Personal Protective Equipment Hazard Assessment
Laboratory Work Activities
(although this could be used for other work as well)

WEB-SUBMIT
FORM

     Hazard assessment and its written record, "certification," are required by OSHA for all work activities that require personal protective equipment.  Use this utility if it helps you satisfy this requirement for your work area(s).  It is not fast, nor simple, but it might be quite a bit faster and simpler than performing the process another way.  
     The supervisor makes the rules for workplace PPE, and must make reasonable and responsible rules.  The posted, written Hazard Assessment Certification constitutes those rules, which are to be understood and obeyed by all workers, and which are to be enforced whenever necessary by the supervisor or by a designee to whom the supervisor has given the authority and power to enforce them.
Date:   Dept: Bldg: Room(s):
Supervisor: name of preparer:
Supervisor email: email of preparer:
    
For every task or activity in your work area which requires personal protective equipment, state the task description and the hazards, and in the right-most column of the row enter the PPE which is required in the work area(s) (bldg/room(s) indicated above).  Click SUBMIT to view the resulting Hazard Assessment Certification.
Modify anything in these columns
so that it fits your needs
                             

You may copy and paste from "minimum PPE recommended" cells below into the "required by supervisor" field at right.  Modify if needed. 
(But don't copy/paste the text in italics.)

Insert your requirements here
Task description

Description of hazards

minimum PPE
recommended by REM
PPE required by 
supervisor

Safety glasses, disposable nitrile gloves, skin cover to knees, elbows, throat, closed shoe, socks.

Splash goggles, disposable nitrile gloves, skin cover to ankles, wrists, throat, closed shoe, socks.

Face shield (to chin) with splash goggles under, disposable nitrile gloves, lab coat and other skin cover to ankles, wrists, throat, closed shoe, socks.

Shaded (IR filter) glasses, googles, or visor appropriate to the wavelength(s) and to potential for exposure.  Specify shade rating as per PPE Policy Appendix. 

Fire retardant apparel, gloves, and impact goggles (shaded if also appripriate).  Keep hair short, covered, or tied away from sparks.

Bind vulnerable clothing/hair, remove jewelry

Safety glasses.  No loose clothing, no jewelry.

Safety glasses, disp gloves, skin cover to elbows, knees, throat, full shoes/socks for < 50mL.  For > 50mL splash goggles, cryogloves, skin cover to ankles, wrists, throat.

UV blocking goggles, skin cover on all potentially exposed areas.  When face sunburn potential exists, a filtering face shield is required.

Goggles appropriate to beam parameters, closed shoe, no jewelry/reflective items.

Safety glasses, "exam" gloves, skin cover on all potentially exposed areas, shoes/socks, work at Biosafety Level II.

Safety glasses, disposable nitrile gloves, skin cover to elbows/knees/throat, closed shoes/socks, lab coat.
Safety glasses, gloves chosen for substance, skin cover to wrists/ankles/throat, closed shoes/socks.

  The only rows (tasks) that will be shown are the rows in which you have entered supervisor required PPE.