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Write a risk assessment for Meter Ramp x1 Plastic Cup x1 Marbles x3 (Small, Medium, Large) Meter Ruler x1 Stopwatch x 1 Electronic Balance x1 Protractor x

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A suitable risk assessment for this classroom physics experiment should identify each task step, the hazards present, where they occur, the likelihood of injury, the severity of injury, and any PPE needed. The source documents describe a PPE hazard assessment as an evaluation that includes the tasks being done, the hazards, where they are located, the likelihood of injury, the severity of injury, and the PPE necessary. For a meter ramp, plastic cup, marbles, ruler, stopwatch, balance, and protractor experiment, the main hazards are low-energy physical hazards rather than chemical or high-temperature hazards, so the assessment should focus on impact, rolling, pinch, trip, and small-object risks, then document the controls and certification details required by school laboratory procedures. [6] [11] [7]

Hazard identification and typical controls for this experiment:

  • Small object choking hazard: marbles are small enough to present a choking risk, especially for younger pupils or anyone who mouths objects. Control by restricting the activity to age-appropriate students, giving a clear 'no marbles in mouth' instruction, counting marbles in and out before and after the lesson, and maintaining close supervision.
  • Rolling object hazard: marbles can roll unexpectedly off benches or onto the floor, creating slip or trip hazards and minor impact hazards to feet. Control by using a tray, lip, or stop block at the end of the ramp, keeping only one marble in motion at a time, retrieving escaped marbles immediately, and keeping walkways clear.
  • Trip hazard: meter ramps, rulers, bags, stools, and dropped marbles can obstruct movement around benches. Control by setting up away from main walkways, marking a clear working zone, keeping school bags off the floor, and stopping the activity until any dropped marble is recovered.
  • Equipment stability hazard: the ramp can slip or collapse if poorly supported, and the cup or balance can be knocked from the bench. Control by placing apparatus on a stable bench, securing the ramp angle before release, checking that the support point is firm, and keeping the balance away from the ramp runout path.
  • Impact or pinch hazard: fingers can be pinched while adjusting the ramp or struck by a moving marble at the bottom of the ramp. Control by adjusting apparatus slowly, keeping hands clear of the marble path, and using the cup or a barrier as the catcher.
  • Manual handling hazard: although equipment is light, awkward carrying of meter rulers, ramps, or multiple items can cause minor strains or collisions. Control by carrying one setup at a time, holding long items vertically or close to the body, and having students transport equipment under instruction.
  • Misuse hazard: throwing marbles, sword-fighting with rulers, or swinging the ramp creates unnecessary risk. Control by enforcing laboratory behavior rules, stopping unsafe behavior immediately, and removing equipment from any student who misuses it.

[7] [7] [14] Using the risk-priority approach in the source documents, most hazards in this experiment are normally low to medium risk when standard classroom controls are in place. A dropped or rolling marble is typically a minor-injury hazard with possible or occasional probability, so it should be treated as a medium risk until controls are applied, then reduced to low. Equipment instability or unsafe behavior can also be medium risk because they are unacceptable unless controlled. Any situation where apparatus is unstable, students are unsupervised, or marbles are being misused should be corrected before the activity continues. In practice, the teacher should record initial risk, apply controls, and confirm the residual risk is acceptable for a supervised school lesson. [13] [13] [9]

Safe operating procedure:

  1. Inspect the apparatus before use. Check that the meter ramp is not cracked or warped, the ruler edges are smooth, the cup is intact, and the balance and stopwatch are in good condition.
  2. Set up on a stable bench away from the classroom traffic route. Fix the ramp angle with a secure support and verify that it cannot slide during release.
  3. Place the plastic cup or another suitable stop at the end of the ramp so the marble is captured and cannot continue onto the floor.
  4. Keep only the equipment needed for the current run on the bench. Store spare marbles in a container so they cannot roll away.
  5. Explain the method before starting: one student releases the marble, one times, one records, and no one reaches across the ramp while a run is in progress.
  6. Release one marble at a time from the agreed start point. Do not push the marble forcefully; use a consistent release to avoid unpredictable motion.
  7. Retrieve marbles immediately after each run. If a marble falls to the floor, stop movement nearby and pick it up before continuing.
  8. Use the electronic balance on a separate stable area of the bench, away from the ramp path, to avoid knocks or dropped equipment.
  9. At the end of the lesson, count all marbles back in, dismantle the ramp carefully, and return long items and small objects in a controlled manner.

