PPE Compliance Monitoring Checklist Form
Complete this checklist to monitor and document compliance with personal protective equipment (PPE) requirements.
Inspector Name
*
First Name
Last Name
Date of Inspection
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Location of Inspection
*
PPE Required for This Area
*
Hard Hat
Safety Glasses
Gloves
High-Visibility Vest
Hearing Protection
Respirator/Mask
Other
PPE Items Inspected and Compliance Status
*
Rows
Compliant
Non-Compliant
Hard Hat
1
2
Safety Glasses
3
4
Gloves
5
6
High-Visibility Vest
7
8
Hearing Protection
9
10
Respirator/Mask
11
12
Were any PPE items found to be non-compliant?
*
Yes
No
Describe any issues found with PPE (if any)
Corrective Action Required
Overall PPE Compliance Rating
*
1
2
3
4
5
Inspection Outcome
*
Pass
Fail
Conditional Pass (with corrective actions)
Submit Checklist
Should be Empty: