PPE User Acknowledgment Form

Complete this form upon the issuance of personal protective equipment (PPE) to employees. It is essential to ensure that each employee acknowledges receipt and understands the proper use and maintenance of the PPE provided.

Employee Information:

Employee Name:	[Your Name]
Department:	[Your Department]
Date:	[MM-DD-YYYY]

PPE Issued: 

PPE Item	Date Issued	Employee Signature	Supervisor Signature
Respirator	[MM-DD-YYYY]
Safety Glasses
Other PPE

Acknowledgment:

I, [Your Name], acknowledge that I have received the above-listed personal protective equipment (PPE). I have been trained and understand the proper use, care, and maintenance of this equipment. I agree to use the PPE as instructed and report any damage or need for replacement to my supervisor.

Employee's Signature:__________

Date: [MM-DD-YYYY]

Health & Safety Templates @ Template.net