PPE Issue Report
This report outlines a safety concern regarding a tear in the right glove, emphasizing the need for prompt resolution to ensure employee well-being and workplace safety.
Employee Information:
Name: | [Name] |
Job Title: | |
Department: | |
Date of Report: | |
Contact Number: | |
Email: | |
PPE Details:
Type of PPE: | Safety Gloves |
Brand/Model: | |
Issue Description: | |
Date Issue Noticed: | |
Location: | |
Issue Severity:
Severity Level: | Medium |
Impact on Safety: | |
Action Taken:
Immediate Action: | The affected glove has been replaced with a spare one from the supply. |
Recommendations: | |
Verification and Follow-Up:
Verifier's Name: | [Name] |
Verification Date: | |
Resolution Date: | |
Follow-Up Actions: | |
Signatures:
I, [Your Name], the undersigned, acknowledge the accuracy of the information provided in this PPE Issue Report. I confirm that I reported the issue on the specified date.
Employee's Signature:
[Your Name]
[Job Title]
[Month Day, Year]
I, [Name], the [Safety Supervisor], have reviewed and verified the reported PPE issue. I confirm the actions taken and the resolution date as stated.
Safety Supervisor's Signature:
[Name]
[Job Title]
[Month Day, Year]
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