PPE Acknowledgment Form

Document Control Company: [COMPANY NAME] · Logo: [COMPANY LOGO] · Address: [COMPANY ADDRESS] Prepared by: [RESPONSIBLE PERSON] · Date: [DATE] · Approved by (signature): _________________

How to Use This Template

Have the employee read the content, then sign and date. Keep the signed acknowledgment in the employee's training or personnel file.

Acknowledgment

I acknowledge that [COMPANY NAME] has trained me on the PPE program — why PPE is required, how to select it from the hazard assessment, and how to use, inspect, clean, store, and replace it. I agree to wear required PPE, inspect it before use, and report damaged or worn PPE.

Employee (print): ____________________ Signature: ____________________ Date: [DATE] Trainer/Supervisor: ____________________ Date: [DATE]