Professional Documents
Culture Documents
Work Activities
FACE
Work activities, such as:
cleaning
siphoning
painting
other________________________________
Completed by:___________________________
Possible Health Hazards
Date:
HEAD
Work activities, such as:
building maintenance
confined space operations
construction
electrical wiring
walking/working under catwalks
walking/working under conveyor belts
walking/working under crane loads
utility work
other: _______________________________
HANDS/ARMS
Work activities, such as:
grinding
welding
working with glass
using computers
using knives
other: _______________________________
Work-related exposure
material
to: handling
blood
sawing
irritating chemicals hammering
tools or materials that could scrape,
bruise, or cut
extreme heat/cold
other: ________________________
If no, use:
Gloves
Chemical resistance
Liquid/leak resistance
Temperature resistance
Abrasion/cut resistance
Slip resistance
Protective sleeves
Other: _______________________________
FEET/LEGS
Work activities, such as:
building maintenance
construction
demolition
plumbing
trenching
use of highly flammable materials
welding
other: ______________________________
BODY/SKIN
Work activities such as:
battery charging
fiberglass installation
irritating chemicals
sawing
other: _______________________________
explosive atmospheres
explosives
If no, use:
exposed electrical wiring /components
Safety shoes or boots
heavy equipment
Toe protection
slippery surfaces
Electrical protection
Heat/cold protection
tools
Puncture resistance
Chemical resistance
other: _______________________
Anti-slip soles
Leggings or chaps
Foot-Leg guards
Other: ________________________________
Vest, Jacket
Coveralls, Body suit
Raingear
Apron
Welding leathers
Abrasion/cut resistance
Other: ________________________________
Body/Whole
Work activities such as:
building maintenance
construction
utility work
other: ______________________________
Fall Arrest/Restraint:
Type:______________
PFD: Type:
_________________________
Other: _________________________________
LUNGS/RESPIRATORY
Work activities such as:
cleaning
pouring
mixing
sawing
painting
fiberglass installation
compressed air or gas operations
other: ________________________
EARS/HEARING
Work activities such as:
generator
ventilation fans
motors
sanding
pneumatic equipment
punch or brake presses
other:__________________
loud noises
loud work environment
noisy machines/tools
punch or brake presses
other: ____________________
Additional Notes: