Pirtek Steelpoort

Pirtek PPE Request Form

Safety is a major issue for day laborers and skilled laborers. Each year, accidents happen frequently in the construction industry, and often times it is due to the absence of Personal Protective Equipment (PPE) or failure to wear the provided PPE.

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Title Page

Site
Date
Location

Employee Information

Full name of Employee
Requested by
Job Title
Overall Jacket
Number of UNITS & Size Requested
Overall Pants
Number of UNITS & Size Requested
Hard Hat
T-Shirt
Number of UNITS & Size Requested
Safety Shoes
Size
Please provide evidence for replacement PPE, if any?
Please provide picture of all replacement PPEs

Final Questions

Please read and acknowledge by selecting the following option:
I understand that all orders are subject to availability constraints. My order will be filled to the extent that supplies allow.
I understand

Pirtek Steelpoort

Pirtek PPE Request Form

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.