siemens - Public Service Commission

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ATTACHMENT 8
Sheet 1 of 1
Personal Protective Equipment Waiver Form
Please maintain a copy of this attachment at the job site for the duration of the work
taking place under this waiver.
Effective
Job Description:
Supervisor (print):
Hard Hat
In accordance with the site hazard assessment, the work governed by this waiver is
taking place where there is not risk of injury from falling objects or exposed electrical
conductors.
0 Safety Glasses
In accordance with the site hazard assessment, the work governed by this waiver is
taking place where there is not risk of eye injury from flying particles, metal, chemicals,
acids or caustics, or light radiation.
0 Other (specify):
In accordance with the site hazard assessment, the work governed by this waiver is
taking place where there is not risk of injury from (specify hazard)
Therefore the use of
is waived.
0 Compensatory MeasureslComments
Approved by (supervisor’s signature):
-SAF-NGGC-2172 REV. 8
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