Gear Bag Inspection Form

• Employees' Gear bag observed:

• Conducted by

• Conducted on

  Date

Gear Bag Inspection

• Employee's Name

• 1. Full Face Respirator - (Amount Needed 1)

  Yes

  No

  N/A

• 2. Defender (multi purpose) cartridges - (Amount Needed 4 pairs)

  Yes

  No

  N/A

• 3. Ammonia cartridges - (Amount Needed 1 pair)

  Yes

  No

  N/A

• 4. Acid gas cartridges - (Amount Needed 1 pair)

  Yes

  No

  N/A

• 5. Dust Masks - (Amount Needed 2)

  Yes

  No

  N/A

• 6. Tyvek Coveralls - (Amount Needed 5)

  Yes

  No

  N/A

• 7. Poly-Tyvek Coveralls - (Amount Needed 2)

  Yes

  No

  N/A

• 8. Tyvek Labcoats - (Amount Needed 5)

  Yes

  No

  N/A

• 9. Leather gloves – (Amount Needed 5 pairs)

  Yes

  No

  N/A

• 10. Nitrile gloves – (Amount Needed 2 boxes)

  Yes

  No

  N/A

• 11. Thick nitrile gloves – (Amount Needed 2)

  Yes

  No

  N/A

• 12. Ear plugs – (Amount Needed 5)

  Yes

  No

  N/A

• 13. RCRA labels – (Amount Needed 20)

  Yes

  No

  N/A

• 14. Safety glasses – (Amount Needed 5)

  Yes

  No

  N/A

• 15. Hard hat – (Amount Needed 1)

  Yes

  No

  N/A

• 16. Respirator Wipes – (Amount Needed 1 Box)

  Yes

  No

  N/A

Sign-Off

• Name and Signature of the Employee

  Sign

• Name and Signature of the Inspector

  Sign