Personal Protective Equipment Checklist/log Template
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4Personal Protective Equipment Checklist/Log
Name: ____________________________________________________________________________
Date: ____________________________________
Title: _____________________________________________
Assignment: ______________________________________________________________
ASSIGNED EQUIPMENT
Item
Manufacturer
Year
New/Reassigned
Make
Model
Serial #
Date of Issue
Coat
Pants
Helmet
Gloves
Hood
Footwear
Routine or Advanced Inspection
“ ” Condition
In Need Of ( Mark with an “X”)
COAT
PROPER FIT (Refer to Appropriate NFPA Standard)
PASS
FAIL
CLEAN
REPLACE
REPAIR
Routine
Evaluation of fit and coat/trouser overlap (at least 2”)
Soiling
Routine
Routine
Contamination from hazardous materials or biological agents
Routine
Rips, tears and cuts
Routine
Damaged or missing hardware
Routine
Thermal damage such as charring, burn holes, or melting in any layer
Routine
Damaged or missing reflective trim
Advanced
Moisture barrier integrity- Rips, discoloration, thermal damage
Loss or shifting of liner material
Advanced
Advanced
Broken or missing stitches
Material integrity: UV, chemical degradation
Advanced
Advanced
Wristlets: elasticity, stretching, cuts, thermal damage
Reflective trim: attached, reflectivity, damage
Advanced
Advanced
Label integrity, legibility
Advanced
Hook and Loop functionality
Advanced
Liner attachment systems
Advanced
Closure system functionality
Action Taken:
Routine or Advanced Inspection
“ ” Condition
In Need Of ( Mark with an “X”)
PANTS
PROPER FIT (Refer to Appropriate NFPA Standard)
PASS
FAIL
CLEAN
REPLACE
REPAIR
Evaluation of fit and coat/trouser overlap (at least 2”)
Routine
Routine
Soiling
Contamination from hazardous materials or biological agents
Routine
Routine
Rips, tears and cuts in any layer
Damaged or missing hardware
Routine
Routine
Thermal damage such as charring, burn holes, or melting in any layer
Damaged or missing reflective trim
Routine
Advanced
Moisture barrier integrity- Rips, discoloration, thermal damage
Advanced
Loss or shifting of liner material
Advanced
Broken or missing stitches
Advanced
Material integrity: UV, chemical degradation
Advanced
Anklets: elasticity, stretching, cuts, thermal damage
Advanced
Reflective trim: attached, reflectivity, damage
Label integrity, legibility
Advanced
Advanced
Hook and Loop functionality
Liner attachment systems
Advanced
Advanced
Closure system functionality
Action Taken:
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