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 29 CFR 1910.132
2. The following information may be useful in developing your program:
- OSHA’s Personal Protective Equipment Booklet
- Non-mandatory Compliance Guidelines for Hazard Assessment and Personal Protective Equipment Selection
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:
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Negligible Hazard |
Can hazard be eliminated without the use of PPE? Yes No |
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Work-related exposure to: Airborne dust Flying particles Intense light Blood splashes Other: __________ |
PPE required to manage hazard: Safety glasses Safety goggles Face Shield Shading/Filter (# ) Welding shield Other: __________
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Comments:
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Negligible Hazard |
Can hazard be eliminated without the use of PPE? Yes No |
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Work-related exposure to: 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:
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HANDS/ARMS |
Negligible Hazard |
Can hazard be eliminated without the use of PPE? Yes No |
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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:
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FEET/LEGS |
Negligible Hazard |
Can hazard be eliminated without the use of PPE? Yes No |
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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:
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BODY/SKIN |
Negligible Hazard |
Can hazard be eliminated without the use of PPE? Yes No |
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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:
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BODY/WHOLE |
Negligible Hazard |
Can hazard be eliminated without the use of PPE? Yes No |
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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:
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LUNGS/EARS |
Negligible Hazard |
Can hazard be eliminated without the use of PPE? Yes No |
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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:
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Personal Protective Equipment Training Roster
Training Performed By:
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Employee Name |
Employee Signature |
Training Date |
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