Title Page
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CMS019 PPE
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Project
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Form Completed By
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Package
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Operations Manager
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Logistics Manager/Supervisor
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Date / Time
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Are all operatives complying to PPE requirements as follows:
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Eye Protection either glasses or goggles? (Impact rated where required)
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Hard Hat? (with 4-point chinstrap where required)
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Hearing Protection?
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Hi-Visibility clothing? (clean with reflective bands)
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Is RPE required?
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Are operatives issued with rubber half-mask (JSP or equivalent)
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Have wearers of RPE undergone a face-fit test?
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Are operatives using the correct filters in the RPE?
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Overalls / protective clothing (where applicable)?
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Safety Footwear? (including mid-sole protection for construction works)
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Protective Gloves? (with sufficient protection based upon the task)
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Is the PPE suitable for the environment being worked in?
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Is the PPE Clipfine approved?
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Is PPE recycled?
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Is PPE checked at regular intervals by supervision/management?
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Are PPE issue records kept?
Sign Off
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Inspection carried out by
Additional Attendees
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Attendee
