Per 29 CFR 1910.132(d) — Personal Protective Equipment | EHS Community Template
SECTION 1 — Eye & Face Hazard Assessment
Hazard Present
Yes / No
PPE Selected (Type / ANSI Standard)
Notes
Flying particles / chips
Liquid chemicals / splashes
Molten metal / sparks
Harmful light radiation (UV/IR)
Dust / airborne particles
SECTION 2 — Head Protection Assessment
Hazard Present
Yes / No
PPE Selected (Class / ANSI Z89.1)
Notes
Falling objects
Low overhead hazards
Electrical contact risk
Hair entanglement hazard
SECTION 3 — Hand & Arm Protection Assessment
Hazard Present
Yes / No
PPE Selected (Material / Cut Level)
Notes
Chemical skin absorption
Thermal burns / hot surfaces
Cuts / lacerations / punctures
Electrical hazards
Vibration exposure
SECTION 4 — Foot & Leg Protection Assessment
Hazard Present
Yes / No
PPE Selected (ASTM Standard)
Notes
Falling / rolling objects
Penetrating materials (nails)
Corrosive chemicals
Slippery / wet surfaces
Electrical hazards
SECTION 5 — Hearing Protection Assessment
Noise Level (TWA)
Action Required
HPD Selected (NRR)
Notes
≥ 85 dBA (Action Level)
≥ 90 dBA (PEL)
Impulse noise
SECTION 6 — Respiratory Protection Assessment
Airborne Hazard
Yes / No
Respirator Type / Cartridge
Fit Test Required?
Dusts / particulates
Chemical vapors / gases
Welding / metal fumes
IDLH / oxygen-deficient atm.
CERTIFICATION (Required per 29 CFR 1910.132(d)(2))
I certify that the workplace indicated above has been evaluated for hazards, and that appropriate PPE has been selected based on the findings of this assessment.
This template is provided for educational purposes by EHS Community (ehscommunity.com). It does not constitute legal advice. Verify compliance with the current version of all referenced OSHA standards. Reference: 29 CFR 1910.132 — Personal Protective Equipment.