PPE Assessment Form

Personal Protective EquipmentHazard Assessment CertificationJob Title: Custodial Worker Date: 10/16/00Department: Physical Plant Supervisor:Location / Worksite: Analysis: Dave EricksonEmployee Name(s): Signature:Tasks, Job Classificationor WorkstationMixing of bulk chemicals fromtransfer towersPotential Hazard Type of PPE Required PPE Required(Yes / No)Splash of concentrated chemicals Goggles, faceshields, rubber gloves, apron. YPigeon Waste Histoplasmosis 1/2 respirator (HEPA cartridges), rubber gloves. Y

Personal Protective EquipmentHazard Assessment CertificationJob Title: Maintenance Worker, Mechanic Date: 10/16/00Department: Physical Plant, Service Garage Supervisor:Location / Worksite: Analysis: Dan BeachnauEmployee Name(s): Signature:Tasks, Job Classificationor WorkstationAutomobile/Heavy EquipmentMechanic WorkPotential Hazard Type of PPE Required PPE Required(Yes / No)Flying particles, petroleumsolvents and wastesSafety glasses, chemical resistant glovesYLocksmith Work Flying particles Safety glasses, face shield when using highspeed toolsYWood Working Work (Shop)Noise, flying particles,lifting/carrying, rough surfacedmaterialsHearing protection, safety glasses, face shield forhigh speed tools, puncture/cut resistant gloves,safety shoes, guards in placeYMetal Working Work (Shop)Noise, flying particles,lifting/carrying, rough surfacedmaterials, metal workingchemicalsHearing protection, safety glasses, face shield forhigh speed tools, puncture/cut resistant gloves,safety shoesYPainting (Shop)Vapors, mists, solvents andchemical, flammablesOrganic vapor respirator w/paint pre-filter,chemical resistant glovesYUpholstery Work (Shop) Solvents, glues, punctures Chemical resistant gloves Y

Personal Protective EquipmentHazard Assessment CertificationJob Title: Maintenance Worker Date: 10/16/00Department: Power Plant, Housing Supervisor:Location / Worksite: Analysis: Dan BeachnauEmployee Name(s): Signature:Tasks, Job Classificationor WorkstationPower Plant WorkPotential Hazard Type of PPE Required PPE Required(Yes / No)Hot surfaces, contact withsurfaces (head), noiseHeat resistant gloves, hard hats, hearingprotectionYPower Plant Laboratory WorkCorrosive chemicals, splashingchemicalsSafety glasses, chemical resistant gloves, apron.When pouring large quantities of chemicals, aface shield and gogglesYTunnel WorkContact (head), restricted accessareas, heat stress, hot surfacesHard hat, light clothing, temperature resistantgloves, safety glassesYElevator Maintenance WorkUncovered electrical switches andcircuits, falling, moving machineryElectrically insulated gloves (rated for energizedvoltage), fall protection, cut/puncture resistantglovesYConfined Space WorkHazardous atmosphere, restrictedexit, other depending on nature ofthe spaceDetermine appropriate personal protectiveequipment in accordance with the ConfinedSpace Entry ProgramY

Personal Protective EquipmentHazard Assessment CertificationJob Title: Maintenance Worker Date: 10/16/00Department: Physical Plant, Housing, Power Plant Supervisor:Location / Worksite: Analysis: Dan BeachnauEmployee Name(s): Signature:Tasks, Job Classificationor WorkstationArc Welding or CuttingOxy-fuel Welding or CuttingTorch BrazingTorch SolderingMetal Grinding or ChippingPotential Hazard Type of PPE Required PPE Required(Yes / No)Electric shock, metal sparks,molten and hot metal, UV, IR andvisible light, falling, dropping,rolling and sharp objectsMetal sparks, molten and hotmetal, UV, IR and visible light,falling, dropping, rolling and sharpobjectsMetal sparks, molten and hotmetal, UV, IR and visible light,falling, dropping, rolling and sharpobjectsMolten and hot metal, UV, IR andvisible light, falling, dropping,rolling and sharp objectsMetal sparks and chips, falling,dropping, rolling and sharpobjectsInsulating mats or blankets, insulated/heat andpuncture/cut resistant gloves, safety shoes, hardhat, safety glasses, welding shield or helmet withappropriate eye shade.Heat and puncture/cut resistant gloves, safetyshoes, hard hat, safety glasses, welding shield orhelmet with appropriate eye shade.Heat and puncture/cut resistant gloves, safetyshoes, hard hat, filer lens spectacles or goggles,or safety glasses and hand shield, withappropriate eye shade (at least #3).Heat and puncture/cut resistant gloves, flameresistant clothing, safety shoes, hard hat, filterlens spectacles or goggles, or safety glasses andhand shield, with appropriate eye shade (at least#2).Heat and puncture/cut resistant gloves, typicalwork clothing, safety shoes, safety glasses, fullface shield.YYYYY

