Personal Protection Equipment (PPE) Inspection Record

• Conducted on

  Date

• Service specialist

• Inspector

• Location
  Address

• Hard Hat

  Yes

  No

  N/A

• Condition & Date of manufacture (usually a stamp under the lid)

  Good

  Fair

  Poor

  N/A

• Gloves in good condition

  Yes

  No

  N/A

• Condition

  Good

  Fair

  Poor

  N/A

• Ear Protection

  Yes

  No

  N/A

• Condition

  Good

  Fair

  Poor

  N/A

• Goggles

  Yes

  No

  N/A

• Condition

  Good

  Fair

  Poor

  N/A

• Hi-Vis

  Yes

  No

  N/A

• Condition

  Good

  Fair

  Poor

  N/A

• Eye Protection

  Yes

  No

  N/A

• Condition

  Good

  Fair

  Poor

  N/A

• Safety Boots

  Yes

  No

  N/A

• Condition

  Good

  Fair

  Poor

  N/A

Equipment under PUWER

• Do you have a cleaning pole

  Yes

  No

  N/A

• Is the pole in good condition.

  Yes

  No

  N/A