Free PPE Evaluation Form Template

PPE Evaluation Form

Employee Information

Employee Name:

Department:

Job Title: 

Date of Issue:

PPE Checklist

PPE Item

Model/Type

Date Issued

Condition

Compliance Standard

Safety Helmet

Model A123

07/30/2050

New

ANSI Z89.1

Employee Feedback

Are you comfortable with the PPE?

  • Yes

  • No

Comments:                               

Do you require additional training?

  • Yes

  • No

Comments: ___________________________

Any concerns or suggestions?

Comments: ___________________________

Safety Officer's Remarks

Comments: ___________________________

Safety Officer's Signature:

Date:                               

Employee's Signature:

Date:                               

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