PPE Eye Protection Form
Please fill out this PPE Eye Protection Form to document the use and maintenance of eye protection in your workplace. Your detailed feedback is crucial for enhancing the effectiveness and user experience of our eye protection equipment.
User Information
Name: | |
Job Title/Position: | |
Department/Area: | |
Eye Protection Equipment Details
Type of Eye Protection Used: | Safety glasses with side shields |
Frequency and Context of Use: | |
Condition and Maintenance
Condition Inspection: | No damage, lenses clear, frames intact |
Maintenance Procedures: | |
Training and Compliance
Training Record: | [Month Day, Year] |
Compliance: | |
Comfort and Usability
Comfort Level (Rate on a scale of 1-5):
Ease of Use
Any discomfort or issues experienced while using the eye protection.
Suggestions for Improvement
Satisfaction with Current Eye Protection
Improvement Suggestions
Incident Reporting and Feedback
Have you experienced any eye-related incidents or near misses while using the PPE? If yes, please provide details of the incident(s).
Additional feedback on how the eye protection equipment could better support your safety needs.
Submitted by:
[Name]
[Job Title]
[Date]
Your contribution to this survey is invaluable in our continuous efforts to maintain and improve eye safety in our workplace. Thank you.
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