The PPE Hazard Assessment Certification Form is a crucial workplace safety document required under Indonesian law to systematically identify, assess, and document workplace hazards and corresponding PPE requirements. This form must be completed in compliance with Law No. 1 of 1970 on Work Safety and related regulations whenever new hazards are identified, work processes change, or during regular safety reviews. The document serves multiple purposes: it demonstrates regulatory compliance, provides a systematic approach to hazard assessment, specifies appropriate PPE for identified risks, and creates a record of safety measures implemented. The certification form should be regularly reviewed and updated to reflect changes in workplace conditions or when new hazards are identified.
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1. Workplace Information: Basic details including facility name, address, work area/department being assessed, and date of assessment
2. Assessor Details: Name, position, and qualifications of person(s) conducting the hazard assessment
3. Work Activities Description: Detailed description of job tasks and routine activities being assessed
4. Hazard Identification: Systematic listing of all potential physical, chemical, biological, and ergonomic hazards present in the workplace
5. Risk Assessment: Evaluation of identified hazards including severity and likelihood of occurrence
6. PPE Requirements: Specific PPE requirements for each identified hazard, including type, class, and standards to be met
7. Implementation Details: Information about PPE distribution, training requirements, and maintenance procedures
8. Certification Statement: formal certification statement confirming the assessment has been properly conducted in accordance with Indonesian regulations
1. Previous Assessment Reference: Include when this is a review or update of a previous assessment, providing reference to prior documentation
2. Emergency PPE Requirements: Include when specific emergency scenarios require additional or specialized PPE
3. Contractor Requirements: Include when external contractors work in the assessed area and need specific PPE requirements
4. Special Conditions: Include when there are unique environmental conditions or special circumstances affecting PPE selection
5. Cost Analysis: Include when budget justification for PPE procurement is required
1. PPE Selection Matrix: Detailed matrix showing specific PPE requirements for each identified hazard and task
2. Hazard Assessment Checklist: Standardized checklist used during the assessment process
3. PPE Specifications: Technical specifications and standards for required PPE
4. Training Record Template: Template for recording PPE training and fitting sessions
5. Maintenance Schedule: Schedule for PPE inspection and maintenance requirements
6. Employee Acknowledgment Form: Form for workers to acknowledge receipt and training of required PPE
Relevant legal definitions
Clauses
Relevant Industries
Manufacturing
Construction
Mining
Oil and Gas
Chemical Processing
Pharmaceuticals
Food Processing
Warehousing and Logistics
Agriculture
Forestry
Marine and Shipping
Healthcare
Waste Management
Utilities
Metal Processing
Relevant Teams
Health and Safety
Operations
Production
Quality Assurance
Facilities Management
Maintenance
Human Resources
Risk Management
Environmental Health
Training and Development
Compliance
Emergency Response
Relevant Roles
Health and Safety Manager
Environmental Health and Safety (EHS) Coordinator
Risk Assessment Officer
Occupational Health Specialist
Safety Compliance Officer
Industrial Hygienist
Plant Manager
Operations Director
Production Supervisor
Quality Control Manager
Facility Manager
Safety Engineer
Department Supervisor
Training Coordinator
Maintenance Manager
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