Personal Protective EquipmentHazard Assessment CertificationJob Title: Maintenance Worker Date: 10/16/00Department: Physical Plant, Power Plant, Housing Supervisor:Location / Worksite: Analysis: Dan BeachnauEmployee Name(s): Signature:Tasks, Job Classificationor WorkstationCarpentry Work (Construction Site)Masonry Work (Construction Site)Laborer Work (Construction Site)Painting Work (Construction Site)Roofing WorkSheet Metal Work (ConstructionSite)Low Voltage Electrified EquipmentWorkPotential Hazard Type of PPE Required PPE Required(Yes / No)Flying particles, falling, fallingobjects, cuts/punctures,lifting/carryingFlying particles, falling, fallingobjects, cuts/puncture,lifting/carryingFlying particles, falling, fallingobjects, cuts/puncture,lifting/carryingFlying particles, falling, fallingobjects, cuts/puncture,lifting/carrying, cleaning solventsFalling, hot surfaces, heat andcold stress, sealing chemicals,solvents, lifting/carryingFlying particles, lifting/carrying,rough surfaced materialsElectric shock, fallingSafety glasses, safety shoes, hard hat,cut/puncture resistant gloves, fall protectionwhen working at elevations. When using highspeed power tools, a face shield.Safety glasses, safety shoes, hard hat,cut/puncture resistant gloves, fall protectionwhen working at elevations. When using highspeed power tools, a face shield.Safety glasses, safety shoes, hard hat,cut/puncture resistant gloves, fall protectionwhen working at elevations. When using highspeed power tools, a face shield.Safety glasses, safety shoes, hard hat,cut/puncture resistant gloves, fall protectionwhen working at elevations. When using highspeed power tools, a face shield.Safety glasses, safety shoes, fall protection, heatresistant gloves, chemical resistant gloves.Temperature stress protective clothing,depending on weather conditions.Safety glasses, safety shoes, puncture/cutresistant gloves. When using high speed powertools, a face shield.Electrically insulated gloves (rated for voltage ofenergized equipment), insulated blankets ormats non-synthetic work clothing fall protectionYYYYYYY

mats, non-synthetic work clothing, fall protectionwhen working at elevations.High Voltage Electrified EquipmentWorkElectric shock, arc, explosion andburns, falling, confined spaces,vehicles in traffic areasHard hat, safety glasses, face shield, insulatedgloves (rated for voltage of energizedequipment), insulated blankets or mats, nonsyntheticwork clothes, safety shoes, fallprotection when working at elevations, reflectiveclothing when working near traffic.Y

plant toxinsand reentry requirements, skin protection frominsects and plants, safety shoes, safety glasses,glovesMoving Work Lifting/carrying Safety shoes Y

Personal Protective EquipmentHazard Assessment CertificationJob Title: Maintenance Worker Date: 10/16/00Department: Physical Plant Supervisor:Location / Worksite: Analysis: Dan BeachnauEmployee Name(s): Signature:Tasks, Job Classificationor WorkstationPlumbing WorkPotential Hazard Type of PPE Required PPE Required(Yes / No)Hot surfaces, rough surfacedmaterials, sewageHeat resistant gloves, cut/puncture resistantgloves, rubber gloves, safety glassesYGeneral Maintenance WorkRough surfaced materials,lifting/carryingCut/puncture resistant gloves, safety shoes,safety glassesYMachine Tools (drills, grinders andsaws)Flying particles Safety glasses YArc Welding or CuttingElectric shock, metal sparks,molten and hot metal, UV, IR andvisible light, falling, dropping,rolling and sharp objectsInsulating mats or blankets, insulated/heat andpuncture/cut resistant gloves, safety shoes, hardhat, safety glasses, welding shield or helmet withappropriate eye shadeMoving Work Lifting/carrying Safety shoes, gloves YY

Personal Protective EquipmentHazard Assessment CertificationJob Title: Scenic Carpenter Date: 10/16/00Department: Theatre Supervisor:Location / Worksite: Auditorium, Wharton Analysis: Dan BeachnauEmployee Name(s): Signature:Tasks, Job Classificationor WorkstationOperating saws and other powertoolsPotential Hazard Type of PPE Required PPE Required(Yes / No)Eye hazard, cuts from bladeSafety glasses with side shields (hearingprotection), guard in placeYOperating metal saw Eye hazard and skin hazard Safety glasses with side shields and face shield,Long cuffed leather glovesYWeldingEye hazard, Hand and skinhazardWelding helmet with appropriate shadeprotection, Long cuffed leather glovesYMoving wood and metal pieces,liftingFoot hazard, dropping objects andpiercing objects, wood splinter,pinchLeather work shoe/boot with thick sole, glovesY

