Agriculture PPE Checklist Form

Please fill out this form to ensure you have the necessary personal protective equipment (PPE) for your safety while working in agriculture. Your well-being is our priority!

PPE Item	Condition	Worn
Hard Hat	New Good Word Damaged	Yes No
Safety Goggles/Face Shield	New Good Word Damaged	Yes No
Respirator/Masks	New Good Word Damaged	Yes No
Hearing Protection	New Good Word Damaged	Yes No
Gloves	New Good Word Damaged	Yes No
Protective Clothing	New Good Word Damaged	Yes No
Steel-Toed Boots	New Good Word Damaged	Yes No
High-Visibility Vest	New Good Word Damaged	Yes No

Have you received training on how to use and maintain your PPE?

Worker Supervisor

Name: Name:

Date: Date:

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