Personal Protective Equipment Checklist/log Template Page 2
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4Routine or Advanced Inspection
“ ” Condition
In Need Of ( Mark with an “X”)
FOOTWEAR
PROPER FIT (Refer to Appropriate NFPA Standard)
PASS
FAIL
CLEAN
REPLACE
REPAIR
Routine
Evaluation of fit
Routine
Soiling
Routine
Contamination from hazardous materials or biological agents
Routine
Rips, tears, cuts or thermal damage
Routine
Loss of water resistance
Closure systems damage
Routine
Routine
Damage or deformed steel toe, mid-sole and shank
Seam integrity and condition of liner
Advanced
Advanced
Heel and excessive tread wear
Closure system damage and functionality
Advanced
Advanced
Condition of lining
Action Taken:
Routine or Advanced Inspection
“ ” Condition
In Need Of ( Mark with an “X”)
GLOVES
PROPER FIT (Refer to Appropriate NFPA Standard)
PASS
FAIL
CLEAN
REPLACE
REPAIR
Routine
Evaluation of fit
Soiling
Routine
Routine
Contamination from hazardous materials or biological agents
Rips, tears, cuts or thermal damage
Routine
Routine
Inverted liner
Shrinkage
Routine
Routine
Loss of elasticity and flexibility
Action Taken:
Routine or Advanced Inspection
“ ” Condition
In Need Of ( Mark with an “X”)
HELMETS
PROPER FIT (Refer to Appropriate NFPA Standard)
PASS
FAIL
CLEAN
REPLACE
REPAIR
Routine
Evaluation for fit
Soiling
Routine
Routine
Damage to shell: cracks, dents and abrasions
Damage to liner: rips, tears or thermal damage
Routine
Routine
Suspension system
Damage or missing components to face-shield or goggle system
Routine
Routine
Damage or missing reflective trim
Face-shield/goggle functionality
Advanced
Advanced
Damage to impact cap
Action Taken:
Routine or Advanced Inspection
“ ” Condition
In Need Of ( Mark with an “X”)
HOOD
PROPER FIT (Refer to Appropriate NFPA Standard)
PASS
FAIL
CLEAN
REPLACE
REPAIR
Routine
Evaluation of fit
Soiling
Routine
Routine
Contamination from hazardous materials or biological agents
Rips, tears, cuts or thermal damage
Routine
Routine
Loss of face opening adjustment/Shrinkage
Seam integrity
Advanced
Advanced
Elasticity
Action Taken:
Comments: ____________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________
Inspected By: ___________________________________________
Signature: _____________________________________
Date: ____/____/____
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