Information
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The PPE and Work Equipment listed below has been issued to the employee named in accordance with the Management of Health and Safety at Work Regulations 1999 and the Personal Protective Equipment Regulations 1992. The employee has responsibility under the Health and Safety at Work Regulations 1974 to: - Take reasonable care of the Equipment and PPE issued; use the PPE and other equipment in accordance with their training and instructions given; to keep and maintain the PPE and equipment in good order and store after use in accordance with the manufacturers guidance; take all reasonable measures to prevent theft or accidental damage or unauthorised use; report loss or defects immediately to your line manager; When leaving your employment with NJS for any reason - to return the equipment in a reasonable condition, or each item will be charges at cost of replacement.
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Employee Name
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Date of Issue
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Equipment Issued By:
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Type of Personal Protective Equipment Issued
- Hard hat
- Fall Arrest Harness
- Eye Protection (LEP)
- Safety Goggles
- Ear Plugs
- Ear Defenders
- Dust Mask (Half Face Mask)
- Other RPE (BA Kit Etc)
- Gloves - General
- Hi viz vest
- Waterproof Clothing
- Steel Toecap Boots or Similar
- Other
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Specify Work Equipment Issued
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Specify Make/Model/Serial Number and any Accessories Issued
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Specify Make/Model/Serial Number and any accessories Issued
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Specify Make/Model/Serial Number and any Accessories Issued
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Specify the Type of Equipment Issued and any Serial Numbers etc
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Record the Serial Numbers of the Harness and or Lanyard Issued
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Is this Equipment First Issue or Replacement?
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State the reason for replacement (Damaged/Wear and Tear/Negligence)
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Have you been provided with information, training and instruction on the use of the PPE and / or Equipment issued to you, including its fitting, storage, cleaning and maintenance.<br><br>By signing this acknowledgement, you also confirm your understanding of the above and to whom you contact for replacement of PPE and Equipment and subsequent training and advice.
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Sign to acknowledge receipt
