Semi-Annual PPE Audit

• Department

• Employee

• Prepared by

• Location
  Address

Hard Hat

• Full Name on Hard Hat

  Pass

  Fail

  N/A

• Within 5 years from the date of manufacture

  Pass

  Fail

  N/A

• Shell in good condition

  Pass

  Fail

  N/A

• Shell liner in good condition

  Pass

  Fail

  N/A

• Reflective striping in good condition and on all 4 sides

  Pass

  Fail

  N/A

• Blue light working

  Pass

  Fail

  N/A

• Clean / Unmarked

  Pass

  Fail

  N/A

• Ear muffs attached

  Pass

  Fail

  N/A

Ear Muffs

• Shell in good condition

  Pass

  Fail

  N/A

• Shell liner in good condition (ear pad and inner sponge)

  Pass

  Fail

  N/A

• Reflective striping

  Pass

  Fail

  N/A

• Molded ear plugs under 2 years old?

  Yes

  No

  N/A

Eye protection

• Clean

  Pass

  Fail

  N/A

• Side shields in place

  Pass

  Fail

  N/A

• Scratch free

  Pass

  Fail

  N/A

• Condition of frame

  Pass

  Fail

  N/A

• Appropriate for the task

  Yes

  No

  N/A

Gloves

• Good condition (no tears or punctures)

  Pass

  Fail

  N/A

• Appropriate for the task

  Yes

  No

  N/A

Foot protection

• Type

  Mucker

  Leather

  Winter

  Rubber

• CSA Approved

  Pass

  Fail

  N/A

• Condition of tread

  Pass

  Fail

  N/A

• No holes, cracks or punctures

  Pass

  Fail

  N/A

• Condition of laces, loops and fasteners

  Pass

  Fail

  N/A

• Appropriate for the task

  Pass

  Fail

  N/A

Reflective Clothing

• type

  Class 2

  Class 3

• Overly soiled

  Pass

  Fail

  N/A

• In good condition (no rips or tears, zippers and buttons work)

  Pass

  Fail

  N/A

• Proper fit

  Pass

  Fail

  N/A

• Striping adheres to standard

  Pass

  Fail

  N/A

• Arc Flash rated (Electrical, Welders ect)

  Pass

  Fail

  N/A

Miners Belt

• Webbing in good condition

  Pass

  Fail

  N/A

• Grommets and buckle in good condition

  Pass

  Fail

  N/A

• D ring in good condition

  Pass

  Fail

  N/A

• Proper fit (prong in at least the 3rd grommet and tail in keeper)

  Pass

  Fail

  N/A

Welding

• Helmet in good condition

  Pass

  Fail

  N/A

• Face shield in good condition

  Pass

  Fail

  N/A

• Welding apron or jacket in good condition

  Pass

  Fail

  N/A

Golden Guide

• Available and in good condition

  Pass

  Fail

  N/A

• Picture

  Pass

  Fail

  N/A

• Pledge

  Pass

  Fail

  N/A

• Commitment

  Pass

  Fail

  N/A

Respirator

• Type

  Half face

  Full face

  Full face power flow

  N/A

• Clean

  Pass

  Fail

  N/A

• In good condition

  Pass

  Fail

  N/A

• Log book available

  Pass

  Fail

  N/A

• Appropriate cartridge for task

  Yes

  No

  N/A

Signatures

• Employee signature

  Sign

• Supervisor signature

  Sign