Purpose The purpose of this safety program is to aid business owners with their Federal or applicable State OSHA compliance efforts. Each business is unique and each program will require customization. As the program is customized, remember to only include words, sections, concepts, procedures, etc. that are relevant to the operations. The purpose of any written safety program is to provide a clear and consistent plan for addressing safety in a particular area of focus. Use Use this wizard to customize your program. Instructions To develop your customized plan, follow steps 1 through 3 in order by clicking the buttons and following the instructions prompted by the program. Customize Review and Format Approve & Save

<CompanyName>

Personal Protective Equipment Program

Version <Version>

Updated: <Date>

Contents

1.	Program Purpose	3

2.	Responsibilities	3

3.	Definitions	3

4.	Hazard Assessment	3

5.	Selection of PPE	4

6.	Using, Inspecting, Maintaining, and Replacing PPE	4

7.	Specific Requirements	4

8.	Employee Information & Training	5

Appendix I: PPE Hazard Assessment	6

Appendix II: PPE Requirements	8

Appendix III: Information for Employees Using Respirators (Dust Masks) When Not Required	9

Employee Acknowledgement	10

Program Purpose

<CompanyName>’s Personal Protective Equipment (PPE) Program is to provide a consistent approach to managing workplace hazards when personal protective equipment is necessary to maintain employee safety.

Responsibilities

<ProgramReviewer> is responsible for reviewing and updating of the program annually or when significant changes in operations occur.

<NewHireTrainer> is responsible for assuring employees are trained upon hire.

<OngoingTrainer> is responsible for assuring employees are trained upon job transfer, addition of a new substance, or after significant changes in operation.

<PPEPurchaser> is responsible for obtaining PPE.

Employees are responsible for the following:

Asking questions about PPE use in the workplace

Wearing assigned PPE in the prescribed manner

Properly maintaining assigned PPE

Recognizing when PPE should be replaced

Keeping track of assigned PPE in order to keep costs down

Definitions

PPE – Personal protective equipment

Required – officially considered essential

Voluntary – acting of one's own free will

Hazard Assessment – systematic review of hazards and appropriate controls

Hazard Assessment

The hazard assessment process will be managed by <HazardAssessor> and may employ the assistance of other qualified people. A hazard assessment will be conducted at least annually and when changes to operations occur.

The assessment will consider but not necessarily be limited to the following hazards: impact, penetration, compression, chemical, heat, cold, dust, light, radiation, and biological.

Controls will be implemented based on the known hierarchy of control method with PPE use being a final resort.

The PPE assessment will be kept on file in <AssessmentFileLocation>.

The hazard assessment may include industrial hygiene monitoring.

Voluntary use of PPE will be considered based on the results of the hazard assessment.

Contractors who introduce new hazards must provide details to <NewHazardDocumenter> and that person will instruct affected employees of temporarily required or voluntary use PPE to be worn while hazard exists.

Selection of PPE

PPE will be selected based on the results of the hazard assessment.

<PPESelector> will work with vendors, supervisors, and employees to determine what PPE to purchase.

<PPEPurchaser> will purchase all PPE through an approved supplier. Minor exceptions to the formal purchasing process can be bypassed with the approval of <PPEPurchaser>.

PPE in use shall be reviewed at least annually by <PPEPurchaser> to determine if alternate and more suitable options are available. Results of the review shall not be mandatory to implement assuming adequate controls are in place.

Employees shall be allowed to request different style PPE to meet their personal needs. Exceptions to the standard PPE options shall be approved by <PPEPurchaser> and the employees’ supervisor.

All PPE used by employees shall meet applicable standards such as the American National Standard Institute (ANSI).

OSHA’s Personal Protective Equipment publication OSHA 3151-12R 2004 may be referenced in determining specific requirements.

Using, Inspecting, Maintaining, and Replacing PPE

PPE shall be used, inspected, maintained, and replaced in accordance with manufacturer’s guidelines.

Daily visual inspection of PPE should be performed to ensure protective nature of the equipment has not been compromised.

Damaged or defective PPE shall be replaced immediately by turning in the damaged or defective item into <PPEReplacer>.

