PPE Hazard Assessment & Certification Form
Document Control Company: [COMPANY NAME] · Logo: [COMPANY LOGO] · Address: [COMPANY ADDRESS] Prepared by: [RESPONSIBLE PERSON] · Date: [DATE] · Approved by (signature): _________________
| Field | Value |
|---|---|
| Category | PPE Documents |
| Recommended Industry | All |
| Document Type | Form |
| Access Level | Starter |
| Last Reviewed | 2026-06-29 |
| Last Updated | 2026-06-29 |
How to Use This Template
Walk each work area or task and assess the hazards that could injure the head, eyes/face, hands, feet, hearing, or body. For each hazard present, select the PPE that addresses it. When finished, the assessor signs the certification block at the bottom — this documents that a hazard assessment was performed and dated. Reassess when tasks, equipment, materials, or the worksite change.
PPE Hazard Assessment
Work area / task assessed: [DESCRIBE] Location: [LOCATION] Date: [DATE] Assessed by: [NAME / TITLE]
| Body Area | Potential Hazards (check all present) | Hazard Present? | Required PPE | Notes |
|---|---|---|---|---|
| Head | Falling/flying objects, fixed objects, electrical | ☐ | Hard hat (Type/Class: ____) | |
| Eyes / Face | Dust, flying particles, chemical splash, light radiation | ☐ | Safety glasses / goggles / face shield | |
| Hearing | High noise levels, prolonged exposure | ☐ | Ear plugs / muffs (NRR: ____) | |
| Hands | Cuts, abrasions, chemicals, heat, electrical | ☐ | Gloves (type: ____) | |
| Feet | Falling/rolling objects, punctures, electrical, slips | ☐ | Safety-toe / puncture-resistant footwear | |
| Body / Skin | Heat, cold, chemicals, visibility | ☐ | Hi-vis / appropriate clothing | |
| Respiratory | Dust, fumes, vapors (see note) | ☐ | See Respiratory Protection Program* | |
| Fall | Working at height | ☐ | See Fall Protection Plan* |
* Respiratory protection and fall protection have additional program requirements — refer to those documents; do not rely on this form alone.
Hazards that cannot be eliminated or controlled by other means require PPE. Where feasible, eliminate or engineer out the hazard first.
Certification of Hazard Assessment
I certify that I have performed a hazard assessment of the work area/task identified above to determine the personal protective equipment required.
Assessor (print): ____________________ Signature: ____________________ Date: [DATE] Reviewed by (optional): ____________________ Date: [DATE]
Company Customization Needed
- Replace the bracketed fields with your company information and the specific tasks/areas you assess.
- Specify the exact PPE types, classes, and ratings your work requires.
- Add rows for trade-specific hazards (e.g., arc flash, silica, biological).
- Review and customize based on applicable federal, state, local, client, and project-specific requirements.
- Keep completed certifications on file and re-certify when conditions change.
Last Reviewed / Last Updated
- Last Reviewed: 2026-06-29
- Last Updated: 2026-06-29
- Next Review Due: [SET DATE]
Disclaimer
This document is a general safety template and educational resource. It is not legal advice, does not replace a site-specific hazard assessment, and does not guarantee compliance with OSHA or any federal, state, or local requirement. Employers are responsible for reviewing, customizing, implementing, training employees on, and maintaining their own safety programs and records. Consult a qualified safety professional, legal counsel, or regulatory authority when needed.
Template ID: ppe-hazard-assessment-form · Editable master (Markdown). Export to Word/PDF for distribution. Access level: Starter.