PURPOSE: Review each job task performed by employees to determine where job task hazards exist; provide recommendations for hazard elimination/protection, identify appropriate personal protective equipment (PPE), and training to inform employees of appropriate safety standards and precautions.

Date:	Click or tap to enter a date.	☐ New ☐ Revised
Department:	Click or tap here to enter text.	Reviewed By:	Click or tap here to enter text.
Job Title:	Click or tap here to enter text.
Primary Tasks:	Click or tap here to enter text.
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REQUIRED PERSONAL PROTECTIVE EQUIPMENT (PPE) (Choose ALL that apply to this task. If additional information is needed, please specify.)
Body Protection	Hand Protection
Click or tap here to describe the specific protection needed.	☐Disposable Gloves ☐Leather Gloves ☐Wire Mesh Gloves	☐Insulated Gloves ☐Electrical Safety Gloves ☐Chemical Resistant Gloves
Eye Protection	Head Protection
☐Safety Glasses ☐Safety Goggles ☐Laser Eyewear ☐Face Shield	☐Optical Face Shield ☐Welder’s Goggles ☐Welder’s Helmet ☐Arc-Rated Face Shield	☐Bump Cap ☐Hard Hat ☐Other Please Describe: Click or tap here to enter text.
Fall Protection	Hearing Protection
Click or tap here to describe the specific equipment needed.	Click or tap here to describe the specific equipment needed.
Foot Protection	Respiratory Protection
☐Slip Resistant Shoes ☐Composite/Steel-Toed Shoes	Click or tap here to describe the specific equipment needed.

Task/Step	Hazard(s)	Control Methods
INSTRUCTIONS: Break the job into a sequence of steps. Each of the steps should accompany some major tasks.	Identify the hazard(s) associated with each step. Every possible source of energy must be identified. Look at the entire environment to determine every conceivable hazard.	Decide what actions are necessary to eliminate, control, or minimize hazards that could lead to accidents, injuries, environmental damage, or illness.
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