Eye and Face Protection Checklist

HAZARD ASSESSMENT

Are any of the following eye and face injury hazards present in the work area? Yes No
Sources of dust/flying particles, such as chipping, grinding, drilling, chiseling, riveting, or sanding?
Molten metal?
Acids or caustic liquids?
Chemical gases or vapors?
Potentially injurious light radiation?
Handling of chemicals or other toxic substances?
Smoke and fumes?
Other eye injury hazards?

If yes – please specify:  ___________________________________________

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EXISTING EYE AND FACE PROTECTION

Is protective eye wear or other eye or face protection currently used? Indicate the types of eye and face protection used. Yes No
Protective device Tasks used for
Safety glasses
Goggles
Face shields
Welding shields
Helmets that include face shields

SUMMARY OF HAZARDS IDENTIFIED AND PPE REQUIREMENTS

Task Hazard Abatement Measure