Hand Protection Evaluation PPE Form
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
|
Date of Evaluation: |
[Month Day, Year] |
|
Time of Evaluation: |
|
|
Evaluator: |
|
|
Position: |
|
|
Email: |
HAND PROTECTION RATING SCALE
|
Rating Scale |
Description |
|
5 - Excellent |
The hand protection is highly effective, and there are minimal to no identified risks. |
|
4 - Good |
The hand protection is effective, with only minor areas that may need improvement. |
|
3 - Adequate |
The hand protection meets basic requirements but may require some improvements for enhanced safety. |
|
2 - Marginal |
There are significant issues with the current hand protection, and improvements are urgently needed. |
|
1 - Poor |
The hand protection is insufficient, and there is a high risk of injury. Immediate action is required. |
EMPLOYEE INFORMATION
|
Name: |
[Name] |
|
Employee ID: |
|
|
Job Title: |
|
|
Department: |
|
|
Email: |
HAND PROTECTION EVALUATION
|
Items |
Fit and Size |
Material Quality |
Hazard Assessment |
Overall Rating |
Comments |
|
Leather Gloves |
[4] |
[5] |
[3] |
[4] |
The fit is slightly loose. |
|
Nitrile Gloves |
|||||
|
Cut-Resistant Sleeves |
|||||
|
Insulated Mittens |
|||||
|
Chemical-Resistant Hand Guards |
|||||
|
Heat-Resistant Hand Sleeves |
|||||
|
Impact-Resistant Finger Guards |
|||||
|
Disposable Finger Cots |
|||||
|
Welding Hand Shields |
|||||
|
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]
