Hanover Risk Solutions

Sample Personal Protective

Equipment (PPE) Policy
The purpose of the Personal Protective Equipment Policies (PPE) is to protect the employees
of [name of company] 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 have at your workplace] are also addressed in [Identify the section or location in your
Safety Program where these are found].

The [Name of your business] Personal Safety Coordinator [or person who has
Protective Equipment Policies includes: this responsibility]
• Responsibilities of supervisors Note: Depending on your business and the
and employees number of employees you have, you may
• Hazard assessment and PPE selection simply have a “designated safety person”
(who may be a supervisor/lead worker) or
• Employee training
a larger organized safety and health unit.
• Cleaning and Maintenance of PPE
Customize this section to fit the needs of
your policy.
Responsibilities
[Name of safety person] is responsible
[Add any additional responsibilities or for the development, implementation, and
delete those that do not apply to your administration of [Name of company] PPE
company] policies. This involves:

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1. C
 onducting workplace hazard assessments 4. E
 nsuring that employees properly use and
to determine the presence of hazards maintain their PPE, and follow [name of
which requires the use of PPE. business] PPE policies and rules.

2. Selecting and purchasing PPE. 5. Notifying [name of business] management

and the Safety Person when new hazards
3. R
 eviewing, updating, and conducting PPE
are introduced or when processes are
hazard assessments whenever:
added or changed.
• A job changes
6. E
 nsuring that defective or damaged PPE is
• New equipment is used
immediately disposed of and replaced.
• There has been an accident
Employees
• A supervisor or employee requests it
The PPE user is responsible for following the
• Or at least every year
requirements of the PPE policies. This involves:
4. Maintaining records on hazard assessments.
1. Properly wearing PPE as required.
5. Maintaining records on PPE assignments
2. Attending required training sessions.
and training.
3. P
 roperly caring for, cleaning, maintaining,
6. P
 roviding training, guidance, and
and inspecting PPE as required.
assistance to supervisors and employees
on the proper use, care, and cleaning of 4. Following [name of business] PPE policies
approved PPE. and rules.

7. P
 eriodically re-evaluating the suitability of 5. Informing the supervisor of the need to
previously selected PPE. repair or replace PPE.

8. R
 eviewing, updating, and evaluating the Employees who repeatedly disregard and do
overall effectiveness of PPE use, training, not follow PPE policies and rules will be: [add
and policies. your disciplinary policies]

Supervisors [lead personnel and/or

Procedures
designated persons]
Supervisors have the primary responsibility Hazard Assessment for PPE

for implementing and enforcing PPE use and [Safety or designated person] in
policies in their work area. This involves: conjunction with Supervisors, will conduct
a walk-through survey of each work area
1. P
 roviding appropriate PPE and making it
to identify sources of work hazards. Each
available to employees.
survey will be documented using the Hazard
2. E
 nsuring that employees are trained on Assessment Certification Form, which
the proper use, care, and cleaning of PPE. identifies the work area surveyed, the person
3. E
 nsuring that PPE training certification and conducting the survey, findings of potential
evaluation forms are signed and given to hazards, and date of the survey. [Safety or
[safety/designated person] designated person] will keep the forms in
the [specify exact location]

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[Safety or designated person] will conduct, or accepted for use. Newly purchased PPE
review, and update the hazard assessment must conform to the updated ANSI standards
for PPE whenever: which have been incorporated into the PPE
• A job changes regulations, as follows:

• New equipment or process is installed • Eye and Face Protection ANSI Z87.1-2003

• There has been an accident • Head Protection ANSI/ISEA Z89.1-2009

• Whenever a supervisor or employee • Foot Protection ASTM F2412-05 and

requests it ASTM F2413-05

• Or at least every year • Hand Protection (There are no ANSI

standards for gloves, however, selection
Any new PPE requirements that are must be based on the performance
developed will be added into [name of characteristics of the glove in relation to the
business] written Safety Program. tasks to be performed.)

Selection of PPE Affected employees whose jobs require

the use of PPE will be informed of the
Once the hazards of a workplace have been
PPE selection and will be provided PPE by
identified, [safety or designated person] will
[name of business] at no charge. Careful
determine if the hazards can first be eliminated
consideration will be given to the comfort and
or reduced by methods other than PPE,
proper fit of PPE in order to ensure that the
i.e., methods that do not rely on employee
right size is selected and that it will be used.
behavior, such as engineering controls.

If such methods are not adequate or feasible, Training

then [safety or designated person] will Any worker required to wear PPE will receive
determine the suitability of the PPE presently training in the proper use and care of PPE
available; and as necessary, will select new or before being allowed to perform work
additional equipment which ensures a level of requiring the use of PPE. Periodic retraining
protection greater than the minimum required will be offered to PPE users as needed. The
to protect our employees from the hazards. training will include, but not necessarily be
Care will be taken to recognize the possibility limited to, the following subjects:
of multiple and simultaneous exposure to • When PPE is necessary to be worn
a variety of hazards. Adequate protection
• What PPE is necessary
against the highest level of each of the
• How to properly don, doff, adjust, and
hazards will be recommended for purchase.
wear PPE
All personal protective clothing and
• The limitations of the PPE
equipment will be of safe design and
• The proper care, maintenance, useful life,
construction for the work to be performed
and disposal of the PPE
and will be maintained in a sanitary and
reliable condition. Only those items of After the training, the employees will
protective clothing and equipment that demonstrate that they understand how to
meet NIOSH or ANSI (American National use PPE properly, or they will be retrained.
Standards Institute) standards will be procured

