Download:
docx |
pdf
|
Respondent Answers
|
Requirements and
Features
|
Was PPE
[CORRECT]?
|
|
R
17.
Verified Product:
YES NO/DK/REF
|
|
R19. Location:
On your farm
Other:
________________________________________________
In your nursery
DK/REF
In your orchard
In your greenhouse
|
HEADWEAR
|
R28_30_33. Headwear
Worn:
Bandana, scarf, or t-shirt
Cap or short-brimmed hat
Wide-brimmed hat
Hood
Hooded respirator
Helmet/helmet respirator
No
DK/REF
“Cover over your…”
|
DK, None
[HEADWEAR]:_________________________________________
_____________________________________________________
_____________________________________________________
[HFEATURES]:
_____ Hat with wide brim all the
way around, hood, hooded
respirator, helmet,
or helmet respirator
_____ The headwear, or a cover over
the headwear, in the
specified material
_____ No special features
|
YES
NO
DK
N/A
|
EYEWEAR
|
R39_41. Eyewear
Worn:
Glasses
Goggles
Face shield
Full-face respirator
Helmet respirator with face
shield
No
DK/REF
|
DK, None
[EYEWEAR]:
__________________________________
_____________________________________________________
_____________________________________________________
[EFEATURES]:
_____ Glasses with side and brow
protection
_____Goggles
_____Splash-proof goggles (shielded
openings)
_____Face shield
_____Full-face respirator or helmet
respirator with face shield
_____Any of the above checked items
_____No special features
|
YES
NO
DK
N/A
|
CLOTHING
|
R49_56_57. CLOTHING WORN:
|
DK, None
[CLOTHING]:
__________________________________
_____________________________________________________
_____________________________________________________
[CFEATURES]:
_____Coveralls
or its equivalent
_____Coveralls,
or its equivalent, in the specified material
_____No special
features
|
YES
NO
DK
N/A
|
RSCREEN1.
Pesticide 1:
___________________________________________________________________________
RSCREEN2.
Pesticide 2:
___________________________________________________________________________
RSCREEN3.
Pesticide 3:
___________________________________________________________________________
RSCREEN4. Focus Pesticide:
_______________________________________________________________________
FOOTWEAR
FOOTWEAR
|
R63_70. FOOTWEAR WORN:
Sandals or other open toe or
open heel shoes
Shoes
Boots
NONE
DK/REF
“Covers over your…”
|
DK, None
[FOOTWEAR]:
__________________________________
_____________________________________________________
_____________________________________________________
[FFEATURES]:
_____Closed toe and closed heel
shoes, overshoes, boots or
overboots
_____Shoes, boots, or shoe or boot
covers, in the specified
material
_____Socks
_____No special features
|
YES
NO
DK
N/A
|
GLOVES
|
R76. GLOVES WORN:
Yes
No
DK/REF
R78. MORE THAN ONE GLOVE ON
EITHER HAND?
Yes
No
DK/REF
CHEMICAL RESISTANT GLOVES?
R81. (OUTER) R90.
INNER
Yes Yes
No No
DK/REF DK/REF/NA
R87. REUSED (OUTER) GLOVES?
Yes
No/DK/REF
|
DK, None
[GLOVES]:
_____________________________________
_____________________________________________________
_____________________________________________________
[GFEATURES]:
_____Gloves in the specified
material
_____No special features
|
YES
NO
DK
N/A
|
RESPIRATORS
|
R105_107. RESPIRATOR WORN:
Piece of cloth or bandana
Filtering facepiece respirator
Air-purifying respirator (non-
powered)
Powered air-purifying
respirator (PAPR)
Supplied air respirator (SAR)
Self-contained breathing
apparatus (SCBA)
No
DK/REF
|
DK, None
[RESPIRATOR/FILTER]:____________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
[RFEATURES]:
_____Filtering facepiece respirator
_____Air-purifying respirator
(non-powered) or powered air-
purifying respirator
(PAPR) with a [TYPE BELOW] filter,
cartridge, or canister
____
Particulate
____
Organic Vapor
____ Particulate
and Organic Vapor
_____Self-contained breathing
apparatus (SCBA)
_____Supplied-air respirator (SAR)
_____Any of the above checked items
_____No special features
|
YES
NO
DK
N/A
|
|
R
125.
EVER READ LABEL FOR… (PPE/CLOTHING)... FROM SAME
PRODUCT?: YES NO/DK/REF
|
|
R
132.
ABLE TO FIND INFORMATION ON PRODUCT LABEL
ABOUT…(PPE/CLOTHING)?: YES
NO/DK/REF/NA
|
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Jeremy Beach |
File Modified | 0000-00-00 |
File Created | 2021-01-28 |