PPE User Acknowledgment Form
PPE User Acknowledgment Form
Complete this form upon the issuance of personal protective equipment (PPE) to employees. It is essential to ensure that each employee acknowledges receipt and understands the proper use and maintenance of the PPE provided.
Employee Information:
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Employee Name: |
[Your Name] |
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Department: |
[Your Department] |
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Date: |
[MM-DD-YYYY] |
PPE Issued:
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PPE Item |
Date Issued |
Employee Signature |
Supervisor Signature |
|
Respirator |
[MM-DD-YYYY] |
|
|
|
Safety Glasses |
|||
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Other PPE |
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Acknowledgment:
I, [Your Name], acknowledge that I have received the above-listed personal protective equipment (PPE). I have been trained and understand the proper use, care, and maintenance of this equipment. I agree to use the PPE as instructed and report any damage or need for replacement to my supervisor.
Employee's Signature:__________
Date: [MM-DD-YYYY]
