Title Page
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Date Issued
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Issued to NAME
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Reason for issue (first issue,lost,stolen)
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Issued by NAME
PPE Issue
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List of PPE Issued
- Gloves
- Glasses
- Goggles
- Hard Hat
- Hi Viz Vest
- Hi Viz Jacket
- Face Mask
- Ear plugs
- Ear defenders
- Safety boots
- Overalls
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Face fit tested to this mask
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Do not Issue Issue until passed face fit test
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Any other PPE Issue not listed above list below
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Have you retuned old PPE
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Returned PPE is ensuring you have not misused or lost it.
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On retuning PPE the new issue is reasonable and replaced due to ware and tear.
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Take pictures of old PPE
Accepting PPE
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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.
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I except responsibility for PPE Issue.