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H A N OV E R R I S K S O LU T I O N S

Training of each employee will be will be distributed for individual use

documented using the [name of form whenever possible.
company uses ie; Personal Protective
If employees provide their own PPE, make
Equipment Training Documentation Form]
sure that it is adequate for the work place
and kept on file. The document certifies that
hazards, and that it is maintained in a clean
the employee has received and understood
and reliable condition.
the required training on the specific PPE he/
she will be using. Defective or damaged PPE will not be
used and will be immediately discarded
The PPE Training Quiz will be used to
and replaced.
evaluate employees’ understanding and will
be kept in the employee training records. NOTE: Defective equipment can be worse
than no PPE at all. Employees would avoid
Retraining a hazardous situation if they knew they were
The need for retraining will be indicated when not protected; but they would get closer to
• An employee’s work habits or knowledge the hazard if they erroneously believed they
indicates a lack of the necessary were protected, and therefore would be at
understanding, motivation, and skills required greater risk.
to use the PPE (i.e., uses PPE improperly)
It is also important to ensure that contaminated
• New equipment is installed
PPE which cannot be decontaminated is dis-
• Changes in the work place make previous posed of in a manner that protects employees
training out-of-date from exposure to hazards.
• Changes in the types of PPE to be used
Safety Disciplinary Policy
make previous training out-of-date
[Company name] believes that a safety
Cleaning and Maintenance of PPE and health Accident Prevention Program
It is important that all PPE be kept clean is unenforceable without some type of
and properly maintained. Cleaning is disciplinary policy. Our company believes
particularly important for eye and face that in order to maintain a safe and healthful
protection where dirty or fogged lenses workplace, the employees must be cognizant
could impair vision. Employees must inspect, and aware of all company, State, and Federal
clean, and maintain their PPE according to safety and health regulations as they apply to
the manufacturers’ instructions before and the specific job duties required. The following
after each use (see attached). [Attach a disciplinary policy is in effect and will be
copy of the manufacturers cleaning and applied to all safety and health violations.
care instructions for all PPE provided to
The following steps will be followed unless
employees]. Supervisors are responsible for
the seriousness of the violation would dictate
ensuring that users properly maintain their
going directly to Step 2 or Step 3.
PPE in good condition.
1. A
 first time violation will be discussed
Personal protective equipment must not
orally between company supervision and
be shared between employees until it has
the employee. This will be done as soon
been properly cleaned and sanitized. PPE
as possible.

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2. A
 second time offense will be followed up
in written form and a copy of this written
documentation will be entered into the
employee’s personnel folder.

3. A
 third time violation will result in time off
or possible termination, depending on the
seriousness of the violation.

[Add any additional disciplinary actions or

delete those that do not apply to
your company]

[See Personal Protective Equipment

Training Certification Form, attached]

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visit hanoverrisksolutions.com

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440 Lincoln Street, Worcester, MA 01653

The recommendation[s], advice and contents of this material are provided for informational purposes only and do not purport to address every possible legal obligation, hazard, code
violation, loss potential or exception to good practice. The Hanover Insurance Company and its affiliates and subsidiaries [“The Hanover”] specifically disclaim any warranty or representation
that acceptance of any recommendations or advice contained herein will make any premises, property or operation safe or in compliance with any law or regulation. Under no circumstances
should this material or your acceptance of any recommendations or advice contained herein be construed as establishing the existence or availability of any insurance coverage with
The Hanover. By providing this information to you, The Hanover does not assume [and specifically disclaims] any duty, undertaking or responsibility to you. The decision to accept or
implement any recommendation[s] or advice contained in this material must be made by you.

171-0955 [3/17] LC 12‐213

 Hanover Risk Solutions

Sample PPE Training

Certification Form
Employee’s name:__________________ Employee ID No.:_____________________________________

Job title/work area:______________________________________________________________________

Employer:______________________________________________________________________________

Trainer’s name (person completing this form):_______________________________________________

Date of training:_________________________________________________________________________

Types of PPE employee is being trained to use (List all PPE used):_____________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

The following information and training on the personal protective equipment (PPE) listed above
were covered in the training session:

____ The limitations of personal protective equipment: PPE alone cannot protect the employee
from on-the-job hazards.

____ What work place hazards the employee faces, the types of personal protective equipment
that the employee must use to be protected from these hazards, and how the PPE will
protect the employee while doing his/her tasks.

____ When the employee must wear or use the personal protective equipment.

____ How to use the personal protective equipment properly on-the-job, including putting it on,
taking it off, and wearing and adjusting it (if applicable) for a comfortable and effective fit.

____ How to properly care for and maintain the personal protective equipment: look for signs of
wear, clean and disinfect, and dispose of PPE.

Note to employee: This form will be made a part of your personal file. Please read and under-
stand its contents before signing.

(Employee) I understand the training I have received, and I can use PPE properly.

Employee’s signature:____________________________________ Date:__________________________

(Trainer must check off)

____ Employee has shown an understanding of the training.

____ Employee has shown the ability to use the PPE properly.

Trainer’s signature:_______________________________________ Date:__________________________

Reference
Washington Department of Labor and Industries