PPE Defect Report Form
Report defects in personal protective equipment quickly and efficiently. Please complete all fields to help us investigate and resolve issues.
Your Full Name
*
First Name
Last Name
Your Email Address
*
example@example.com
Your Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Department or Work Area
PPE Item Type
*
Please Select
Safety Helmet
Safety Goggles
Face Shield
Respirator/Mask
Gloves
Protective Clothing
Safety Footwear
Other
PPE Item Identifier (e.g., serial, batch, or asset number)
Date Defect Was Observed
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Defect Description
*
Severity of Defect
*
Critical – Unsafe to use
Major – Functionality impaired
Minor – Cosmetic or minor issue
Upload Photo(s) of Defect
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Submit Report
Should be Empty: