Free PPE Hazard Assessment Template + Written Certification

Written certification — fill this in first

These four lines are what makes the assessment OSHA-compliant on paper.

• Workplace / jobsite evaluated: ____________________
• Work area / task assessed: ____________________
• Assessment performed by (name & title): ____________________
• Date of assessment: __________
• I certify this workplace was evaluated for PPE hazards: Signature: ____________________

Head, eyes & face

• ☐ Overhead work, falling/flying objects, or struck-by risk → hard hat (Type/Class: ______)
• ☐ Cutting, grinding, chipping, drilling → safety glasses or goggles (ANSI Z87.1)
• ☐ Welding, torch cutting → welding helmet / shaded lens (shade #: ______)
• ☐ Chemical splash risk → goggles + face shield

Hands & arms

• ☐ Sharp materials, rebar, sheet metal → cut-resistant gloves (ANSI cut level: ______)
• ☐ Chemicals, concrete, epoxy → chemical-resistant gloves
• ☐ Electrical work → rubber insulating gloves (class: ______, test date: ______)
• ☐ Vibration tools → anti-vibration gloves

Feet, legs & body

• ☐ Heavy materials, dropped-object risk → safety-toe boots (ASTM F2413)
• ☐ Punctures from nails/debris → puncture-resistant soles
• ☐ Vehicle / equipment traffic → hi-vis vest or shirt (Class 2 or 3: ______)
• ☐ Welding, cutting → FR clothing / leather apron

Hearing & respiratory

• ☐ Noise ≥ 85 dBA over 8 hrs (can't hear speech at arm's length) → ear plugs or muffs
• ☐ Silica dust (cutting concrete, masonry) → respirator per exposure control plan
• ☐ Fumes, solvents, confined spaces → respirator (type: ______, fit-tested: ☐)

Fall protection

• ☐ Work at 6 ft or more (construction) → personal fall arrest system or guardrails
• ☐ Harness & lanyard inspected before use (use the fall protection checklist)

Training & re-assessment

• ☐ Each affected worker trained on when/what/how to wear the selected PPE
• ☐ Workers demonstrated understanding before first task
• Re-assess when: new task, new equipment, new materials, or after any incident
• Next scheduled re-assessment date: __________