PPE Request Form

Requester Information

Requester Name:	[Your Name]
Department:
Contact Number:
Email Address:

PPE Details

PPE Type:	Safety Goggles
Quantity:
Purpose of Use:
Urgency Level:

Justification

Reason for Request:	Replacement for damaged stock
Risk Assessment:

Approval Status

• Pending

• Approved

• Denied

Supervisor Name:                               

Supervisor Signature:                               

Date of Approval:                               

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