PPE Assessment Checklist sample. Edit it or build your own.

PPE Assessment Checklist Form

A PPE assessment checklist designed to assess job hazards and the need for personal protective equipment using yes/no questions and "check all that apply". Checkout the Forms Library »

PPE Assessment Checklist - Printable PDF
Download a printable PPE Assessment Checklist (PDF).

What is a PPE Assessment Checklist?

A PPE Assessment Checklist helps you identify what types of PPE (personal protective equipment) a team member will need when performing a specific job. Typical questions include:

  • Do your employees perform tasks, or work near employees who perform tasks, that might produce airborne dust or flying particles?
  • Do your employees handle, or work near employees who handle, hazardous liquid chemicals or encounter blood splashes?
  • Are your employees’ eyes exposed to other potential physical or chemical irritants?
  • Are your employees exposed to intense light or lasers?
  • Do your employees handle, or work near employees who handle, hazardous liquid chemicals?
  • Are your employees’ faces exposed to extreme heat?
  • Are your employees’ faces exposed to other potential irritants?
  • Might tools or other objects fall from above and strike your employees on the head?
  • Are your employees’ heads, when they stand or bend, near exposed beams, machine parts, pipes, etc.?
  • Do your employees work with or near exposed electrical wiring or components?
  • Might tools, heavy equipment, or other objects roll, fall onto, or strike your employees’ feet?
  • Do your employees work with or near exposed electrical wiring or components?
  • Do your employees handle, or work near employees who handle, molten metal?
  • Do your employees work with explosives or in explosive atmospheres?
  • Do your employees’ hands come into contact with tools or materials that might scrape, bruise, or cut?
  • Do your employees handle chemicals that might irritate skin, or come into contact with blood?
  • Do work procedures require your employees to place their hands and arms near extreme heat?
  • Are your employees’ hands and arms placed near exposed electrical wiring or components?
  • Are your employees’ bodies exposed to irritating dust or chemical splashes?
  • Are your employees’ bodies exposed to sharp or rough surfaces?
  • Are your employees’ bodies exposed to extreme heat?
  • Are your employees’ bodies exposed to acids or other hazardous substances?
  • Are your employees exposed to loud noise from machines, tools, music systems, etc.?

This form is a sample report which can be imported into your iScout account and modified to fit your organization's policies and procedures.

If you don't have an iScout account, download the printable PPE Assessment Checklist PDF form so your team can fill out a paper copy.



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