Personal Protective Equipment (PPE) Inventory Checklist Form

Submit the completed PPE Inventory Checklist form to your supervisor upon inspection and provision of PPE items. Ensure all required fields are filled accurately, and both the employee and supervisor have signed the form. You can submit the form via email, fax, or physical copy to the appropriate office. Contact details for email submission: ppesubmission@indot.in.gov, Fax number: 123-456-7890, Physical address for submission: INDOT PPE Department, 1234 Safety Way, Indianapolis, IN 46204. My advice is to double-check all entries and signatures before submission to avoid processing delays.

The PPE Inventory Checklist form should be inspected and updated regularly. Key dates include annual reviews and compliance audits in 2024 and 2025. Ensure your PPE records are current for safety and regulatory adherence.

The purpose of the Personal Protective Equipment (PPE) Inventory Checklist form is to ensure the Indiana Department of Transportation (INDOT) employees are provided with the necessary PPE to perform their duties safely. This form serves as a record for the provision, inspection, and replacement of PPE items to maintain compliance with state and federal Occupational Safety and Health Administration (OSHA) regulations. By using this form, INDOT can track PPE distribution and ensure employees are equipped with properly functioning and compliant safety gear.

• 1. Name of Employee: The full name of the INDOT employee receiving the PPE.
• 2. District: The district where the employee is assigned.
• 3. Sub-district: The sub-district within the district where the employee is based.
• 4. Date of personal protective equipment (PPE) inspection: The date when the PPE items were inspected.
• 5. Provided PPE items: Checkboxes for each type of PPE provided to the employee, such as Soft Cap, Safety Vest, Hard Hat, Safety Shirt, Eye protection, Protective footwear, Hearing protection, PPE gear bag, and Gloves.
• 6. Replaced PPE items: Checkboxes for each type of PPE replaced during the inspection.
• 7. Reason for replacement: Options indicating why PPE items were replaced, such as Missing, Broken/defective, Soiled beyond functional use, Does not fit, Exceeds manufacturer's product life expectancy, Product utilized was non-compliant, and Other.
• 8. Employee signature: Signature of the employee confirming the provision and inspection of PPE.
• 9. Supervisor signature: Signature of the supervisor verifying the inspection and provided/replaced PPE items.

Failure to submit this form could lead to non-compliance with OSHA regulations and potential safety risks for employees. It may result in disciplinary actions or penalties.

• Non-Compliance: Lack of proper PPE records can result in non-compliance with OSHA regulations.
• Safety Risks: Employees may face safety risks due to the lack of appropriate PPE documentation.
• Disciplinary Actions: Failure to submit the form may lead to disciplinary actions against responsible personnel.

• 1. PPE Provision: When issuing new PPE items to employees.
• 2. PPE Inspection: During regular PPE inspections to ensure all items are functional.
• 3. PPE Replacement: When replacing broken, defective, or non-compliant PPE items.
• 4. Compliance Audits: To maintain records for compliance with OSHA regulations.
• 5. Safety Audits: For safety officers conducting safety audits and training.