Appendix I - Hazard Assessment Form for Personal Protective Equipment

Date:
Department:
Type of Lab(s):
Locations(s):
Conducted by:

Send completed form to EH&S

PPE Hazard Form
Check all the apply Task Description Description of hazards Minimum recommended PPE
Use a chemical fume hood or other engineering controls whenever possible
Specifics or additional PPE
glove types, use of respirators, etc.
Work with infrared emitting equipment, e.g., glassblowing, welding, brazing, IR emitting instrument or exposed diodes Corneal burns, cataracts, conjunctivitis, erythema Shaded (IR filter) glasses, goggles, or visor appropriate to the wavelength(s) and to potential for exposure
Spark-producing operations, e.g., metals grinding, welding Burns to hands, skins, eyes, hair, clothing Fire retardant apparel, gloves, Impact goggles. Keep hair covered, or tied away from sparks
Machine operation activities likely to catch clothing, hair, or jewelry Skin/limb injury Bind vulnerable clothing/hair, remove jewelry
Metal working/grinding, Woodworking/grinding, Other operations likely to throw particles. Eye impact injuries Safety glasses. No loose clothing, No jewelry
Handling, moving, pouring, or any use of cryogenic liquids, or close proximity to an open container of cryogen Skin or eye tissue damage Splash goggles, Insulated gloves, Lab coat or skin covered to ankles, wrists, throat, Closed shoes/socks