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]
Health & Safety Templates @ Template.net
