PPE Receipt Slip

Employee Information:

Employee Name:	[Your Name]
Position:	[Machine Operator]
Date:	[Month Day, Year]
Department:	[Operations]

Description of Issued PPE:

PPE Item	Quantity	Date Issued	Condition
Safety Helmet	1	[Month Day, Year]	New
Safety Glasses	1	[Month Day, Year]	New
Ear Protection	1	[Month Day, Year]	New

Employee Acknowledgment:

I acknowledge that I have received the above-listed Personal Protective Equipment (PPE). I understand the importance of using this equipment for my safety while performing job duties. I am responsible for the proper care and use of the issued PPE.

Employee Signature: ________________________    Date: [Month Day, Year]

Safety Officer/Issuer Information:

_____________________

[Safety Officer’s Name]

[Month Day, Year]

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