Specialized PPE Requirement Checklist
(e.g. Confined Spaces)

Project / Task

Date

Location

Personnel Involved

Specialized PPE Required

Check	PPE Item	Required (Y/N)	Notes
	Atmospheric Monitor/Detector
	Full Body Harness
	Retrieval Device
	Supplied Air Respirator
	Escape SCBA
	Communications Equipment
	Other

Additional Comments

Completed By

Supervisor Review

Specialized PPE Requirement Checklist(e.g. Confined Spaces)