CONDITIONS OF ISSUE for PERSONAL PROTECTIVE EQUIPMENT

EMPLOYEE NAME: DEPARTMENT:

EMPLOYEE NUMBER: IDENTIFICATION NUMBER:

1. My PPE is issued to me free of charge at expense of the Company.

2. My PPE remains the property of the Company and must be handed back on termination of
service.
3. If I lose or wilfully damage, misuse or abuse my PPE it may result in disciplinary action being
taken against me subject to an investigation.
4. I will immediately report any loss or damage of PPE to my manager/supervisor.
5. I will wear or use my PPE issued to me in the correct manner, as I have been trained to do,
where and whenever I am required to wear it.
6. I may not remove my PPE from the company premises without written permission.
7. If I don’t use my PPE it may result in disciplinary action being taken against me subject to an
investigation.
8. I understand that it is a legal requirement to wear PPE and that if I refuse to do so it can lead
to disciplinary procedures being instituted against me.
9. I understand that my PPE must be kept in my designated storage place allocated by the
company.
10. The employee understands that my designated storage place should be identified with my
name.
11. I understand that PPE should be stored in the designated place when not in use.
12. I understand and accept responsibility for maintaining PPE issued to me in a clean, safe
condition and that I must comply with the OHS Act 85 of 1993 and its regulations for PPE.

EMPLOYEE
I, the undersigned, understand and accept all the conditions of issue as listed above, the content of
which conditions have been explained to me.
Employee Signature
I, the undersigned, have received training in all aspects of PPE provided by my company and I have
fitted my PPE to make sure the fit is comfortable.
Employee Signature

MANAGER/SUPERVISOR
I, the undersigned have explained the conditions of issue to the employee and have provided
adequate training, fitted and comfortable PPE which has been issued to the employee.
Manager’s
Signature
PPE Description Criteria Identification Issue Control
Transfer Gown Brand Employee Signature
Size
Type
Colour Issue
Date
Conti Suit Pants Brand Employee Signature
Size
Type
Colour Issue
Date
Conti Suit Top Brand Employee Signature
Size
Type
Colour Issue
Date
Dust Coat Brand Employee Signature
Overall Size
Type
Colour Issue
Date
Safety Boots Brand Employee Signature
Size
Type
Colour Issue
Date
Safety Shoes Brand Employee Signature
Size
Type
Colour Issue
Date
Gumboots Brand Employee Signature
With Toe Size
Cap
Without Toe Type
Cap Colour Issue
Date
Air supply hood Brand Employee Signature
Size
Type
Colour Issue
Date
Respirator Brand Employee Signature
Size
Type
Colour Issue
Date
PPE Description Criteria Identification Issue Control
Dust Mask Brand Employee Signature
Size
Type
Colour Issue
Date
Hearing Brand Employee Signature
Protection Size
Type
Colour Issue
Date

Hardhat Brand Employee Signature

Size
Type
Colour Issue
Date
Gloves Brand Employee Signature
Size
Type
Colour Issue
Date
Apron Brand Employee Signature
Size
Type
Colour Issue
Date
Safety Brand Employee Signature
glasses/goggles Size
Type
Colour Issue
Date
Face shield Brand Employee Signature
Size
Type
Colour Issue
Date
Welding Hood Brand Employee Signature
Size
Type
Colour Issue
Date
Thermal Suit Brand Employee Signature
Size
Type
Colour Issue
Date
Thermal Jacket Brand Employee Signature
Size
Type
Colour Issue
Date
Jersey Brand Employee Signature
Size
Type
Colour Issue
Date
Socks Brand Employee Signature
Size
Type
Colour Issue
Date
Lock Employee Signature
Key
Colour
Type of Issue Date
storage