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PPE - Distribution Form

This document is a form for distributing personal protective equipment (PPE) to workers. It lists various types of PPE including safety boots, hard hats, work suits, gloves, harnesses, and more. For each item, it indicates the relevant risks protected against, such as falls, impacts, dust, and chemicals. The worker signs to acknowledge receipt of the PPE and agrees to use it correctly and report any issues.

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Nuno Lopes
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779 views

PPE - Distribution Form

This document is a form for distributing personal protective equipment (PPE) to workers. It lists various types of PPE including safety boots, hard hats, work suits, gloves, harnesses, and more. For each item, it indicates the relevant risks protected against, such as falls, impacts, dust, and chemicals. The worker signs to acknowledge receipt of the PPE and agrees to use it correctly and report any issues.

Uploaded by

Nuno Lopes
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLSX, PDF, TXT or read online on Scribd
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DISTRIBUTION FORM MEECAMW-HS-FTP-002-REV0

Personal Protective Equipment Date: 20/03/2017

Cost Centre -

Name of worker
Nr. of worker Category:
Mota-Engil Subcontractor:

Size
PPE or Color Risks Authoriz. Return PPE Risks Authoriz. Return

4,5,6,
Safety Boots 7,8 14

4,5,6,
Gumboots 8,9,17 Filter mask 17

Hard hat w/ chinstrap 11 Face shield 12,13

Worksuit 16,17 Face shield dark 12,13

Rain suit 9 Safety glasses 12,13

Reflective vest 16 Disposable worksuit 17

T-shirts 20 Ear plugs 3

Blue shirts 20 Ear muffs 3

Orange Jacket 16,17 Snake Gaters 2

Nitrile Gloves 12,13 Leg-Guards 10

Leather gloves 12,13 Welding gloves 13,18

13,18,
Maxiflex Gloves 12,13 Welding mask 19

13,18,
Rubber gloves 15,17 Welding goggles 19

Life-Line 1 Welding apron 13,18

Retractable Life-Line 1
Safety Harness + 1
Double Lanyard

RISKS
1- Fall from heights 8- Impact at ankle/foot level 15- Electrocution
2- Snake Bites 9- Adverse weather conditions 16- Hit by equipment / vehicles
3- Exposure to excessive noise 10- Impact at lower leg level 17- Contact with chemical products
4- Falls caused by slipping 11- Impacts to the head 18- Extreme temperatures
5- Pointed or sharp-edged objects 12- Cuts 19- Extreme lighting
6- Crushing of the foot 13- Projection of particles 20- Others
7- Twisting of the ankle 14- Exposure to dust

DECLARATION
I declare that I have received the Individual Protective Equipment mentioned above and I undertake to use it correctly
in compliance with the instructions received, and to keep it in good condition, reporting all deterioration or defects that I become aware of.

Worker's Signature: Date:

OBSERVATIONS:

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