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Hazard Assessment
Personal Protective Equipment Certification
OSHA 29CFR1910.132(d)(2)

Facility Name: _________________________________________________

Location/Department:____________________________________________

Date/Revision: _________________________________________________

 

Person completing assessment: _______________________________________________



Exceptions for work-related injury or illness
 

1904.5(b)(2)	You are not required to record injuries and illnesses if . . .
(i)	At the time of the injury or illness, the employee was present in the work environment as a member of the general public rather than as an employee.
(ii)	The injury or illness involves signs or symptoms that surface at work but result solely from a non-work-related event or exposure that occurs outside the work environment.
(iii)	The injury or illness results solely from voluntary participation in a wellness program or in a medical, fitness, or recreational activity such as blood donation, physical examination, flu shot, exercise class, racquetball, or baseball.
(iv)	The injury or illness is solely the result of an employee eating, drinking, or preparing food or drink for personal consumption (whether bought on the employer's premises or brought in). For example, if the employee is injured by choking on a sandwich while in the employer's establishment, the case would not be considered work-related. Note: If the employee is made ill by ingesting food contaminated by workplace contaminants (such as lead), or gets food poisoning from food supplied by the employer, the case would be considered work-related.
(v)	The injury or illness is solely the result of an employee doing personal tasks (unrelated to their employment) at the establishment outside of the employee's assigned working hours.
(vi)	The injury or illness is solely the result of personal grooming, self-medication for a non-work-related condition, or is intentionally self-inflicted.
(vii)	The injury or illness is caused by a motor vehicle accident and occurs on a company parking lot or company access road while the employee is commuting to or from work.
(viii)	The illness is the common cold or flu (Note: contagious diseases such as tuberculosis, brucellosis, hepatitis A, or plague are considered work-related if the employee is infected at work).
(ix)	The illness is a mental illness. Mental illness will not be considered work-related unless the employee voluntarily provides the employer with an opinion from a physician or other licensed health care professional with appropriate training and experience (psychiatrist, psychologist, psychiatric nurse practitioner, etc.) stating that the employee has a mental illness that is work-related.

Complete list of all treatments considered first aid
 

1904.7(b)(5)(ii)	"First aid" means the following…
A	Using a non-prescription medication at nonprescription strength (for medications available in both prescription and non-prescription form, a recommendation by a physician or other licensed health care professional to use a non-prescription medication at prescription strength is considered medical treatment for recordkeeping purposes)
B	Administering tetanus immunizations (other immunizations, such as Hepatitis B vaccine or rabies vaccine, are considered medical treatment)
C	Cleaning, flushing or soaking wounds on the surface of the skin;
D	Using wound coverings such as bandages, Band-Aids™, gauze pads, etc.; or using butterfly bandages or Steri-Strips™ (other wound closing devices such as sutures, staples, etc., are considered medical treatment);
E	Using hot or cold therapy;
F	Using any non-rigid means of support, such as elastic bandages, wraps, non-rigid back belts, etc. (devices with rigid stays or other systems designed to immobilize parts of the body are considered medical treatment for recordkeeping purposes)
G	Using temporary immobilization devices while transporting an accident victim (e.g., splints, slings, neck collars, back boards, etc.)
H	Drilling of a fingernail or toenail to relieve pressure, or draining fluid from a blister;
I	Using eye patches
J	Removing foreign bodies from the eye using only irrigation or a cotton swab
K	Removing splinters or foreign material from areas other than the eye by irrigation, tweezers, cotton swabs or other simple means;
L	Using finger guards;
M	Using massages (physical therapy or chiropractic treatment are considered medical treatment for recordkeeping purposes); or
N	Drinking fluids for relief of heat stress.

Periodic Lockout Inspection - 1910.147(c)(6)	Yes/No
Have you completed an inspection of all of your lockout procedures in the last 12 months?
Did an authorized employee other than user of procedure complete the lockout inspection?
Did the inspector and the authorized employees review the employee’s responsibilities?
Did the inspector identify any deviations or inadequacies?
Did someone take action to correct all of the inadequacies and improve the lockout program?
Does the Annual lockout Program review documentation include a list of machines and employees included in the inspection, the dates of the inspection, and name of the inspector?

Signature: _____________________________________________
Date: _________________________________________________



Lockout Inspection Documentation
 

Date of Inspection
Name of Inspector
Inspector reviewed lockout procedure with… [Name(s) of employee(s)]
Machine(s) addressed
Lockout procedure deviations or inadequacies
Who is responsible for taking corrective action

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