PPE Receipt Slip
PPE Receipt Slip
Employee Information:
|
Employee Name: |
[Your Name] |
|
Position: |
[Machine Operator] |
|
Date: |
[Month Day, Year] |
|
Department: |
[Operations] |
Description of Issued PPE:
|
PPE Item |
Quantity |
Date Issued |
Condition |
|
Safety Helmet |
1 |
[Month Day, Year] |
New |
|
Safety Glasses |
1 |
[Month Day, Year] |
New |
|
Ear Protection |
1 |
[Month Day, Year] |
New |
Employee Acknowledgment:
I acknowledge that I have received the above-listed Personal Protective Equipment (PPE). I understand the importance of using this equipment for my safety while performing job duties. I am responsible for the proper care and use of the issued PPE.
Employee Signature: ________________________ Date: [Month Day, Year]
Safety Officer/Issuer Information:
_____________________
[Safety Officer’s Name]
[Month Day, Year]
