Title Page
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Project Number
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Project Name
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Name of Person Issued with Personal Protective Equipment [PPE]
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Date Issued
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Issued by Demo One Site Supervisor
Personal Protective Equipment Register
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This form is to be completed whenever Personal Protective Equipment [PPE] is issued to site personnel or site visitors. All PPE should be checked as fit for purpose prior to issue and use.
Hard Hat
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Type / Make / Model
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Checked as fit for purpose
Foot Protection
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Type / Make / Model
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Checked as fit for purpose
Gloves
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Type / Make / Model
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Checked as fit for purpose
Eye Protection
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Type / Make / Model
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Checked as fit for purpose
Hearing Protection
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Type / Make / Model
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Checked as fit for purpose
High Visibility Vest
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Type / Make / Model
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Checked as fit for purpose
Respiratory Protective Equipment [RPE]
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Type / Make / Model
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Checked as fit for purpose
Foul Weather Gear
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Type / Make / Model
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Checked as fit for purpose
High Visibility Clothing
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Type / Make / Model
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Checked as fit for purpose
Harness and Lanyard
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Type / Make / Model
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Checked as fit for purpose
Other
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List Below (including type / make / model)
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Checked as fit for purpose
Any Comments
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Please detail any extra or additional matters (if any) and / or any comments
Declarations
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I the undersigned agree to abide by Demo One Limited site rules in respect of the use and care of all personal protective equipment [PPE] I have been issued. My failure to comply with the use and care of PPE may result in disciplinary procedures.
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I acknowledge my failure to comply with identified risk control measures in the use and care of PPE may adversely affect any civil case I might bring in the event of being injured or my property damaged whilst at work.
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I agree I have the appropriate PPE for the site operations I shall be undertaking and will wear it at all times.
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I also agree I have been fully briefed on and confirm my understanding of the requirement to use PPE for the tasks I will be undertaking whilst on site.
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Signature of Person issued with Personal Protective Equipment [PPE]
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Signature of Demo One Site Supervisor
