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Please check the items below that you require. Please note that you must give as much notice as possible (minimum of 3 days) At all times it is the employees responsibility to contact the office to order replenished PPE after the initial distribution within the specified order lead times.
Disposable nitrile gloves
Van cleaning materials
When you have received your items of PPE please add the date and time below
Date items received
Employee signature upon receipt of items
Coronavirus 2020 PPE order form
Specialist PPE for use during Corona Virus Pandemic
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Please note that this checklist is a hypothetical example and provides basic information only. It is not intended
take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or
or other applicable laws. You should also seek your own professional advice to determine if the use of such
permissible in your workplace or jurisdiction.