SURVEY OF HAZARDS ASSESSMENT FOR PERSONAL PROTCTIVE EQUIPMENT Department: Job Title: Supervisor's Name: Date: EYE AND FACE PROTECTION (1910.133) Does the employee work in areas where there is exposure to eye and face hazards from flying particles, molten metal, liquid chemicals, acids, caustic liquids, chemical gases or vapors or potentially injuries light radiation? Yes ____ No ______ If Yes, Please Describe The Job Task & Hazard HEAD PROTECTION (1910.135) Does the employee work in areas where there is a potential for injury to the head from falling or moving objects? Yes _____ No ______ If Yes, Please Describe The Job Task & Hazard Does the employee work in areas where they are exposed to electrical conductors which could be contacted by the head? Yes ____ No ______ If Yes, Please Describe The Job Task & Hazard FOOT PROTECTION (1910.136) Does the employee work in areas where there is danger of foot injuries due to falling and rolling objects, or objects piercing the sole, and where such employee's feet are exposed to electrical hazards? Yes ________ No ______ If Yes, Please Describe The Job Task & Hazard HAND PROTECTION (1910.138) Does the employee work in areas where their hands are exposed to skin absorption of harmful substances; severe cuts or lacerations; severe abrasions; punctures; chemical burns; thermal burns; and or harmful temperature extremes? Yes ____ No _______ If Yes, Please Describe The Job Task & Hazard IF ANY OF THE ABOVE QUESTIONS WERE ANSWERED YES, PERSONAL PROTECTIVE EQUIPMENT IS REQUIRED FOR THIS JOB TITLE. IT IS NOW NECESSARY FOR PROPER SELECTION, FITTING, COMMUNICATION, TRAINING AND USE OF PERSONAL PROTECTIVE EQUIPMENT TO TAKE PLACE.