Title Page

  • The PPE listed has been issued to the named employee in accordance with the Occupational Health and Safety Act 2004.

    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 your supervisor

  • Date of issue

  • Employee Name

  • Issuer of PPE

  • Issue Location

  • Address?
  • PPE list number (Automated)

  • PPE (General)

  • How many clear glasses supplied?

  • How many over glasses supplied?

  • How many tinted safety glasses supplied?

  • How much sunscreen was supplied?

  • How many hard hats were supplied?

  • How many dust masks were supplied?

  • How many knee pads supplied?

  • How many hearing protectors were supplied?

  • Gloves (Class 1)

  • Quantity of size XS gloves supplied?

  • Quantity of size S gloves supplied?

  • Quantity of size M gloves supplied?

  • Quantity of size L gloves supplied?

  • Quantity of size XL gloves supplied?

  • Quantity of size XXL gloves supplied?

  • Quantity of size 3XL gloves supplied?

  • Quantity of size 4XL gloves supplied?

  • Quantity of size 5XL gloves supplied?

  • Quantity of size 6XL gloves supplied?

  • Gloves (Class 5)

  • Quantity of size XS gloves supplied?

  • Quantity of size S gloves supplied?

  • Quantity of size M gloves supplied?

  • Quantity of size L gloves supplied?

  • Quantity of size XL gloves supplied?

  • Quantity of size XXL gloves supplied?

  • Quantity of size 3XL gloves supplied?

  • Quantity of size 4XL gloves supplied?

  • Quantity of size 5XL gloves supplied?

  • Quantity of size 6XL gloves supplied?

  • Ladies Shirts - Bisley Work shirt

  • Quantity of size 8 shirt supplied?

  • Quantity of size 10 shirt supplied?

  • Quantity of size 12 shirt supplied?

  • Quantity of size 14 shirt supplied?

  • Quantity of size 16 shirt supplied?

  • Quantity of size 18 shirt supplied?

  • Quantity of size 20 shirt supplied?

  • Quantity of size 22 shirt supplied?

  • Quantity of size 24 shirt supplied?

  • Men's Shirts - Bisley Work shirt

  • Quantity of size XS shirt supplied?

  • Quantity of size S shirt supplied?

  • Quantity of size M shirt supplied?

  • Quantity of size L shirt supplied?

  • Quantity of size XL shirt supplied?

  • Quantity of size XXL shirt supplied?

  • Quantity of size 3XL shirt supplied?

  • Quantity of size 4XL shirt supplied?

  • Quantity of size 5XL shirt supplied?

  • Quantity of size 6XL shirt supplied?

  • Men's Work Boots

  • Quantity of size 3 (UK) 4 (US) supplied?

  • Quantity of size 3.5 (UK) 4.5 (US) supplied?

  • Quantity of size 4 (UK) 5 (US) supplied?

  • Quantity of size 4.5 (UK) 5.5 (US) supplied?

  • Quantity of size 5 (UK) 6 (US) supplied?

  • Quantity of size 5.5 (UK) 6.5 (US) supplied?

  • Quantity of size 6 (UK) 7 (US) supplied?

  • Quantity of size 6.5 (UK) 7.5 (US) supplied?

  • Quantity of size 7 (UK) 8 (US) supplied?

  • Quantity of size 7.5 (UK) 8.5 (US) supplied?

  • Quantity of size 8 (UK) 9 (US) supplied?

  • Quantity of size 8.5 (UK) 9.5 (US) supplied?

  • Quantity of size 9 (UK) 10 (US) supplied?

  • Quantity of size 9.5 (UK) 10.5 (US) supplied?

  • Quantity of size 10 (UK) 11 (US) supplied?

  • Quantity of size 10.5 (UK) 11.5 (US) supplied?

  • Quantity of size 11 (UK) 12 (US) supplied?

  • Quantity of size 11.5 (UK) 12.5 (US) supplied?

  • Quantity of size 12 (UK) 13 (US) supplied?

  • Quantity of size 12.5 (UK) 13.5 (US) supplied?

  • Quantity of size 13 (UK) 14 (US) supplied?

  • Quantity of size 13.5 (UK) 14.5 (US) supplied?

  • Quantity of size 14 (UK) 15 (US) supplied?

  • Men's Work Long Pants

  • Quantity of size 72R pants supplied?

  • Quantity of size 77R pants supplied?

  • Quantity of size 82R pants supplied?

  • Quantity of size 87R pants supplied?

  • Quantity of size 92R pants supplied?

  • Quantity of size 102R pants supplied?

  • Quantity of size 107R pants supplied?

  • Quantity of size 112R pants supplied?

  • Ladies Work Boots

  • Quantity of size 3 (UK) 4 (US) supplied?

  • Quantity of size 3.5 (UK) 4.5 (US) supplied?

  • Quantity of size 4 (UK) 5 (US) supplied?

  • Quantity of size 4.5 (UK) 5.5 (US) supplied?

  • Quantity of size 5 (UK) 6 (US) supplied?

  • Quantity of size 5.5 (UK) 6.5 (US) supplied?

  • Quantity of size 6 (UK) 7 (US) supplied?

  • Quantity of size 6.5 (UK) 7.5 (US) supplied?

  • Quantity of size 7 (UK) 8 (US) supplied?

  • Quantity of size 7.5 (UK) 8.5 (US) supplied?

  • Quantity of size 8 (UK) 9 (US) supplied?

  • Quantity of size 8.5 (UK) 9.5 (US) supplied?

  • Quantity of size 9 (UK) 10 (US) supplied?

  • Quantity of size 9.5 (UK) 10.5 (US) supplied?

  • Quantity of size 10 (UK) 11 (US) supplied?

  • Quantity of size 10.5 (UK) 11.5 (US) supplied?

  • Quantity of size 11 (UK) 12 (US) supplied?

  • Quantity of size 11.5 (UK) 12.5 (US) supplied?

  • Quantity of size 12 (UK) 13 (US) supplied?

  • Quantity of size 12.5 (UK) 13.5 (US) supplied?

  • Quantity of size 13 (UK) 14 (US) supplied?

  • Quantity of size 13.5 (UK) 14.5 (US) supplied?

  • Quantity of size 14 (UK) 15 (US) supplied?

  • Ladies Work Long Pants

  • Quantity of size 8 pants supplied?

  • Quantity of size 10 pants supplied?

  • Quantity of size 12 pants supplied?

  • Quantity of size 14 pants supplied?

  • Quantity of size 16 pants supplied?

  • Quantity of size 18 pants supplied?

  • Quantity of size 20 pants supplied?

  • Quantity of size 22 pants supplied?

  • Quantity of size 24 pants supplied?

  • Unisex Jumpers

  • Quantity of size XS jumper supplied?

  • Quantity of size S jumper supplied?

  • Quantity of size M jumper supplied?

  • Quantity of size L jumper supplied?

  • Quantity of size XL jumper supplied?

  • Quantity of size XXL jumper supplied?

  • Quantity of size 3XL jumper supplied?

  • Quantity of size 4XL jumper supplied?

  • Quantity of size 5XL jumper supplied?

  • Quantity of size 6XL jumper supplied?

  • 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 have been trained in the correct use, storage, cleaning and care of the PPE and also understand that I must report any lost or defective/damaged items immediately to my Field Officer and Host Supervisor who will reissue as applicable.

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