Title Page

  • Date Issued

  • Issued to NAME

  • Reason for issue (first issue,lost,stolen)

  • Issued by NAME

PPE Issue

  • List of PPE Issued

  • Face fit tested to this mask

  • Do not Issue Issue until passed face fit test

  • Any other PPE Issue not listed above list below

  • Have you retuned old PPE

  • Returned PPE is ensuring you have not misused or lost it.

  • On retuning PPE the new issue is reasonable and replaced due to ware and tear.

  • Take pictures of old PPE

Accepting PPE

  • On signing below you are excepting responsibility for the PPE issued to you. Misuse and not taking care of your PPE issue could result in being charged for issuing you new PPE.

  • I except responsibility for PPE Issue.

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.