PPE Issuance Form
Employee Information
Employee Name
Employee ID
Department
Job Title
Date
PPE Items Issued
PPE Item
Quantity
Size
Condition
Remarks
New
Good
Damaged
New
Good
Damaged
New
Good
Damaged
Employee Acknowledgement
I acknowledge receipt of the above Personal Protective Equipment and agree to use and maintain them as instructed.
Employee Signature
Date
Issuer
Issuer Name
Issuer Signature
Date