Specific Requirements

All employees who enter <PPERequiredLocation> are required to wear the following:

Piece of Protective Equipment
<RequiredPPE1>
<RequiredPPE2>
<RequiredPPE3>
<RequiredPPE4>
<RequiredPPE5>
<RequiredPPE6>
<RequiredPPE7>
<RequiredPPE8>
<RequiredPPE9>
<RequiredPPE10>

Department and task-specific PPE is outlined in Appendix II.

Employee Information & Training

New employees shall be trained on the <CompanyName> PPE Program by <NewHireTrainer>, including the location of the program and contents of the program including:

Results of the PPE assessment

When PPE use is required and when PPE is voluntary

Proper use, care, inspection, and replacement of PPE

Limitations of PPE in controlling hazards

Hazards that can be created through the use of PPE

Physical limitation faced when wearing PPE

Job specific training will be conducted upon hire or transfer to a new position or department by <OngoingTrainer> before any task requiring PPE is performed.

Employees can ask questions concerning the PPE or any other safety concern to <SafetyManager>.

Contractors working on site will be trained on PPE requirements.

Appendix I: PPE Hazard Assessment

Building/Department/Worksite:
Assessment Conducted By:	Assessment Date:
Task/Process/Position:

Possible exposure to:
☐ Airborne dust/debris/vapor/gases/smoke ☐ Direct skin contact ☐ Chemical/liquid splash ☐ Blood/infectious material ☐ Noise ☐ Falling objects ☐ Laser/intense light/radiation/sunlight	☐ Extreme temperatures ☐ Electrical ☐ Sharp/rough objects materials/surfaces ☐ Wet/slippery conditions ☐ Congestion/traffic ☐ Other: ☐ Other:
Can any hazard be eliminated without the use of PPE? ☐ Yes ☐ No ☐ Maybe Explain:

Body Part Affected	Hazard	PPE
Eyes
Face
Head
Ears
Hands/Arms
Feet/Legs
Body Skin
Whole Body
Lungs/Respiratory
Other:

Appendix II: PPE Requirements

Department or Task	Required PPE	Voluntary PPE

Appendix III: Information for Employees Using Respirators (Dust Masks) When Not Required

(Appendix D to OSHA sec. 1910.134, Cal OSHA sec. 5144)

Respirators are an effective method of protection against designated hazards when properly selected and worn. Respirator use is encouraged, even when exposures are below the exposure limit, to provide an additional level of comfort and protection for workers. However, if a respirator is used improperly or not kept clean, the respirator itself can become a hazard to the worker. Sometimes, workers may wear respirators to avoid exposures to hazards, even if the amount of hazardous substance does not exceed the limits set by OSHA standards. If your employer provides respirators for your voluntary use, or if you provide your own respirator, you need to take certain precautions to be sure that the respirator itself does not present a hazard.

You should do the following:

Read and heed all instructions provided by the manufacturer on use, maintenance, cleaning and care, and warnings regarding the respirator’s limitations.

Choose respirators certified for use to protect against the contaminant of concern. NIOSH, the National Institute for Occupational Safety and Health of the U.S. Department of Health and Human Services, certifies respirators. A label or statement of certification should appear on the respirator or respirator packaging. It will tell you what the respirator is designed for and how much it will protect you.

Do not wear your respirator into atmospheres containing contaminants for which your respirator is not designed to protect against. For example, a respirator designed to filter dust particles will not protect you against gases, vapors, or very small solid particles of fumes or smoke.

Keep track of your respirator so that you do not mistakenly use someone else's respirator.

I have read and understood the above information:

Print Employee Name:
Employee Signature:
Date & Location:

Employee Acknowledgement

I have received information on <CompanyName>’s Personal Protective Equipment Program. By signing below, I agree to abide by the procedures in this document and bring to the attention of my supervisor any questions or concerns had.

Employee Name:
Employee Signature:
Date:

icwgroup.com ICW Group is the marketing name for ICW Group Holdings, Inc. For a list of all ICW Group Holdings, Inc. subsidiaries, please visit our website www.icwgroup.com.
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