Title Page
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
Hand Protection Testing information (by department)
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Department
Department #
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Department Name
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Name of Person (wearing the test glove)
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Shift
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Glove being tested
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Image of Gloves being tested
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Start Date
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End Date
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Current Glove being used
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Current glove life
- Less than a day
- 1 day
- 2 days
- 3 days
- 4 days
- 5 days
- 6 days
- 7 days
- 1 week
- 2 weeks
- 3 weeks
- 1 month
- 2 months
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Rating CE (Please choose all CAPT)
- Cut 1
- Cut 2
- Cut 3
- Cut 4
- Cut 5
- Abrasion 1
- Abrasion 2
- Abrasion 3
- Abrasion 4
- Tear 1
- Tear 2
- Tear 3
- Tear 4
- Puncture 1
- Puncture 2
- Puncture 3
- Puncture 4
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Rating ANSI
- A1
- A2
- A3
- A4
- A5
- A6
- A7
- A8
- A9
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Comfort - How would you rate the material of this glove?
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Fit - How does this glove fit your hand
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Dexterity/Precision - Does this glove provide better dexterity while doing your job?
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Grip - How would you rate the grip of this glove?
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Protection - How would you rate the protection of this glove?
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Current vs. Proposed - How would you rate the TEST glove over the current glove?
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End User Signature
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Customer Contact Signature
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Fastenal Signature
