Information
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Requesting Employee name
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Conducted on
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Prepared by
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All basic P.P.E. is provided to safely perform your daily work. This process allows you to choose upscale and specialized P.P.E. at a subsidized rate.
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If there is a Replacement cost, it will be deducted from your next paycheck.
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Do you require a Hard Hat?
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Will you be returning a defective Hard Hat or you a New Employee?
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What type of Hard Hat do you want?
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What type of Hard Hat do you want to purchase?
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Do you require a Safety Vest?
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Will you be returning a defective Safety Vest or you a New Employee?
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What type of Safety Vest do you want?
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What type of Safety Vest do you want to purchase?
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Do you require a Safety Glasses?
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Will you be returning a defective Safety Glasses or you a New Employee?
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Safety Glasses ($0.00)
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Safety Glasses ($6.00)
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Do you require a Fall Arrest Harness?
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Will you be returning a defective Fall Arrest Harness or have you just completed Fall Arrest training?
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What type of Fall Arrest Harness do you want?
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What type of Fall Arrest Harness do you want to purchase?
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Will you be returning a defective Lanyard or have you just completed Fall Arrest Training?
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What type of Fall Arrest Harness do you want?
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What type of Lanyard do you want to purchase?
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Do you require a Gloves?
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Will you be returning a defective Gloves or you a New Employee?
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What type of Gloves do you want?
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What type of Gloves do you want to purchase?
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Do you require a Caulking Gun?
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Will you be returning a defective Caulking gun or you a New Employee?
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Caulking Gun ($0.00) allowed 2 per quarter (Jan / Apr / Jul / Oct)
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Caulking gun ($72.00 ea)
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Add any photo documentation as required
Photo of P.P.E.
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Add media
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By signing his agreement you will maintain, inspect, and keep in good order your personal protective equipment. If it is found that your Personal Protective equipment has been abused and not properly cared for, you will be responsible for the full replacement cost.
Should you require replacement Personal Protective Equipment, return the defective P.P.E. to your supervisor or the office in order to receive the subsidized cost. -
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