Free Hand Protection Evaluation PPE Form Template
HAND PROTECTION EVALUATION PPE FORM
This form is designed to systematically assess and ensure the effectiveness of hand protection measures within [Your Company Name]. The purpose of this evaluation is to enhance workplace safety by identifying potential hazards related to hand protection and implementing appropriate measures to mitigate risks.
EVALUATION OVERVIEW
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Date of Evaluation: |
[Month Day, Year] |
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Time of Evaluation: |
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Evaluator: |
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Position: |
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Email: |
HAND PROTECTION RATING SCALE
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Rating Scale |
Description |
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5 - Excellent |
The hand protection is highly effective, and there are minimal to no identified risks. |
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4 - Good |
The hand protection is effective, with only minor areas that may need improvement. |
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3 - Adequate |
The hand protection meets basic requirements but may require some improvements for enhanced safety. |
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2 - Marginal |
There are significant issues with the current hand protection, and improvements are urgently needed. |
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1 - Poor |
The hand protection is insufficient, and there is a high risk of injury. Immediate action is required. |
EMPLOYEE INFORMATION
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Name: |
[Name] |
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Employee ID: |
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Job Title: |
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Department: |
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Email: |
HAND PROTECTION EVALUATION
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Items |
Fit and Size |
Material Quality |
Hazard Assessment |
Overall Rating |
Comments |
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Leather Gloves |
[4] |
[5] |
[3] |
[4] |
The fit is slightly loose. |
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Nitrile Gloves |
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Cut-Resistant Sleeves |
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Insulated Mittens |
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Chemical-Resistant Hand Guards |
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Heat-Resistant Hand Sleeves |
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Impact-Resistant Finger Guards |
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Disposable Finger Cots |
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Welding Hand Shields |
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Latex Barrier Cream |
ACKNOWLEDGEMENT
I, [Your Name], acknowledge that I have conducted the Hand Protection Evaluation for the employee named above. I certify that the information provided in this evaluation is accurate to the best of my knowledge.
Signature:
[Your Name]
[Job Title]
[MM/DD/YYYY]
