Title Page
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PPE Inspection
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Jobsite:
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Date of Inspection:
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Superintendent (s):
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Inspected By:
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Employee Name
Items for Inspection
ITEMS TO INSPECT
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Footwear (slip-resistant and puncture-resistant soles) (Steel Toe Required for Gilbane & Skanska)
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Puncture Proof Insert for Boots
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Reason for Declining?
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1926.95(d)(2) The employer is not required to pay for non-specialty safety-toe protective footwear (including steel-toe shoes or steel-toe boots) and non-specialty prescription safety eyewear, provided that the employer permits such items to be worn off the job-site.
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Clothing (vest, pants, shirt)
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1926.95(d)(4) The employer is not required to pay for: Everyday clothing, such as long-sleeve shirts, long pants. Ordinary clothing, skin creams, or other items, used solely for protection from weather, such as winter coats, jackets, gloves, parkas, rubber boots, hats, raincoats, ordinary sunglasses, and sunscreen.
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Hammer (no grinder cuts in the head)
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Double Yo-Yo (gate, condition of webbing, legible tags)
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Harness (legible tags, webbing, back D-ring)
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Positioning Chains (gate latches, tags legible)
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Eye & Face Protectors (Select Based on Anticipated Hazards)
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Respiratory Protection
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Hearing Protection
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Hard Hat & Suspension Liner
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Does this Employee Demonstrate the Understanding and Skill Level in the use of PPE?
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Was Retraining Required During this Inspection?
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1926.95(d)(5) The employer must pay for replacement PPE, except when the employee has lost or intentionally damaged the PPE.
