User Information

Name:

[Name]

Job Title/Position:

[Job Title]

Department/Area of Work:

[Department Name]

PPE Types and Usage

What types of PPE do you use regularly? 

Safety googles, gloves, ear protection.

How frequently do you use each type of PPE? 

1. Comfort and Fit

How would you rate the comfort of the PPE provided? 

(Scale from 1-5)

4

Are there any issues with the fit of the PPE?

(Yes/No) If yes, please specify.

2. Effectiveness and Safety

Do you feel the PPE effectively protects you in your work environment? 

Yes.

Have you experienced any safety incidents while wearing the PPE? If yes, please describe.

3. Feedback and Improvement Suggestions

What improvements, if any, would you suggest for the PPE provided?

More breathable materials for gloves, adjustable straps for goggles.

Additional comments or feedback about the PPE? 

4. Maintenance and Durability

How do you rate the durability of the PPE provided? (Scale from 1-5)

3

How often do you need to replace your PPE?

Are there any maintenance or cleaning challenges with the PPE? If yes, please explain.

5. Training and Information

Have you received adequate training on the correct use of PPE?

Yes.

Is there additional information or training you feel would be beneficial? If yes, please specify.