Agriculture PPE Checklist Form

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

Notes

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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