PPE HAZARD ASSESSMENT FORM

Use and modify this sample form to help you determine what hazards workers are exposed to and what PPE must be worn to protect them.

• If you check YES, determine if the hazard can be eliminated.
• If NO, can the method or equipment be changed to eliminate the hazard?
  • If so, consider doing it.
• If the hazard can’t be eliminated, would adding a guard protect employees from the hazard, e.g., machine guards?
  • If this is the case, indicate a guard is being installed.
• In the last column, list the type of […]

  This content is for CoAction Insurance policy holders.

  To request portal access, send an email to losscontrol@coactionspecialty.com with “Coaction LC Portal” in the subject line and include your policy number in the email body.