Worker details
Name
Role and work area
Start date
Known fit considerations Prescription eyewear, facial hair affecting respirator seal, sizing, medical or religious requirements
PPE issued
One row per item. The signature column is what turns this from a stores record into evidence that the worker received the item and the instruction that goes with it.
| Item and specification | Standard or rating | Size | Date issued | Issued by | Worker signature |
|---|---|---|---|---|---|
Fit and training record
- Worker was shown why the item is required and what it protects against
- Correct fitting was demonstrated and the worker demonstrated it back
- Fit testing was completed where the item requires it, and the result recorded
- Inspection before each use was explained, including what a fail looks like
- Cleaning, storage and charging requirements were explained
- Worker knows how to report a damaged, lost or poorly fitting item, and that replacement is free
- Limitations were explained, including what the item does not protect against
Inspection and replacement schedule
Items with a service life or an inspection requirement go here. Record the interval from the manufacturer's instructions, not from habit.
| Item | Inspection interval | Last inspected | Result | Replacement due | Inspector |
|---|---|---|---|---|---|
Returned, replaced or damaged
| Item | Date | Reason | Replaced with | Signed |
|---|---|---|---|---|
Declaration
I confirm I have received the items listed, been shown how to fit, inspect, clean and store them, and understand that I must wear them where required and report any damage or poor fit immediately. I understand replacements are provided at no cost to me.
Worker signature and date. Issuer signature and date.