Personal Protective EquipmentHazard Assessment CertificationJob Title: Grounds Keeper Date: 10/16/00Department: Housing, Grounds, Physical Plant Supervisor:Location / Worksite: Campus, Stadium Analysis: Dan BeachnauEmployee Name(s): Signature:Tasks, Job Classificationor WorkstationUse of powered ground keepingequipment; lawn mowers, weedwhips, chainsaw etcConducting any type of activities onan active fairway. Conductingactivities with the potential formaterials to be dropped onto head.Potential Hazard Type of PPE Required PPE Required(Yes / No)Skin and eye damageImpactSafety glasses, long sleeved shirts, long pants,cloth glovesHard hatTrash Clean up Dust, cuts, noise Mask, gloves, ear protection YYYUse of Pruning devices Cuts Gloves Y

Personal Protective EquipmentHazard Assessment CertificationJob Title: Laboratory Worker Date: 09/17/03Department: All Supervisor:Location / Worksite: Research Buildings Analysis: Dave EricksonEmployee Name(s): Signature:Tasks, Job Classificationor WorkstationWorking with low hazard chemicalswhen a low probability of splashexistsWorking with smaller amounts ( 1 liter), or toxiccorrosivesWorking with small volumes oforganic solvents (< 1 liter)Working with large volumes oforganic solvents ( > 1 liter), highlytoxic organic solvents or workwhich may create a splash hazardPotential Hazard Type of PPE Required PPE Required(Yes / No)Skin and eye irritationSkin and eye damageLarge surface area skin and eyedamage, Poisoning, orGreat potential for eye and skindamageSkin and eye damageSlight poisoning potential throughskin absorptionMajor skin and eye damagePotential poisoning through skinabsorptionSafety glasses, Light chemical resistant gloves,Lab coat, closed shoe, pantsChemical splash goggles, Light chemicalresistant gloves, Lab coat, closed shoe, pantsChemical splash goggles & face shield,Appropriate heavy resistant glovesLab coat, closed shoes, pants and chemicalresistant apronSafety glasses, goggles if splash hazard exists,Light chemical resistant glovesLab coat, closed shoe, pantsSafety goggles & face shieldAppropriate heavy resistant glovesAbove clothes and chemical resistant apronYYYY

Personal Protective EquipmentHazard Assessment CertificationJob Title: Laboratory Worker Date: 09/17/03Department: All Supervisor:Location / Worksite: Research Buildings Analysis: Dave EricksonEmployee Name(s): Signature:Tasks, Job Classificationor WorkstationWorking with small volumes ofhuman blood, body fluids or otherpotentially infectious materials(OPIM) as defined in the MSUBloodborne Pathogen ExposureControl PlanWorking with large volumes ofhuman blood, body fluids or otherother potentially infectiousmaterials and/or splash hazardsWorking with hazardous powdersWorking with acutely toxichazardous powdersWorking with dispersibleradioactive materialsWorking with radioactive chemicals(corrosives, solvents, toxics, etc.)Potential Hazard Type of PPE Required PPE Required(Yes / No)Potentially infected with infectiousdisease (BBP)Potential spread of infectiousdiseaseIncrease potential of becominginfected with infectious disease(BBP)Increased potential spread ofinfectious diseasePotential skin and eye damage,Potential for poisoning throughskin absorptionGreat potential skin and eyedamageGreat potential for poisoningthrough skin absorptionPotential tissue damagePotential spread of radioactivecontaminationSee appropriate chemical sectionabovePotential tissue damagePotential spread of radioactiveSafety glassesDisposable nitrile glovesLab coat, closed shoe, pantsSafety goggles & face shieldNitrile glovesLab coat, closed shoe, pantsCoveralls and foot covers may be necessarySafety glassesGoggles for large quantitiesLight chemical resistant glovesLab coat, closed shoe, pantsSafety gogglesAppropriate chemical resistant glovesLab coat, closed shoe, pantsCoveralls and booties if necessaryAppropriate eye protection,Disposable nitrile glovesLab coat, closed shoe, pantsSafety glasses, goggles for splash hazardLight chemical resistant glovesLab coat, closed shoe, pantsUse PPE for applicable tasks aboveYYYYYY

contaminationWorking with radioactive humanblood, body fluids or otherpotentially infectious materialsPotential tissue damagePotential spread of radioactivecontaminationPotential exposure to OPIMSafety glasses, goggles for splash hazardDisposable nitrile glovesLab coat, closed shoe, pantsYWorking with sealed radioactivesourcesDamaged or leaking source mayspread contamination, Someleaking sources may pose anexternal does risk.Safety glasses, light gloves, shield may beneeded for high energy sourcesY

