Title Page
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Employee Name
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Conducted on
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Service Territory
- ACT
- NSW
- NT
- QLD
- SA
- TAS
- VIC
- WA
Do you require replacement/new PPE Head Protection Items?
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Hard Hat with Eaton Logo - Marketplace
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Balaclava - Marketplace
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Helmet and Visor - Marketplace?
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Safety Glasses (Clear Lens) - Marketplace
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Quantity (How many do you require?)
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Safety Glasses (Smoke Lens) - Marketplace
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Quantity (How many do you require?)
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Outdoor Hard Hat Neck Sun Protection (Optional) - Marketplace
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Headlamp (Optional) - Marketplace
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Ear Plug (Optional) - Marketplace
Do you require replacement/new PPE - Body Items?
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Arc Flash Jacket
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Fluro Vest with EATON logo - Marketplace
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Arc Flash Work Shirts - Marketplace TBC
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Quantity
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Arc Flash Work Trousers - Marketplace TBC
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Quantity
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Rubber Glove - Marketplace
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Electrical OverGlove - Goatskin Leather - Marketplace
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Cotton Inner Gloves - Marketplace
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Glove Bag - Insulated - Marketplace
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Glove - Protection/Arc Flash - Marketplace
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Quantity
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Safety Boots - Min. AS/NZS 2210.3/EN ISO 20345/ASTM 2413
Do you require replacement/new LOTO/First Aid/LV Rescue Kits?
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LOTO KIT - Marketplace TBC
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Red Padlock
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Quantity
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Gate Valve Lockout
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Diameter - 127mm
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Diameter - 254mm
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Electrical First Aid KIT - Marketplace
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LV Rescue KIT - Marketplace
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LV Insulation Mat
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LV Busbar Mat - Marketplace
Do you require replacement/new "Other" Items?
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Fire Extinguisher
Sign Off
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I confirm that I have inspected and provided an accurate response to all questions and according to policies & guidelines.
