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Ployee Name(s): Signature: Tasks, Job Classification or Workstation Potential Hazard Type of PPE Required PPE Required (Yes / No) Mixing of bulk chemicals from transfer towers Splash of concentrated chemicals Goggles, faceshields, rubber gloves, apron. Y Pigeon Waste Histoplasmosis 1/2 respirator (HEPA cartridges), rubber gloves. Y Personal Protective Equipment Hazard Assessment Certification Job Title: Maintenance Worker, Mechanic Date: 10/16/00 Department: Physical Plant, Serv.

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