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 Field Officer & Host supervisor. -
Date of issue
-
Employee Name
-
Issuer of PPE
-
Issue Location
-
Address?
-
PPE list number (Automated)
-
PPE (General)
- Ear Protectors (Ear Muffs)
- Safety glasses (Clear)
- Glasses (Over glasses)
- Safety glasses (Tinted)
- Sunscreen
- Hard Hat
- Dust mask
- Knee pads
-
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)
- Size XS
- Size S
- Size M
- Size L
- Size XL
- Size XXL
- Size 3XL
- Size 4XL
- Size 5XL
- Size 6XL
-
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)
- Size XS
- Size S
- Size M
- Size L
- Size XL
- Size XXL
- Size 3XL
- Size 4XL
- Size 5XL
- Size 6XL
-
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?
-
Men's Shirts - Bisley Work shirt
- Size XS
- Size S
- Size M
- Size L
- Size XL
- Size XXL
- Size 3XL
- Size 4XL
- Size 5XL
- Size 6XL
-
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 Long Pants
- 72R
- 77R
- 82R
- 87R
- 92R
- 102R
- 107R
- 112R
-
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?
-
Men's Work Boots
- 3 (UK) 4 (US) 36 (Euro)
- 3.5 (UK) 4.5 (US) 36.5 (Euro)
- 4 (UK) 5 (US) 37 (Euro)
- 4.5 (UK) 5.5 (US) 37.5 (Euro)
- 5 (UK) 6 (US) 38 (Euro)
- 5.5 (UK) 6.5 (US) 39 (Euro)
- 6 (UK) 7 (US) 40 (Euro)
- 6.5 (UK) 7.5 (US) 40.5 (Euro)
- 7 (UK) 8 (US) 41 (Euro)
- 7.5 (UK) 8.5 (US) 41.5 (Euro)
- 8 (UK) 9 (US) 42 (Euro)
- 8.5 (UK) 9.5 (US) 42.5 (Euro)
- 9 (UK) 10 (US) 43 (Euro)
- 9.5 (UK) 10.5 (US) 44 (Euro)
- 10 (UK) 11 (US) 45 (Euro)
- 10.5 (UK) 11.5 (US) 45.5 (Euro)
- 11 (UK) 12 (US) 46 (Euro)
- 11.5 (UK) 12.5 (US) 46.5 (Euro)
- 12 (UK) 13 (US) 47 (Euro)
- 12.5 (UK) 13.5 (US) 47.5 (Euro)
- 13 (UK) 14 (US) 48 (Euro)
- 13.5 (UK) 14.5 (US) 48.5 (Euro)
- 14 (UK) 15 (US) 49 (Euro)
-
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 Shirts - Bisley Work shirt
- Size 8
- Size 10
- Size 12
- Size 14
- Size 16
- Size 18
- Size 20
- Size 22
- Size 24
-
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?
-
Ladies Long Work Pants
- Size 8
- Size 10
- Size 12
- Size 14
- Size 16
- Size 18
- Size 20
- Size 22
- Size 24
-
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?
-
Ladies Work Boots
- 3 (UK) 4 (US) 36 (Euro)
- 3.5 (UK) 4.5 (US) 36.5 (Euro)
- 4 (UK) 5 (US) 37 (Euro)
- 4.5 (UK) 5.5 (US) 37.5 (Euro)
- 5 (UK) 6 (US) 38 (Euro)
- 5.5 (UK) 6.5 (US) 39 (Euro)
- 6 (UK) 7 (US) 40 (Euro)
- 6.5 (UK) 7.5 (US) 40.5 (Euro)
- 7 (UK) 8 (US) 41 (Euro)
- 7.5 (UK) 8.5 (US) 41.5 (Euro)
- 8 (UK) 9 (US) 42 (Euro)
- 8.5 (UK) 9.5 (US) 42.5 (Euro)
- 9 (UK) 10 (US) 43 (Euro)
- 9.5 (UK) 10.5 (US) 44 (Euro)
- 10 (UK) 11 (US) 45 (Euro)
- 10.5 (UK) 11.5 (US) 45.5 (Euro)
- 11 (UK) 12 (US) 46 (Euro)
- 11.5 (UK) 12.5 (US) 46.5 (Euro)
- 12 (UK) 13 (US) 47 (Euro)
- 12.5 (UK) 13.5 (US) 47.5 (Euro)
- 13 (UK) 14 (US) 48 (Euro)
- 13.5 (UK) 14.5 (US) 48.5 (Euro)
- 14 (UK) 15 (US) 49 (Euro)
-
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?
-
Unisex Jumpers
- Size XS
- Size S
- Size M
- Size L
- Size XL
- Size XXL
- Size 3XL
- Size 4XL
- Size 5XL
- Size 6XL
-
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.