[8] For PPE, this experiment usually requires minimal PPE because the hazards are low-energy and can mostly be controlled by setup, supervision, and good working practices. The documents emphasize that engineering, work-practice, and administrative controls should be used before PPE, and that PPE is only a supplementary method. In a normal school laboratory, closed-toe shoes are advisable to protect against dropped or rolling objects and to reduce slip risk. Eye protection is not usually mandatory for a simple marble ramp experiment unless there is a realistic chance of marbles rebounding toward faces, in which case safety glasses may be justified by the local school policy. Gloves, hearing protection, respiratory protection, head protection, and special torso protection are generally not required for this activity. [3] [5] [14]

Supervision should be direct and active. A competent teacher or laboratory supervisor should brief students before the activity, monitor behavior throughout, and intervene immediately if marbles are thrown, apparatus becomes unstable, or the floor becomes obstructed. Younger students or students with additional support needs require closer supervision because of the small-object choking risk and the greater likelihood of unsafe handling. Students should not set up or modify the ramp angle without instruction. Good practice is to limit group size at each station so the supervisor can clearly observe releases, timing, and retrieval of marbles. [4] [10]

For documentation and compliance with school laboratory health and safety requirements, prepare a written risk assessment or JHA-style record for the experiment. It should identify the task, location, hazards, persons at risk, severity, probability, risk code, control measures, PPE decision, supervision arrangements, and emergency actions for minor incidents such as slips or finger pinches. The record should also include a certification section with the workplace or school laboratory name, assessor, and date. In school practice, this should sit within the laboratory safety management system, be communicated to staff, and be reviewed if the setup changes, if younger pupils use it, or if any incident or near miss occurs. [12] [1] [2]

Practical overall conclusion:

This classroom experiment is generally suitable for routine school laboratory use if it is treated as a low-complexity physical activity with clear controls: stable setup, one marble released at a time, immediate retrieval of dropped marbles, closed-toe footwear, no horseplay, and active teacher supervision. The most important specific issues are the small-object choking hazard, rolling marble slip/trip hazard, and apparatus stability. With those controls documented and enforced, the residual risk is typically low and consistent with normal school laboratory health and safety expectations.

14 source record(s)

Sources used for this answer

[1] Personal Protective Equipment (PPE) Guide

Page 43

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Source excerpt

# What is a hazard? A hazard is an existing (or potential) hazardous or unsafe condition or work practice that, by itself or in combination with other conditions, could cause injury, illness, or death to workers, as well as cause property damage. Hazards may exist from • Processes, procedures • Unsafe equipment, machinery, or tools • Unsafe work practices - Any series of actions or operations (manufacturing, equipment, product flow, etc., and handling) that convert raw material into a product - For example damaged tools, unguarded blades or unguarded moving parts, etc. - Allowing untrained workers to perform hazardous tasks, taking unsafe shortcuts, being distracted, working long shifts, etc. The table below describes some common types of hazards. It does not cover all the possible hazards that employees may face or for which personal protective equipment may be required. Some hazards, such as noisy environments or those that may require respirators, must be evaluated with appropriate test equipment to quantify the exposure level when overexposure is suspected. (Hearing and respiratory protection will be covered in future volumes.) <table><tr><th>Hazard Type</th><th>General Description</th><th>Examples</th></tr><tr><td>Impact</td><td>Person can strike an object or be struck by a moving or flying or falling object.</td><td>• movement of machine parts · chips thrown from machines falls from elevation or on the same level</td></tr><tr><td>Penetration</td><td>Person can strike, be struck by, or fall upon an object or tool that would break the skin.</td><td>. sharp edges or protrusions on tools, machines, or in aisles</td></tr><tr><td>Crush or pinch</td><td>An object(s) or machine may crush or pinch a body or body part.</td><td>a falling, rolling, or dropped object that causes crushing injury to hands or feet • press</td></tr><tr><td>Harmful Dust</td><td>Presence of dust that may cause irritation, or breathing or vision difficulty. May also have ignition pot…

