This is a sample Personal Protective Equipment Program of the type required by the OSHA

standard. You should modify it to meet the needs of your particular operations and hazards.

XYZ CORPORATION, INC.

PERSONAL PROTECTIVE EQUIPMENT PROGRAM

PURPOSE:

The purpose of this program is to protect our employees by ensuring that Personal Protective
Equipment (PPE) is provided, used, and maintained in a sanitary and reliable condition whenever
it is necessary due to hazards from processes or in the work environment. To the extent that it is
possible and feasible, the company will remove or eliminate hazards or exposures through
engineering means to eliminate the need for PPE.

This program covers eye and face protection, head protection, foot protection, hand protection,
and electrical protection. Respiratory hazards and hearing hazards are covered by other
programs, but they will also be included in the Hazard Assessment described below. This
program covers the responsibilities of managers, supervisors and workers, assessment of hazards,
selection and use of personal protective equipment (PPE), and training.

RESPONSIBILITIES:

       (Name of responsible person)     will be responsible for assessing the hazards and exposures
that may require the use of PPE, determining the type of equipment to be provided, and
purchasing the equipment. Input from managers, supervisors, and employees will be obtained
and considered in selecting appropriate equipment.

Managers/supervisors will be responsible for training employees in the use and proper care of
PPE, ensuring that all employees are assigned appropriate PPE, and ensuring that PPE is worn by
employees when and where it is required.

Employees are responsible for following all provisions of this program and related procedures.
They are expected to wear PPE when and where it is required.

HAZARD ASSESSMENT:

The company will perform an assessment of the workplace to determine if hazards are present, or
likely to be present, which necessitate the use of personal protective equipment (PPE). This
assessment will consist of a survey of the workplace to identify sources of hazards to workers.
Consideration will be given to hazards such as impact, penetration, laceration, compression
(dropping heavy objects on foot, roll-over, etc.), chemical exposures, harmful dust, heat, light
(optical) radiation, electrical hazards, noise, etc. Where such hazards are present, or likely to be
present, we will:
· Select, and have each affected employee use, the types of PPE that will protect the employee
from the hazards identified in the hazard assessment.

· Communicate equipment selection decisions to each affected employee

· Select PPE that properly fits each affected employee

· Train employees in the use and care of PPE as described elsewhere in this program

The company will verify that the required workplace hazard assessment has been performed by
completing a written certification which is dated and signed by the person doing the assessment.
Whenever there is a change in process or in the workplace that might introduce or change an
exposure or hazard, the company will perform an assessment to determine if there needs to be
additional PPE provided or if there is a need for a change in the PPE provided. These
supplemental hazard assessments will also be documented, signed and dated by the person
performing the assessment. We will review and update the workplace hazard assessment on an
annual basis.

SELECTION OF PERSONAL PROTECTIVE EQUIPMENT (PPE):

Personal protective equipment (PPE) will be selected on the basis of the hazards to which the
workers' are exposed or potentially exposed. All selections will be made by with input from
managers, supervisors and workers.

Personal protective equipment will meet the following standards:

Eye & Face Protection devices - ANSI Z87.1-1989 "American National Standard Practice for
Occupational and Educational Eye and Face Protection"

Head Protection devices - ANSI Z89.1-1986 "American National Standard for Personal

Protection - Protective Headwear for Industrial Workers"

Foot Protection devices - ANSI Z41-1991 "American National Standard for Personal

Protection - Protective Footwear"

Hand Protection - No national standard available - selection will be based on task performed,
conditions present, duration of use, and the hazards and potential hazards identified.

Electrical Protective equipment - No national standard - equipment will be tested electrically

TRAINING:

Each employee who is required to use PPE will be trained in the following:
• Why PPE is necessary

• When PPE is necessary

• What PPE is necessary and any alternative choices of equipment

• How to properly don, doff, adjust, and wear PPE

• The proper care, maintenance, storage, useful life, and disposal of PPE

The training will include an opportunity for employees to handle the PPE and demonstrate that
they understand the training and have the ability to use the PPE properly. The training will be
provided by the manager or supervisor of the affected employees. The training will be
documented in writing with the documentation including the names of each employee trained,
the date(s) of the training, and the subject matter covered.

If an employee who has been trained demonstrates a lack of knowledge or behavior which leads
the supervisor to believe the employee does not have a proper understanding of the PPE
involved, that employee will be retrained. If there are changes in the workplace or processes that
change the exposures or type of PPE to be used, all affected employees will be retrained.

CARE OF PERSONAL PROTECTIVE EQUIPMENT:

Whenever practical, PPE will be assigned to individual workers for their exclusive use.
Employees will be responsible for the PPE equipment assigned to them or used by them.

PPE will be regularly cleaned, inspected and stored according to instructions given during the
training sessions or as directed by supervisors or managers. Defective or damaged PPE shall not
be used. Employees are to report any defective or damaged equipment to their supervisor for
repair or replacement.

________________________________________________________________________

PERSONAL PROTECTIVE EQUIPMENT

HAZARD ASSESSMENT

Date of Hazard Assessment:

Person Performing Hazard Assessment:

Location Job         Task/Position                   Hazards                              PPE Required

EXAMPLE:

Molding Dept.       Press Operator             Flying particles                     Safety Glasses

PERSONAL PROTECTIVE EQUIPMENT

CERTIFICATION OF HAZARD ASSESSMENT

XYZ Corporation certifies that a hazard assessment of the workplace was performed at our
facility located in , CT. This assessment consisted of a review of prior injury and illness records
and a walk-through inspection of all areas of the facility. The purpose of this assessment was to
identify sources of hazards to workers that are present, or are likely to be present, in the
workplace which necessitate the use of personal protective equipment (PPE).

Workplace Evaluated:

(Insert address of the facility and a listing of all departments or areas of the facility that were
inspected.)

Person Certifying Hazard Assessment:

Name:                                               Title:                                      

Date(s) of Hazard Assessment:                                          

Attachments:  Hazard Assessment forms

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