SF-009-PPE issue form

• Site conducted

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• Issued on

  Date

• Issued by

• Employee

  Select

• Please detail

• Reason for issue

  First Issue

  Lost

  Damaged

  Replacement

• This PPE Register logs the issue of personal protective equipment such as protective gloves, hi-visibility vests, ear defenders etc to each employee
  
  The PPE register documents the following
  
  1) PPE issued
  2) Statement of acceptance that the employee understands it is their responsibility not to misuse the PPE issued and to request a further issue of PPE once the item is no useable.
  3) Name of Employee and signature
  4) Management Name and signature

• Select what PPE has been issued using the drop-down menu

  Select Hard Hat Harness Lanyard Hi-visibility Vest Hi-visibility long sleeve vest Hi-visibility trousers Hi visibility jacket / coat Ear plugs Ear defenders Protective Gloves Protective Eyewear overalls anti static overalls -flame retardant RPE Work Boots Other

  • Hard Hat
  • Harness
  • Lanyard
  • Hi-visibility Vest
  • Hi-visibility long sleeve vest
  • Hi-visibility trousers
  • Hi visibility jacket / coat
  • Ear plugs
  • Ear defenders
  • Protective Gloves
  • Protective Eyewear
  • overalls anti static
  • overalls -flame retardant
  • RPE
  • Work Boots
  • Other

• description of other

• Type / Modle

• Additional information such as rating, protection level

• I understand that the PPE that has been issued today is my responsibility to keep in good order. It is also my responsibility to inform the office if PPE issued is no longer fit for purpose. I agree that PPE issued will not be misused in any way and if found to have been misused will replace at my own cost.

• Add media

  Media

Sign off

• Employee Name & Signature

  Sign

• Management Name & Signature

  Sign