Rev: 8/2004 by EHS

JOB HAZARD ANALYSIS & PPE CHECKLIST

Name: Department/Lab/Shop: Date:

I am Name of Employee:
Analyzing ‰ An Individual Position (in your Title of Position:
(check the lab/shop/department)
appropriate Position Type:
box): ‰ A Position Description for Title of Position:
a Group of Employees Position Type:

Eye Hazards may include the following: working with chemicals, chipping, sanding, grinding, welding, metal & wood working,
radioactive materials, biological substances/organisms, laboratory work/research.
Check the appropriate box for each Description of hazard(s): Based upon the hazard assessment, the
hazard: following PPE is required:
Chemical Exposure ‰ Yes ‰ No
Dust/Flying Debris ‰ Yes ‰ No
High Heat/Cold Temp. ‰ Yes ‰ No
Light/Ionizing Radiation ‰ Yes ‰ No

Head Hazards may include the following: working below other employees who are using tools or materials that could fall; working
on energized equipment; and working in confined spaces & trenches, construction sites.
Check the appropriate box for each hazard: Description of hazard(s): Based upon the hazard assessment, the
Impact ‰ Yes ‰ No following PPE is required:

Electrical Shock ‰ Yes ‰ No

Noise Hazards may include the following: grinding, sanding, using pneumatic equipment, generators, motors, boilers,
jackhammers, lawn equipment, working in heating plant. ADDITIONAL TRAINING/MONITORING VIA EHS REQUIRED.
Check the appropriate box for each hazard: Description of hazard(s): Based upon the hazard assessment, the
following PPE is required:
Noisy Work Environment ‰ Yes ‰ No
 Rev: 8/2004 by EHS

Foot Hazards may include the following: exposure to chemicals, welding, cutting, materials handling, demolition, renovation,
construction, electrical work, flammable or explosive materials, forklifts, and heavy moving equipment.
Check the appropriate box for each hazard: Description of hazard(s): Based upon the hazard assessment, the
Chemical Exposure ‰ Yes ‰ No following PPE is required:
Impact/Compression ‰ Yes ‰ No
High Heat/Cold Temp. ‰ Yes ‰ No
Slips/Trips/Falls ‰ Yes ‰ No
Puncture ‰ Yes ‰ No
Slippery/Wet Surfaces ‰ Yes ‰ No
Electrical ‰ Yes ‰ No
Flammable/Explosive
Atmospheres
‰ Yes ‰ No

Hand Hazards may include the following: work with chemicals, abrasion/cut hazards during demolition & renovation,
woodworking, hot or cold objects/materials, medical facilities, lab research, radioactive & biological materials. ADDITIONAL
TRAINING REQUIRED VIA EHS FOR BLOODBORNE PATHOGENS.
Check the appropriate box for each hazard: Description of hazard(s): Based upon the hazard assessment, the
Chemical Exposure ‰ Yes ‰ No following PPE is required:
Cuts/Abrasion ‰ Yes ‰ No
High Heat/Cold Temp. ‰ Yes ‰ No
Electrical Shock ‰ Yes ‰ No
Puncture ‰ Yes ‰ No
BBP/Infectious Waste ‰ Yes ‰ No

Body/Torso Hazards may include the following: chemical/hazardous material exposure, abrasive blasting, welding, cutting,
brazing, chipping, sanding, grinding, using chain saws, asbestos work, boiler work, high heat/cold, radiological or biological work.
Check the appropriate box for each hazard: Description of hazard(s): Based upon the hazard assessment, the
Chemical Exposure ‰ Yes ‰ No following PPE is required:
Abrasion ‰ Yes ‰ No
High Heat/Cold Temp. ‰ Yes ‰ No
Impact ‰ Yes ‰ No

Respiratory Hazards may include the following: using certain chemicals outside a fume hood, applying paints/chemicals in
confined spaces, welding certain metals, disturbing asbestos, lead, or mold. ADDITIONAL TRAINING REQUIRED VIA EHS.
Check the appropriate box for each hazard: Description of hazard(s): Based upon the hazard assessment, the
Chemical Exposure ‰ Yes ‰ No following PPE is required:
Confined Space Work ‰ Yes ‰ No
Particulate Exposure ‰ Yes ‰ No
Welding/Cutting ‰ Yes ‰ No
 Rev: 8/2004 by EHS

PPE RESOURCES & CONTACT INFORMATION

PPE Suppliers – This is by no means a full list of PPE suppliers. This is only a sample of a few companies to illustrate that there are
numerous options when purchasing PPE.
• Ansell - http://www.ansell-edmont.com/ - (800) 800-0444 - Protective gloves & clothing
• Best Gloves -http://www.bestglove.com/aspx/default.aspx – (800) 241-0323 - Protective gloves
• DuPont - http://www.personalprotection.dupont.com/en/index.shtm - (800) 931-3456 - Protective clothing
• Lab Safety Supply – http://www.labsafety.com/ - (800) 356-0783 - All types of PPE
• MSA Safety Works - http://www.msasafetyworks.com/home.html - (888) 672-4692 - All types of PPE
• North Safety Products - http://www.northsafety.com/usa/en/bs_home.html - (800) 430-4110 - All types of PPE
• 3 M Safety Products - http://solutions.3m.com/wps/portal/_s.155/8204 - (800) 328-1667 - All types of PPE

PPE Regulations & Information

• OSHA PPE Standard - http://www.osha.gov/SLTC/personalprotectiveequipment/standards.html

EHS Contact Information – Contact EHS with any questions regarding job hazard analysis, PPE selection & usage, training, and
program information.

Adriane Mohlenkamp
Environmental Safety Coordinator
Hudson Health Center 215
Office - 593-1662