPE

Does the equipment undergo testing and in a good condition?

Yes No

Take a photo 

Does the equipment fit perfectly?

Yes No

Take a photo 

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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.

Dust Fall
Chemical Cut/Abrasions Dust/Flying Particulates Electrical Electrical Hazard He
Exposure Debris Arc Shock

Description of Hazard

Required PPE

Does the equipment undergo testing and in a good condition?

Yes No

Take a photo 

Does the equipment fit perfectly?

Yes No

Take a photo 

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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.

Dust Fall
Chemical Cut/Abrasions Dust/Flying Particulates Electrical Electrical Hazard He
Exposure Debris Arc Shock

Description of Hazard

Required PPE

Does the equipment undergo testing and in a good condition?

Yes No

Take a photo 

Does the equipment fit perfectly?

Yes No

Take a photo 

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

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

Dust Fall
Chemical Cut/Abrasions Dust/Flying Particulates Electrical Electrical Hazard He
Exposure Debris Arc Shock

Description of Hazard

Required PPE

Does the equipment undergo testing and in a good condition?

Yes No

Take a photo 

REFERENCE: Gloves are resistant to chemicals

[This is an example of how you can use iAuditor to include best practice reference
images in your templates to assist with inspections]

Does the equipment fit perfectly?

Yes No

Take a photo 

BODY/TORSO HAZARDS

Handling/dispensing chemicals or ingredients; exposure to abrasive materials; cutting,

brazing, welding, chipping or sanding; working around electrical panels

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

Dust Fall
Chemical Cut/Abrasions Dust/Flying Particulates Electrical Electrical Hazard He
Exposure Debris Arc Shock

Description of Hazard

Required PPE

Does the equipment undergo testing and in a good condition?

Yes No

Take a photo 

Does the equipment fit perfectly?

Yes No

Take a photo 

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.

Dust Fall
Chemical Cut/Abrasions Dust/Flying Particulates Electrical Electrical Hazard He
Exposure Debris Arc Shock

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Description of Hazard

Required PPE

Does the equipment undergo testing and in a good condition?

Yes No

Take a photo 

Does the equipment fit perfectly?

Yes No

Take a photo 

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.

Dust Fall
Chemical Cut/Abrasions Dust/Flying Particulates Electrical Electrical Hazard He
Exposure Debris Arc Shock

Description of Hazard

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Required PPE

Does the equipment undergo testing and in a good condition?

Yes No

Take a photo 

Does the equipment fit perfectly?

Yes No

Take a photo 

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.

Dust Fall
Chemical Cut/Abrasions Dust/Flying Particulates Electrical Electrical Hazard He
Exposure Debris Arc Shock

Description of Hazard

Required PPE

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Does the equipment undergo testing and in a good condition?

Yes No

Take a photo 

Does the equipment fit perfectly?

Yes No

Take a photo 

RECOMMENDATION

State recommendations here

COMPLETION

Auditor's Full Name and Signature 

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's
solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice.
You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should
independently determine whether the template is suitable for your circumstances.

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