[2] Personal Protective Equipment (PPE) Guide

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# Option 2 <table><tr><th colspan="7">Job Hazard Analysis Matrix</th></tr><tr><td colspan="2">Severity of Injury</td><td colspan="5">Probability of an Accident Occurring</td></tr><tr><td>Level</td><td>Description</td><td>A Frequent</td><td>B Several Times</td><td>C Occasional</td><td>D Possible</td><td>E Extremely Improbable</td></tr><tr><td></td><td>Fatal or Permanent Disability</td><td>1</td><td></td><td>1</td><td>2</td><td>3</td></tr><tr><td></td><td>Severe Illness or Injury</td><td>1</td><td>1</td><td>2</td><td>2</td><td>3</td></tr><tr><td>III</td><td>Minor Injury or illness</td><td>2</td><td>2</td><td>2-3</td><td>3</td><td>3</td></tr><tr><td>IV</td><td>No Injury or illness</td><td>3</td><td>3</td><td>3</td><td>3</td><td>3</td></tr></table> c. Assign a RISK PRIORITY CODE (1, 2, or 3) to the task step based upon the severity and probability assessments on the matrix. For example, a Severity of "III" and a Probability of "B" gives a Risk Code of "2" (look at where they intersect). ## 3. Take Action on the Assessment: <table><tr><th colspan="3">Risk Priority</th></tr><tr><td>Risk Code</td><td>Risk Level</td><td>Action Required</td></tr><tr><td>1</td><td>High</td><td>Stop work activities immediately until hazard can be eliminated, controlled, or reduced to a lower level.</td></tr><tr><td>2</td><td>Medium</td><td>Job hazards are unacceptable and must be controlled by engineering, work practice, administrative, and/or PPE methods as soon as possible.</td></tr><tr><td>3</td><td>Low</td><td>No real or significant hazard exists. Controls are not required but may increase employees' comfort level.</td></tr></table> If the risk priority code is • LOW (3) for a task step then it requires no further action. Note: If you assign a risk code of 3, be sure that there isn't a WISHA standard that requires specific protection be provided. For example: WAC 296-24- [redacted postal code] requires personal protective equipment when using compressed air for cleaning. • MEDIUM (2…

[3] Personal Protective Equipment (PPE) Guide

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Source excerpt

# SAMPLE PPE POLICIES # Introduction The purpose of the Personal Protective Equipment Policies is to protect the employees of (Name of your business) from exposure to work place hazards and the risk of injury through the use of personal protective equipment (PPE). PPE is not a substitute for more effective control methods and its use will be considered only when other means of protection against hazards are not adequate or feasible. It will be used in conjunction with other controls unless no other means of hazard control exist. Personal protective equipment will be provided, used, and maintained when it has been determined that its use is required to ensure the safety and health of our employees and that such use will lessen the likelihood of occupational injury and/or illness. This section addresses general PPE requirements, including eye and face, head, foot and leg, hand and arm, body (torso) protection, and protection from drowning. Separate programs exist for respiratory protection and hearing protection as the need for participation in these programs is established through industrial hygiene monitoring. (List other programs or policies requiring PPE, such as Hearing Protection, Respiratory Protection, Fall Protection, etc., that you may have at your work place) are also addressed in (State the section or location in your Accident Prevention Program where they are found) The (Name of your business) Personal Protective Equipment Policies includes: - Responsibilities of supervisors and employees • Hazard assessment and PPE selection - Employee training - Cleaning and Maintenance of PPE Sample Policies-2

[4] Personal Protective Equipment Hazard Assessment

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# Table of contents What is a PPE hazard assessment?.. 2 Why should you do a PPE hazard assessment? .2 What are Oregon OSHA's requirements for PPE hazard assessments?........3 Oregon OSHA's hazard assessment rules .3 How to do a PPE hazard assessment..... Do a baseline survey to identify workplace hazards... Evaluate your employees' exposures to each hazard identified in the baseline survey.... Document your hazard assessment ..5 Do regular workplace inspections .6

