|Project Name:||Project Location:|
PERSONAL PROTECTIVE EQUIPMENT ISSUE
I have received the following Personal Protective Equipment for my safety on this project:
Hard Hat with Suspension:
|Body Harness with Lanyard:||______|
|Full Face Shield:||______|
|Hearing Protection (muffs)||______|
|Back Support Belt:||______|
I agree to use this safety equipment as is required by OSHA, State, Local and Company safety regulations. I also agree to care for and maintain this equipment in good condition. I understand that any unserviceable safety equipment may be turned in for new equipment, but if lost, must be replace at my own expense. Upon termination of my employment with the company, I agree to return all equipment to my supervisor.
* Items listed above may not be necessary for all employees.
Employee's Signature: _________________________________________ Date: _________
Issuer's Signature: ____________________________________________