Rev: 8/2004 by EHS
J
J
O
O
B
B
H
H
A
A
Z
Z
A
A
R
R
D
D
A
A
N
N
A
A
L
L
Y
Y
S
S
I
I
S
S
&
&
P
P
P
P
E
E
C
C
H
H
E
E
C
C
K
K
L
L
I
I
S
S
T
T
Name: Department/Lab/Shop: Date:
A Worksite
Identify Site:
Name of Employee:
Title of Position:
An Individual Position (in your
lab/shop/department)
Position Type:
Title of Position:
I am
Analyzing
(check the
appropriate
box):
A
Position Description for
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
hazard:
Chemical Exposure
Yes No
Dust/Flying Debris
Yes No
High Heat/Cold Temp.
Yes No
Light/Ionizing Radiation
Yes No
Description of hazard(s): Based upon the hazard assessment, the
following PPE is required:
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:
Impact
Yes No
Electrical Shock
Yes No
Description of hazard(s): Based upon the hazard assessment, the
following PPE is required:
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:
Noisy Work Environment
Yes No
Description of hazard(s): Based upon the hazard assessment, the
following PPE is required:
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:
Chemical Exposure
Yes No
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
Description of hazard(s): Based upon the hazard assessment, the
following PPE is required:
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:
Chemical Exposure
Yes No
Cuts/Abrasion
Yes No
High Heat/Cold Temp.
Yes No
Electrical Shock
Yes No
Puncture
Yes No
BBP/Infectious Waste
Yes No
Description of hazard(s): Based upon the hazard assessment, the
following PPE is required:
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:
Chemical Exposure
Yes No
Abrasion
Yes No
High Heat/Cold Temp.
Yes No
Impact
Yes No
Description of hazard(s): Based upon the hazard assessment, the
following PPE is required:
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:
Chemical Exposure
Yes No
Confined Space Work
Yes No
Particulate Exposure
Yes No
Welding/Cutting
Yes No
Description of hazard(s): Based upon the hazard assessment, the
following PPE is required:
Rev: 8/2004 by EHS
P
P
P
P
E
E
R
R
E
E
S
S
O
O
U
U
R
R
C
C
E
E
S
S
&
&
C
C
O
O
N
N
T
T
A
A
C
C
T
T
I
I
N
N
F
F
O
O
R
R
M
M
A
A
T
T
I
I
O
O
N
N
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 PPE program – http://www.ohio.edu/ehs
• NIOSH PPE information - http://www.cdc.gov/niosh
• International Safety Equipment Association - http://www.safetyequipment.org/
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