[5] Personal Protective Equipment (PPE) Guide

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# Option 2 # Job Hazard Analysis Assessment for PPE Use with WAC [redacted identifier] Personal Protective Equipment (PPE) The Job Hazard Analysis (JHA) approach to doing a hazard assessment for PPE is a more comprehensive method and may be more useful in larger businesses with many hazards and/or complex safety issues. It also helps you assign a Risk Priority Code to the hazard to determine the course of actions you need to take to control the hazard. Follow the instructions as you conduct your hazard assessment and fill in the hazard assessment form. You can make copies of the form or customize it to fit the needs of your work place. For more detailed explanations of the instructions and guidance on doing the hazard assessment, including completed sample forms, see the "Additional Guidelines on Conducting a JHA Hazard Assessment for PPE," pages 25-30). This tool can also serve as written certification that you have done a hazard assessment as required by WAC 296-800-[redacted postal code] Document your hazard assessment for PPE. Make sure that the blank fields at the bottom of the form (indicated by *) are filled out. *Name of your work place *Address of the work place where you are doing the hazard assessment *Name of person certifying that a workplace hazard assessment was done *Date the hazard assessment was done 24 21 21

[6] Personal Protective Equipment (PPE) Guide

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# Option 2 A high risk priority means that there is a reasonable to high probability that an employee will be killed or permanently disabled doing this task step and/or a high probability that the employee will suffer severe illness or injury! 4. Select PPE: Try to reduce employee exposure by first implementing effective controls that do not primarily rely on individual employee behavior (such as using PPE). Follow the "Hierarchy of Controls" (p. 38). a. For each hazard you identified, ask the question: "Can we change the way this job is done to eliminate or reduce this hazard?" Ideas might include combining steps, changing the sequence, a different tool, a change in the workstation, ventilation etc. The employees who do this job may have some good practical ideas. b. If none of these will work, what personal protective equipment (PPE) is needed? If PPE is needed, it must be appropriately matched to the hazard to provide effective protection against the hazard. c. Write down your solution in the Control Method column opposite the hazard. If you still aren't satisfied that the hazard is under control, you may need to consider not doing this job or doing it less often. 5. Certify the hazard assessment: Make sure you sign and fill in the required information (indicated by *) at the bottom of the form for proper documentation of the hazard assessment. The following pages show two examples of completed JHA hazard assessments for PPE. 28

[7] Personal Protective Equipment (PPE) Hazard Assessment Tool

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# Hazard assessment worksheet: Head protection (cont.) ## Potential hazards (cont.) OSHA Oregon OSHA Department of Consumer and Business Services # Hazard assessment worksheet: Foot protection Salem Central Office [redacted street address]. NE Salem, OR [redacted postal code] Phone: [redacted phone] Toll-free: [redacted phone] osha.oregon.gov Work task: Date ## Potential hazards - No hazards requiring foot protection - Heavy objects such as barrels or tools that might roll onto or fall on a worker's feet - Sharp objects such as nails or spikes that could pierce the soles or uppers of ordinary shoes - Molten metal Hot, wet, or slippery surfaces Energized electrical equipment Other hazard: ## PPE required None required Steel toe shoes Boots or shoes metatarsal guards Slip resistant soles Puncture resistant soles Chemical resistant boots Insulated boots or shoes Other PPE: 440-5871 (07/23/COM)

