High Visibility Clothing PPE Form

High Visibility Clothing PPE Form

Please complete this form accurately and thoroughly for each employee issued with high-visibility clothing.

Employee Information

Name of Employee:

Employee ID:

Job Position:

Contact Information:

High Visibility Clothing Information

Date Issued:

Issued By:

Role/Position:

Contact Information:

Type and Specifications:

Size:

  • Extra Small

  • Small

  • Medium

  • Large

  • Extra Large

Color:

Condition at Issue:

  • New 

  • Good

  • Fair

Inspection Schedule:

Acknowledgement

I acknowledge that I have received and understand the proper use and care of the high-visibility clothing described above. I am committed to wearing and maintaining this PPE for my safety and the safety of those around me.

                                                

[Employee Name]

[MM/DD/YYYY]

Thank you for completing the form. If you have any concerns or require further assistance, please contact the [Department] at [Department Phone].

Your commitment to workplace safety is appreciated.

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