Personal Protective EquipmentHazard Assessment CertificationJob Title: Laboratory Worker Date: 09/17/03Department: All Supervisor:Location / Worksite: Research Buildings Analysis: Dave EricksonEmployee Name(s): Signature:Tasks, Job Classificationor WorkstationWorking with crygenic liquidsWorking with very cold materialsand equipment (freezers, dry ice)Working with hot liquids, equipmentand/or open flames (autoclave,bunsen burner, waterbath, oil bath)Working with large volumes of hot,cold, or cryogenic liquidsWorking with Ultraviolet RadiationWorking with LASER radiationPotential Hazard Type of PPE Required PPE Required(Yes / No)Major skin, tissue and eyedamageFrostbiteHypothermiaSkin damageEye damageMajor skin and eye damageFrozen or burned body tissuesConjunctivitisCorneal eye damageErythemaRetinal eye damageSkin damageChemical splash goggle and face shieldHeavy insulated glovesLab coat, closed shoe, pantsSafety glassesInsulated gloves and warm clothingLab coat, closed shoe, pantsSafety glasses or goggles for large volumes orsplash hazardsInsulated glovesLab coat, closed shoe, pantsSafety glasses or goggles and face shieldHeavy insulated glovesAbove clothes and apron or coverallsUV face shield and gogglesLab coat, closed shoe, pantsAppropriate shaded goggles with optical densitybased on individual beam parametersLab coat, closed shoe, pantsNo jewelry/reflective items allowedYYYYYY

Personal Protective EquipmentHazard Assessment CertificationJob Title: Laboratory Worker Date: 09/17/03Department: All Supervisor:Location / Worksite: Research Buildings Analysis: Dave EricksonEmployee Name(s): Signature:Tasks, Job Classificationor WorkstationWorking with Infrared emittingequipment (glass blowing)Potential Hazard Type of PPE Required PPE Required(Yes / No)Cataracts and flash burns tocorneaAppropriate shaded goggles, Lab coat, closedshoe, pantsYArc/TIG weldingConjunctivitisCorneal eye damageErythemaAppropriate shaded gogglesWorking glovesYInstrument or equipmentrepair/serviceEye damage from foreign objectsSafety glassesNo loose clothing or jewelryYMetal working/Woodworking shop Eye damage from foreign objects Safety glassesNo loose clothing or jewelryGlassware washing Skin lacerations Safety glasses, Heavy rubber glovesLab coat, closed shoe, pantsYYWorking in Industrial lab withpotential injury from fallingequipment or tools (ex. Earthquakelab, Structural Engineering lab, etc.)Head injury, foot injuryHard-hatSteel toe bootsYSpill clean-upSee potential hazards forapplicable task sectionSee applicable individual task sectionYChanging Cryostat knife bladeSkin lacerationsPotential infection by BBPSkin lacerationsPotential infection by BBPY

Personal Protective EquipmentHazard Assessment CertificationJob Title: Farm Worker Date: 10/02/00Department: Farms / Land Management Supervisor:Location / Worksite: State Wide Analysis: Dan BeachnauEmployee Name(s): Signature:Tasks, Job Classificationor WorkstationPotential Hazard Type of PPE Required PPE Required(Yes / No)Farm Worker Falls From machinery Training on safe mount/dismount NoFarm Worker Powered shafts/belts Disengage power for routine maintenance,gloves, lockout tag for extensive repairYesFarm Worker Sun burn, heat stress, frost bite Training, proper clothing, sunscreen YesTransport of equipment onhighway/roadsTraffic crashTraning on safe driving, Slow Moving Vehiclesigns on equipmentNoUse of forks, shovels Foot injury Leather shoes or boots YesFarm WorkerRolling equipment could crushbody/limbsTraining, park or wheel chocksNoMixing/application ofChemicals/HerbicidesSplash to face Gloves, goggles Yes

Personal Protective EquipmentHazard Assessment CertificationJob Title: Tree Trimmer Date: 10-2-00Department: Grounds Supervisor:Location / Worksite: Analysis: Dan BeachnauEmployee Name(s): Signature:Tasks, Job Classificationor WorkstationOperating hand saw, chainsaw andwood chipperImpactPotential Hazard Type of PPE Required PPE Required(Yes / No)Impact approved safety glasses or goggles andfaceshieldYTrimming activities in, under, oraround treesFalling or rolling objects, splinters,cuts, abrasionsHard had and safety boot, leather palm glovesY