Personal Protective Equipment (PPE) Request Form

Personal Protective Equipment (PPE) Request Form

This form is used to request Personal Protective Equipment (PPE), either for first-time issuance or replacement.
1. Employee Information
Date

MonthDayYear
Date
Hour MinutesAM/PM Option
Employee Name

First NameLast Name
Job Title
Area
Select your main area
Supervisor or Manager
Name and Last Name of your Supervisor or Manager
Branch
Employee Type
2. Request Type
Type of request:
3. PPE Requested
Please request only the necessary PPE. All other fields must be left blank. It is mandatory to specify the size and type. If you have any questions please let the HSE Coordinator know.

The maximum replacement of items due to wear & tear would only be TWICE annually under company expense. Anything more than the allowable replacements or any loss of the said items will be charged to the employee.

Every 12 months for footwear.

Baseline PPE

Rows	I'm requesting:	Size	Comments
High‑Visibility Safety Vest (Sizes: M to XXL)
Back Support Belt
Safety Glasses
Gloves: IT
Gloves: Warehouse/Terminal
Gloves: Mechanic
Hearing Protection

Shoes

Rows	I'm requesting:	Option	Size	Comments
Steel-toe shoes

Task-Based PPE

4. Reason / Task Description
Reason for requesting PPE
Briefly describe the task, hazard, or reason this PPE is required. (New Hire, Replacement, Lost, New task, etc..)
5. Approvals
Employee Signature
Should be Empty:

1. Employee Information