PERSONAL PROTECTIVE EQUIPMENT ISSUE REGISTER

Name of Agency: Date:

** As per BOCW Act 1966 and BOCW central rules 1988 it is responsibility of Agency / EIC to ensure issue IS standard PPE to all their
workers based on job requirements**
SL NAME OF PERSON DESIGNATION Personal Protective Equipment SIGNATURE
1 Mandatory:  Safety Helmet  Safety shoes
 Reflective Jacket  Nose Mask  Goggles
Other PEEs: (plz specify as per Job requirement)

2 Mandatory:  Safety Helmet  Safety shoes

 Reflective Jacket  Nose Mask  Goggles
Other PEEs: (plz specify as per Job requirement)

3 Mandatory:  Safety Helmet  Safety shoes

 Reflective Jacket  Nose Mask  Goggles
Other PEEs: (plz specify as per Job requirement)

4 Mandatory:  Safety Helmet  Safety shoes

 Reflective Jacket  Nose Mask  Goggles
Other PEEs: (plz specify as per Job requirement)

5 Mandatory:  Safety Helmet  Safety shoes

 Reflective Jacket  Nose Mask  Goggles
Other PEEs: (plz specify as per Job requirement)

6 Mandatory:  Safety Helmet  Safety shoes

 Reflective Jacket  Nose Mask  Goggles
Other PEEs: (plz specify as per Job requirement)

7 Mandatory:  Safety Helmet  Safety shoes

 Reflective Jacket  Nose Mask  Goggles
Other PEEs: (plz specify as per Job requirement)

8 Mandatory:  Safety Helmet  Safety shoes

 Reflective Jacket  Nose Mask  Goggles
Other PEEs: (plz specify as per Job requirement)

9 Mandatory:  Safety Helmet  Safety shoes

 Reflective Jacket  Nose Mask  Goggles
Other PEEs: (plz specify as per Job requirement)

10 Mandatory:  Safety Helmet  Safety shoes

 Reflective Jacket  Nose Mask  Goggles
Other PEEs: (plz specify as per Job requirement)

Type of PPEs:
 Safety Helmet
 Safety Shoes
 Electrical Safety Shoes
 Gumboots
 Reflective jacket
 Hand Gloves (Cotton)
 Hand Gloves (Leather)
 Hand gloves (Vinyl coated)
 _____________________
 _____________________
 Dust Mask  Full body Safety Harness
 Ear Plug  Rope Grab Fall arrestor
 Ear Muff  Retractable Fall arrestor
 Safety Goggles  Life line Rope (Wire rope - 8mm dia)
 Full Face shield with Helmet Attachment  Safety Net: Size___ m x____m
(Grinder / cutter)  Respirator (Airline)
 Welding Shield (Helmet Attachment)  Arc Flash suit
 Welding aprons  Dielectric Safety Helmet
 Fire blanket  ____________________
 __________________________  ______________________

Name and Signature of EIC Name and signature of Agency