PPE Damage Report Form
PPE Damage Report Form
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Date |
[Date] |
Time |
[10:00 AM] |
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Reported By |
Position |
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Department |
Contact |
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Type of PPE |
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Damage Description |
Left sleeve of the gown has a large tear near the seam, approx. 6 inches long. Unsuitable for use in sterile environment |
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Date & Time of Discovery |
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Location |
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Was the PPE in use at the time of damage discovery? |
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Cause of Damage |
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Was the damaged PPE removed from use? |
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Immediate action taken |
Reviewed by:
[Your Name]
[Job Title]
[Date]
