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Personal Protective Equipment Plan

Personal Protective Equipment Plan

This sample Personal Protective Equipment Program is provided by the Missouri On-Site Safety and Health Consultation Program.  In order to comply with OSHA’s standard for Personal Protective Equipment, 29 CFR 1910.132, this written program must be site specific.  Modify the template to reflect the policies and procedures at your company.  Since OSHA regulations set minimum requirements, you may choose to add additional information to your site specific program. There is no requirement to follow this sample and its use does not guarantee compliance with the OSHA standard.

To prepare your program, follow these steps:

1. Read the Personal Protective Equipment Standard 29CFR 1910.132

2. The following information may be useful in developing your program:

3. For clarification or assistance, contact the Missouri On-Site Safety and Health Consultation Program at 573-522-SAFE.

 

 

Personal Protective Equipment Program

(To customize, please complete and remove the highlighted areas of the program)

                                                                       

Date Created:

Date Reviewed:

1. Company Policy

This Personal Protective Equipment Program is necessary to comply with Occupational Safety and Health Administration (OSHA) regulations 29 CFR 1910.132. The purpose of this program is to ensure worker safety using Personal Protective Equipment (PPE).

2. Responsibility

(Name of person or job title) will assess the workplace to determine if hazards are present, or likely to be present, which will necessitate the use of PPE.

Employees are responsible for complying with (Name of Company)  policies on the use of PPE.

3. Program Review and Update

The Personal Protective Equipment Program will be reviewed or updated whenever there are new equipment or personnel changes that might affect the program.

4. Methods of Compliance

When hazards are present, or likely to be present, the employer will:

  • Perform a hazard assessment of the workplace
  • Select and have each affected employee use the types of PPE that will protect the affected employee from the hazards identified in the hazard assessment
  • Communicate selection decisions to each affected employee
  • Select PPE that properly fits each affected employee

Damaged and defective PPE shall not be used.

5. Training

(Name of person or job title)  will provide training to each employee who is required to use PPE. Each affected employee will demonstrate an understanding of the training and the ability to use PPE properly before being allowed to perform work requiring the use of PPE.  Each employee will be trained to know at least the following:

  • When PPE is necessary
  • What PPE is necessary
  • How to properly put on, take off, adjust, and wear the PPE
  • The limitations of the PPE
  • The proper care, maintenance, useful life and disposal of PPE

Re-training will be provided when there is reason to believe that any affected employee who has already been trained does not have the understanding and skill required to use the PPE.

Circumstances where retraining is required include, but are not limited to:

  • Changes in the workplace render previous training obsolete or
  • Changes in the types of PPE to be used render previous training obsolete or
  • Inadequacies in an affected employee's knowledge or use of assigned PPE

The employer will verify that each affected employee has received and understood the required training through a written certification that contains:

  • The name of each employee trained
  • The date(s) of training
  • The subject of the training
 

Hazard Assessment Instructions

 

1. Perform a survey of each work area and job/task.  Read through the list of work-related exposures in the first column, putting a check next to the exposure(s) in that work area or job. 

2. Decide how you are going to control the hazards.  Consider engineering, workplace controls (elimination/substitution), and/or administrative controls to eliminate or reduce the hazards before resorting to using PPE.  If the hazard cannot be eliminated without using PPE, indicate which type(s) of PPE will be required to protect your employees from the hazards.

3 Make sure that you complete the following fields on the assessment to certify that the hazard assessment was done:

  • Name of your workplace
  • Address of the workplace where you are doing the hazard assessment
  • Name of person certifying that a workplace hazard assessment was done
  • Date the hazard assessment was done

 

         Personal Protective Equipment Hazard Assessment Certification Form

Name of workplace:                                           Assessment conducted by:                                       

Workplace address:                                           Date of assessment:                                                   

Work area(s):                                                       PPE Selected By:                                                         

Job/Task(s):                                                         Effective Date:                                                              

EYES/FACE

  Negligible Hazard

  Can hazard be eliminated without the use of PPE?  Yes    No

Work-related exposure to:

 Airborne dust

 Flying particles

 Hazardous liquids/chemicals

 Intense light

 Blood splashes

 Other:  __________     

PPE required to manage hazard:

Safety glasses                       

 Safety goggles

Face Shield                                           

Shading/Filter (#     )                        

Welding shield

Other:  __________    

 

Comments:

     

HEAD

  Negligible Hazard

  Can hazard be eliminated without the use of PPE? Yes   No

Work-related exposure to:

Beams

Pipes

 Falling objects

Exposed electrical wiring or components

Machine parts

Other: __________      

PPE required to manage hazard:

 Protective Helmet

Type A (low voltage)

 Type B (high voltage)

Type C

 Hair net or soft cap

 Other: __________      

Comments:

     

HANDS/ARMS

  Negligible Hazard

  Can hazard be eliminated without the use of PPE?  Yes    No

Work-related exposure to:

Hazardous liquids/chemicals

Scrapes, bruise, or cut

Injuries from tools

Extreme heat/cold

 Blood (OPIM)

Other: __________      

PPE required to manage hazard:

 Gloves

 Chemical resistance                  Liquid/leak resistance

 Temperature resistance           Cut resistance

 Gauntlet or long necked           Work Gloves

 Chemical Protective sleeves

 Long sleeves

 Other: __________      

Comments:

 

 

 

 

 

FEET/LEGS

  Negligible Hazard

  Can hazard be eliminated without the use of PPE?  Yes    No

Work-related exposure to:

Hazardous liquids/chemicals

 Heavy falling/rolling objects

 Heavy equipment

Exposed electrical wiring or components

Slippery surfaces

 Explosive atmospheres

Tools

Other: __________      

PPE required to manage hazard:

 Closed shoes (e.g. no opened toes or sandals)

 Long pants

 Safety shoes or boots

 Toe protection                    Metatarsal protection

 Electrical protection             Heat/cold protection

 Anti-slip soles                       Chemical resistance

Leggings or chaps

 Foot-Leg guards

Other:__________       

Comments:

 

BODY/SKIN

  Negligible Hazard

  Can hazard be eliminated without the use of PPE?  Yes    No

Work-related exposure to:

Hazardous liquids/chemicals

Sharp or rough edges

 Extreme heat/cold

Other: __________      

PPE required to manage hazard:

 Lab Coat                                Raingear

 Coveralls, Body suit               Apron

 Welding leathers                    Abrasion/cut

 Other:  __________                 resistance

Comments:

     

 

 

 

BODY/WHOLE

  Negligible Hazard

  Can hazard be eliminated without the use of PPE?  Yes    No

Work-related exposure to:

 Working from heights of 4 feet or more

 Working near water

 Other:__________       

PPE required to manage hazard:

Fall Arrest/Restraint:  Type:       

 PFD:  Type:       

Other: __________      

Comments:

     

LUNGS/EARS

  Negligible Hazard

  Can hazard be eliminated without the use of PPE?  Yes    No

Work-related exposure to:

 Irritating dust or particulate

 Irritating or toxic gas/vapor

 Loud work environment

Noisy machines/tools

Other: __________      

PPE required to manage hazard:

Respirator

 Particulate Mask

Hearing Protection

Comments:

     

 

         

Personal Protective Equipment Training Roster

 

Training Performed By:

 

Employee Name

Employee Signature

Training Date