PPE REQUEST FORM

Employee Name: ___________________________ Date: __________________

Department/Position: _Vertical/___________________ Date Needed: __________________

Type of Request: Additional/New Replacement

No. Type of PPE QTY Unit Brand Last Issuance

1 Hard Hat 1 PC Blue Eagle N/A
2 Safety Shoes 1 PAIR Tough Rider N/A
3 Safety Vest 1 PC BM Orange V-Type N/A
4 Safety Gloves 1 PAIR N/A
5 Safety Boots 1 PAIR Tough Rider N/A
6 Rain Coat 1 SET N/A
7 Uniform 3 PC N/A

Justification: Worn Out Lost

Remarks: Ok for Replacement Charged to Department

Damage due to Negligence Charged to Employee

Requested by: Evaluated by: Approved by:

_________________________ ________________________ _______________________

Employee MMD PM/PIC/HEADP

2nd Floor, Starmall Annex, Alabang - Zapote Road, Dona Manuela Ave. Cor., Pamplona III, Las Piñas City, Philippines
(632) 8814-4600