[8] Personal Protective Equipment (PPE) Guide

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# TABLE OF CONTENTS (If viewing this pdf document on the computer, you can place the cursor over the section headings below until a hand appears and then click. You can also use the Adobe Acrobat Navigation Pane to jump directly to the sections.) <table><tr><th></th><th>How To Use This Guide...</th><th>4</th></tr><tr><td>A.</td><td>Introduction</td><td>.6</td></tr><tr><td>B.</td><td>What you are required to do.</td><td>8</td></tr><tr><td></td><td>1. Do a Hazard Assessment for PPE and document it</td><td>8</td></tr><tr><td></td><td>2. Select and provide appropriate PPE to your employees..</td><td>10</td></tr><tr><td></td><td>3. Provide training to your employees and document it.</td><td>11</td></tr><tr><td></td><td>4. Make sure your employees use their PPE properly.</td><td>12</td></tr><tr><td></td><td>5. Make sure PPE is in safe and good condition</td><td>12</td></tr><tr><td>C.</td><td>Resources</td><td>.14</td></tr><tr><td></td><td>Tools/Forms: Checklists and forms you can use to help you</td><td></td></tr><tr><td></td><td>comply with PPE requirements.</td><td>15</td></tr><tr><td></td><td>Guidelines for complying with PPE requirements.</td><td>5672 16</td></tr><tr><td></td><td>Hazard Assessment For PPE.</td><td>17</td></tr><tr><td></td><td>Job Hazard Analysis Assessment for PPE.</td><td>21</td></tr><tr><td></td><td>- Additional Guidelines for Conducting a Job Hazard Analysis (JHA) Assessment for PPE...</td><td>.25</td></tr><tr><td></td><td>Personal Protective Equipment Training Certification Form</td><td></td></tr><tr><td></td><td>Personal Protective Equipment Training Quiz.</td><td></td></tr><tr><td></td><td>Sample PPE Policies</td><td></td></tr><tr><td></td><td>Recognizing and Controlling Hazards</td><td></td></tr><tr><td></td><td>What is a hazard?.</td><td>35</td></tr><tr><td></td><td>How do you control hazards?</td><td>38</td></tr><tr><td></td><td>Engineering Controls.</td><td>38</td></tr><tr><td></td><td>- Work Practice Controls</td><td>39</td></tr><tr><td><…

[9] Personal Protective Equipment Hazard Assessment

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# What types of PPE may be necessary? Your hazard assessment should determine if your employees need any of the following types of PPE: - Eye and face protection ◆ Fall protection - Foot protection • Hand/general skin protection - Head protection • Hearing protection • Leg protection ● Personal floatation device • Respiratory protection • Torso/general body protection ## How to do a PPE hazard assessment ## Do a baseline survey to identify workplace hazards A baseline survey is a thorough evaluation of your entire workplace - including work processes, tasks, and equipment - that identifies safety and health hazards. A complete survey will tell you what the hazards are, where they are, and how severe a potential injury could be. ## Suggestions: Use safety data sheets (SDS) to identify chemical hazards. A safety data sheet has detailed information about a hazardous chemical's health effects, its physical and chemical characteristics, and safe handling practices. Review equipment owner and operator manuals to determine the manufacturer's safety warnings and recommended PPE. Conduct a job-hazard analysis (JHA) - a method of identifying, assessing, and controlling hazards associated with specific jobs. A JHA breaks down a job into tasks. You evaluate each task to determine if there is a safer way to do it. A job-hazard analysis works well for jobs with difficult-to-control hazards and jobs with histories of accidents or near misses. JHAS for complex jobs can take a considerable amount of time and expertise to develop. You may want to have a safety professional help you. Have an experienced safety professional survey your workplace with you. 4

[10] Personal Protective Equipment Hazard Assessment

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# What are Oregon OSHA's requirements for PPE hazard assessments? If you are a general industry, construction, or agricultural employer you must determine if your workplace has hazards you cannot eliminate or control without PPE. If there are such hazards, you must: • Select the PPE that protects your employees from the hazards • Communicate your selection decisions to each affected employee • Ensure the PPE fits each employee • Require your employees to use their PPE when they are exposed to the hazards General industry employers must also prepare a document that says they have done the hazard assessment. The document must include: • A heading that says the document is a "certification" of the hazard assessment • The name of the workplace evaluated • The name of the person certifying the hazard assessment was completed • The date of the hazard assessment ## Oregon OSHA's hazard assessment rules • General industry: [redacted phone](1), Hazard assessment and equipment selection. Appendix B to Subdivision 2/1 has guidelines for conducting a hazard assessment. • Construction: [redacted phone](1), Hazard assessment and equipment selection. Appendix B to Subdivision 2/1 has guidelines for conducting a hazard assessment. • Agriculture: [redacted phone](2), Hazard assessment and protective equipment selection. Appendix A to Subdivision 4/1 has a sample hazard assessment form. 3

