SafetyCulture Authorized

Personal Protective Clothing Checklist - SPG 208.01

Revised 10/31/12

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Information

Which Quarter?

Shift
Station
Employee's Name
Prepared By
Conducted On

Personal Protective Clothing Checklist - SPG 208.01

Personal Protective Clothing

Required Personal Protective Clothing

Fire Helmet with visor or Bourke's
PBI bunker coat and pants
Steel toed bunker boots
Hearing protection plugs
20' 3/4" tubular webbing
Aluminum Carabiner
Fanny pack with personal protective equipment
Three cell flashlight
Leather protective gloves
Firefighting gloves
Clear Safety Glasses
Belt pouch with exam gloves
Nomex or PBI hood
SCBA mask with integrated portable radio interface

Issued Equipment

City of Lenexa ID
City Purchase Card (Visa)
Checkpoint Access Card
Current Drivers License

Signature

Employee's Signature
Supervisor's Signature

SafetyCulture Authorized

Personal Protective Clothing Checklist - SPG 208.01

Revised 10/31/12

Use this Template

Print as PDF

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.