Personal Protective Equipment (PPE) Usage Checklist
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Eye and Face Protection
Ensuring adequate protection from splashes, dust, flying debris, and sunlight.
Type of Eye/Face Protection Required?
Is the Eye/Face Protection ANSI Z87.1 Approved?
Describe any damage or defects observed on eye/face protection (scratches, cracks, fogging, etc.)
Condition of Lens Clarity (1-10, 10=Perfect)
Fit Check Performed?
Notes/Comments Regarding Eye/Face Protection.
Head Protection
Protecting against falling objects, impacts, and sun exposure.
Type of Head Protection Used?
If 'Other' selected above, please specify:
Hard Hat Age (in years)
Is the Hard Hat Damaged?
Describe any damage to the hard hat (if 'Yes' to above)
Is the Hard Hat Clean?
Attach Photo of Hard Hat (if damaged or questionable)
Date of Last Hard Hat Inspection
Hand Protection
Preventing skin contact with chemicals, pesticides, and abrasive materials.
Type of Gloves Used
If 'Other' glove type selected, please specify:
Glove Thickness (mils)
Glove Chemical Resistance Rating (if applicable)
If 'Other' chemical resistance rating selected, please specify:
Potential Hazards Hand Protection Required For:
Glove Condition After Use
Employee Name
Body Protection
Shielding the body from chemical exposure, insects, and physical hazards.
What type of body protection is required for the task?
Fabric Weight (oz/sq yd) - if applicable (e.g., for coveralls)
Material of Body Protection (e.g. Cotton, Polyester, Tyvek)
If 'Other' selected for Material, please specify:
Is the body protection chemical resistant?
If yes, specify which chemicals the protection is rated for:
Upload Photo of Body Protection (for record-keeping)
Condition of body protection - before use
Foot Protection
Protecting feet from punctures, impacts, chemicals, and slipping hazards.
Footwear Type Selected:
If 'Other' selected above, please specify footwear type:
Boot Condition - Soles:
Boot Condition - Upper:
Sole Thickness (mm)
Slip Resistance Rating (if available)
Last Inspection Date
Any repairs needed? If so, please describe.
Respiratory Protection
Preventing inhalation of dust, fumes, gases, and vapors.
Respiratory Hazard Assessment Completed?
Type of Respirator Required (Based on Assessment)
Respirator Fit Test Date (MM/DD/YYYY)
Next Respirator Cartridge/Filter Change Date
Cartridge/Filter Type
Respirator Properly Donned and Fit-Checked?
Notes on Respirator Usage/Condition
Respirator Training Record
Hearing Protection
Reducing exposure to excessive noise levels.
Is a noise hazard assessment completed?
What type of hearing protection is required?
Noise Level (dBA) measured at work area:
Are employees trained on proper fitting and use of hearing protection?
Describe any noise reduction procedures implemented:
Is hearing protection readily available?
Insect/Vector Protection
Minimizing bites and stings from insects and other pests.
What type of insect/vector protection is required?
Which areas have high insect/vector activity?
DEET Concentration (%) (if applicable)
Specific areas/times of day where extra precautions are needed
Date of last inspection/treatment of insect-repellent clothing
Is repellent being used?
Any reported insect/vector related incidents or concerns?
PPE Inspection & Maintenance
Ensuring PPE is in good working order and properly cared for.
Last PPE Inspection Date
Notes on PPE Condition During Last Inspection
Number of damaged or defective items found
Type of Cleaning Agent Used (if applicable)
If 'Other' cleaning agent used, specify:
Which PPE items were inspected?
Upload photos of damaged PPE (if applicable)
Condition of straps and buckles (Head Protection)
Training & Awareness
Confirming employees are properly trained on PPE selection, use, and limitations.
Have you received training on the hazards associated with agricultural chemicals?
Were you trained on the correct PPE selection for your assigned tasks?
Briefly describe the PPE training you received:
Date of last PPE training:
Do you understand the limitations of your PPE?
Which of the following PPE topics were covered in your training? (Select all that apply)
Name of Trainer:
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