Personal Protective Equipment Hazard Assessment Checklist

Hazard

Eye/Face
Flying objects
Splash (metals)
Splash (chemicals)
Dusts
Mists
Gas welding (Shade 4-8)
Cutting/torch (Shade 3-6)
Brazing (Shade 3-4)
Weld/electric (Shade 10-14)
Other:

PPE Selection

Spectacle
Spectacles w/side shield
Face shield
Goggles
Sealed goggles
Welding helmet
Welding shield
Other:

Hazard Severity

CAT I: Catastrophic
Hazard may cause death or loss of facility.
CAT II: Critical
May cause severe injury, severe illness or major property damage.
CAT III: Marginal
May cause minor injury, minor illness or minor property damage.
CAT IV: Negligible
Probably would not cause injury or minor illness

Mishap Probability

A – Likely to occur immediately or within a short period of time
B – Probably will occur in time
C – May occur in time
D – Unlikely to occur

Hazard

Head
Falling objects
Electrical shock
Other

PPE Selection

Class A (<2000 volts)
Class B (>2000 volts)
Class C (Conductive)

Hazard Severity

CAT I: Catastrophic
CAT II: Critical
CAT III: Marginal
CAT IV: Negligible

Mishap Probability

A – Likely to occur immediately or within a short period of time
B – Probably will occur in time
C – May occur in time
D -- Unlikely to occur

Hazard

Foot
Falling objects
Rolling objects
Piercing sole
Electrical hazard
Metatarsal protection

PPE Selection

Safety tip shoes
Safety shoes w/metatarsal protection
Other

Hazard Severity

CAT I: Catastrophic
CAT II: Critical
CAT III: Marginal
CAT IV: Negligible

Mishap Probability

A – Likely to occur immediately or within a short period of time
B – Probably will occur in time
C – May occur in time
D -- Unlikely to occur

Hazard

Hand
Chemical absorption
Chemical burns
Abrasions
Punctures
Thermal burns
Temperature extremes

PPE Selection

Leather gloves
Kevlar gloves
Cryogenic gloves
Chemical gloves (specify material:_______)
Other: (cloth gloves are also acceptable)

Hazard Severity

CAT I: Catastrophic
CAT II: Critical
CAT III: Marginal
CAT IV: Negligible

Mishap Probability

A – Likely to occur immediately or within a short period of time
B – Probably will occur in time
C – May occur in time
D -- Unlikely to occur

XL Environmental • Risk Control Division • 520 Eagleview Boulevard, PO Box 636, Exton, PA 19341 • Phone: 800-327-1414 • Fax: 610-458-7285 • xlenvironmental.com

XL Environmental is a division of XL Specialty Insurance Company.