SAUDI ARCHIRODON LTD

Integrated Management System

Sarco Yanbu Al-Muajjiz Project

Rev.
Issued For
General Use
Reference No. 11067-HSE-000-00-F01
Date Issued
2016-2018
Page
1 of 1

FORM
PPE Issuance

Employee Name:

0.0

Position:

C/No.

I have received the following Personal Protective Equipments (PPEs) for my safety on this project.

Date

Safety
Shoes

Safety
Helmet

Safety
Glass

Cover all
Normal/FRC

Reflective
Vest

Others

Signature

agree to use these safety equipments as is required and/or mandatory by Project HSE, Local and Company safety regulations.
I also agree to care for and maintain this equipment(s) in good condition. I understand that any unserviceable safety
equipment may be turned in for new equipment, but if lost, must be replaced at my own expense. Upon transfer from the
project or termination of my employment with the company, I agree to return all equipment to the store.
* Items listed above may not be necessary for all employees.
Employees (Receiver) Signature:

_____________________________

Promote Safety and Be Safe

Completed by
Job Position
Name Surname
Signature
Date

Approved by
Job Position
HSE Manager
Name Surname Mr. Gomma
Signature
Date

Issued by
Job Position
Name Surname
Signature
Date