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

Hand sanitiser

Face mask

Van cleaning materials

Employee Signature

When you have received your items of PPE please add the date and time below

Date items received
Employee signature upon receipt of items
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.