Title Page
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The PPE listed has been issued to the named employee in accordance with the Management of Health and Safety at Work Regulations 1999 and the Personal Protective Equipment at Work Regulations 1992.
The employee has a responsibility to:
• Take reasonable care of the PPE provided;
• use PPE in accordance with the training and instruction given;
• To keep the PPE clean and return it to its place of storage after use; and
• report any loss or defect immediately to their Manager or Supervisor -
Employee/Subcontractor Name
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Date of issue
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PPE issued
- Hi Vis vest
- Hi Vis Jacket
- Safety Footwear
- Hearing Protection
- Light Eye Protection (Glasses) Low Impact
- Eye Protection (Goggles) Medium/High Impact
- General Purpose Gloves
- Cut Level 3 (C/D) Gloves
- Cut Level 5 (E/F) Gloves
- Kevlar Sleeve/s
- FFP 3 Dust mask
- Hard Hat
- Bump Cap
- Safety Harness
- Fixed Length Harness
- Adjustable Length Harness
- Door Jamb Anchor
- OTHER
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What other PPE if any was issued
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I confirm that the above PPE has been issued to me and I understand that it is my responsibility to wear it when required. I confirm I have been advised of the risk or risks which the personal protective equipment will avoid or limit; I confirm I have been trained in the correct use, storage, cleaning and care of the PPE and understand that I must report any lost or defective/damaged items immediately to my Supervisor or Manager or who will reissue as applicable.
