HFS PPE ISSUED

• Created on

  Date
• Location
  Address

• Staff Name

• Date

  Date

Staff Member Name

• Supervisor

• Select date

  Date

Tool List

• Wet weather trousers

  Select Good Fair Needs Replacement Lost Stolen New

  • Good
  • Fair
  • Needs Replacement
  • Lost
  • Stolen
  • New

• Wet Weather Jacket

• Hard Hat

  Select Good Fair Needs Replacement Lost Stolen New

  • Good
  • Fair
  • Needs Replacement
  • Lost
  • Stolen
  • New

• Safety Glasses

  Select Good Fair Needs Replacement Lost Stolen New

  • Good
  • Fair
  • Needs Replacement
  • Lost
  • Stolen
  • New

• Safety Boots

  Select Good Fair Needs Replacement Lost Stolen New

  • Good
  • Fair
  • Needs Replacement
  • Lost
  • Stolen
  • New

• Safety Goves

  Select Good Fair Needs Replacement Lost Stolen New

  • Good
  • Fair
  • Needs Replacement
  • Lost
  • Stolen
  • New

I accept that I have received the above equipment and am responsible for their care and security. Should any be lost or missing I agree that I may be required to pay for a replacement.

• Name

• Select date

  Date

• Add signature

  Sign