PPE Delivery Form

Date: [Date]

Delivery Details:

Delivered By: [Name of the person delivering PPE]

Received By: [Name of the person receiving PPE]

Delivery Location: [Specify the department or location]

Recipient Information:

Name: [Name of the recipient]

Department/Unit: [Recipient's department or unit]

Contact Number: [Recipient's contact number]

Email: [Recipient's email address]

PPE Details:

Item Quantity Size/Specifications Remarks

[PPE Item 1] [Quantity] [Size/Specs] [Any specific notes or details]

[PPE Item 2] [Quantity] [Size/Specs] [Any specific notes or details]

[PPE Item 3] [Quantity] [Size/Specs] [Any specific notes or details]

Delivery Notes:

[Include any additional notes about the delivery, special instructions, or comments.]

Acknowledgment:

I, the undersigned, acknowledge the receipt of the above-listed PPE items. I confirm that the items have
been inspected, and I understand the proper usage and care instructions for each item.

Recipient's Signature: ________________________ Date: _______________

Deliverer's Signature: ________________________ Date: _______________

By signing above, both parties confirm the accuracy and completeness of the PPE delivery.

For HSE Department Use Only:

Checked By: [Name of HSE personnel checking the delivery]

Date Checked: [Date]

[Include any additional fields or sections as needed for your specific requirements.]