[11] Personal Protective Equipment (PPE) Guide

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# Option 2 <table><tr><th></th><th></th><th colspan="5">Job Hazard Analysis Matrix</th></tr><tr><td colspan="2">Severity of Injury</td><td colspan="5">Probability of an Accident Occurring</td></tr><tr><td>Level</td><td>Description</td><td>A Frequent</td><td>B Several Times</td><td>C Occasional</td><td>D Possible</td><td>E Extremely Improbable</td></tr><tr><td>I</td><td>Fatal or Permanent Disability</td><td>1</td><td>1</td><td>1</td><td></td><td>3</td></tr><tr><td>||</td><td>Severe Illness or Injury</td><td>1</td><td>1</td><td>2</td><td>2233</td><td>3</td></tr><tr><td>III</td><td>Minor Injury or illness</td><td>2</td><td>2</td><td>2-3</td><td></td><td>3</td></tr><tr><td>IV</td><td>No Injury or Illness</td><td>3</td><td>3</td><td>3</td><td></td><td>3</td></tr></table> <table><tr><th colspan="3">Risk Priority</th></tr><tr><td>Code</td><td>Risk Level</td><td>Action Required</td></tr><tr><td>1</td><td>High</td><td>Work activities must be suspended immediately until hazard can be eliminated or controlled or reduced to a lower level.</td></tr><tr><td>2</td><td>Medium</td><td>Job hazards are unacceptable and must be controlled by engineering, administrative, or personal protective equipment methods as soon as possible.</td></tr><tr><td>3</td><td>Low</td><td>No real or significant hazard exists. Controls are not required but may increase the comfort level of employees.</td></tr></table> 3. Take action on the assessment. Depending on the assigned Risk Level/Code (or Risk priority), take the corresponding action according to the table above: • If Risk priority is LOW (3) for a task step → requires no further action. - Note: If you assign a risk code of 3, be sure that there isn't a WISHA standard that requires specific protection be provided. For example: WAC 296-24-[redacted postal code] requires personal protective equipment when using compressed air for cleaning. - If Risk priority is MEDIUM (2) → select and implement appropriate controls. • If Risk priori…

[12] Personal Protective Equipment Hazard Assessment

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# What is a PPE hazard assessment? A personal protective equipment (PPE) hazard assessment is an evaluation of your workplace that helps you determine what hazards your employees are exposed to and what PPE they need to protect themselves. A hazard assessment should include: - The jobs (or tasks) your employees do - The hazards your employees are exposed to • Where the hazards are located - The likelihood those hazards could injure your employees - The severity of a potential injury • The types of PPE necessary to protect your employees from those hazards ## Why should you do a PPE hazard assessment? There are three reasons: 1. A hazard assessment will help you find hazards at your workplace. 2. A hazard assessment will help you determine what personal protective equipment your employees need for protection. 3. Oregon OSHA's rules require you do one. 2

[13] Personal Protective Equipment (PPE) Guide

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# Personal Protective Equipment (PPE) When hazards cannot be engineered completely out of normal operations or maintenance work, and when safe work practices and other forms of administrative control cannot provide sufficient additional protection, use PPE as a supplementary method of control. PPE is the least effective way to protect workers because it does not eliminate or control the hazard itself, but rather places a barrier between the worker and the hazard. PPE devices alone should not be relied on to provide protection against hazards; if the equipment fails, the worker is immediately exposed to the hazard. Ask these questions: • What PPE is available to deal with this kind of hazard? • How intense is the hazard? - For example, - Will the PPE prevent penetration of the projectile? - Will the gloves be harmed by this chemical through absorption or disintegration? - How long will the PPE last before it wears out? • What type of hazard is it, how severe is it, and what capabilities must the PPE have? Select the appropriate PPE based on the answers to these questions. • What is the minimum protection required? Then provide a greater protection than the minimum so that it will be adequate under less than optimum conditions and will have a reasonably long life. 41 41 11

[14] Personal Protective Equipment (PPE) Guide

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# Option 2 # Job Hazard Analysis for Personal Protective Equipment (PPE) Assessment Job/Task: Location: <table><tr><th>Job/Task Step</th><th>Hazard Type</th><th>Hazard Source</th><th>Body Parts At Risk</th><th>Severity</th><th>Probability</th><th>Risk Code</th><th>Control Method¹</th></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr></table> (1) Note: Engineering, work practice, and/or administrative hazard controls such as guarding must be used, if feasible, before requiring employees to use personal protective equipment. Certification of Assessment *Name of work place: <empty> *Address: <empty> *Assessment Conducted By: <empty> Title: <empty> *Date(s) of Assessment: <empty> Implementation of Controls Approved By: <empty> Title: <empty> Date: <empty> Page 24 24 24

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