PPE Sign-Out Log Form
Please complete this form to record the issuance and return of personal protective equipment (PPE).
Employee Full Name
*
First Name
Last Name
Employee ID Number
*
Department
*
Please Select
Maintenance
Production
Warehouse
Administration
Other
Job Title
*
PPE Item(s) Issued
*
Safety Helmet
Safety Glasses
Ear Protection
Gloves
High-Visibility Vest
Respirator Mask
Protective Footwear
Other
Quantity of Each PPE Item Issued
*
Condition of PPE at Issue
*
New
Good
Usable
Other
Date and Time of Issue
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Expected Return Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Date and Time of Return
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Condition of PPE at Return
Good
Damaged
Needs Replacement
Other
Supervisor/Issuer Name
*
First Name
Last Name
Supervisor/Issuer Signature
*
Employee Signature
*
Submit Log
Submit Log
Should be Empty: