PERSONALPROTECTIVE EQUIPMENT ISSUANCE FORM

Name of Worker: Ren Bryan Quirabo

Designation: Cadet Engineer

Date Hired/ Started: September 24, 2019

Project Assignment:

Conditions:

1. Yellow Shirt Long Sleeve & Safety Goggles - Free of charge after three (3) months from the date of
issuance. Salary deduction if not completed the three (3) months period. Cost as follows:
Yellow Shirt = Php 200.00, Safety Googles = Php 50.00

2. Safety Helmet, Safety Shoes & Safety Vest - Free of charge after six (6) months from the date of
issuance. Must surrender after finish contract or replace same item. In the absence of both, cost
of each items less the number of months usage will be deducted on final pay as folows:
Safety Helmet = Php 700.00, Satefy Shoes = Php 1,000.00, Safety Vest = Php 150.00. In case of lost or
damage, salary deduction applies under the same cost as stated.

Quantity Issued Remarks

Blue - Polo jacket

Yellow - T-Shirt (Long Sleeves)

Safety Shoes 1 pair Size 11

Safety Goggles

Safety Helmet

Others, if any :

Issued by:

Signature Over Printed Name/Desination/Date

Agreed & Received By:

Signature Over Printed Name

Date :
 NE 2019-001
Cc:201 File
 PERSONALPROTECTIVE EQUIPMENT ISSUANCE FORM

Name of Worker: Eugenio D. Caballero

Designation: Electrician-B

Date Hired/ Started: September 24, 2019

Project Assignment:

Conditions:

1. Yellow Shirt Long Sleeve & Safety Goggles - Free of charge after three (3) months from the date of
issuance. Salary deduction if not completed the three (3) months period. Cost as follows:
Yellow Shirt = Php 200.00, Safety Googles = Php 50.00

2. Safety Helmet, Safety Shoes & Safety Vest - Free of charge after six (6) months from the date of
issuance. Must surrender after finish contract or replace same item. In the absence of both, cost
of each items less the number of months usage will be deducted on final pay as folows:
Safety Helmet = Php 700.00, Satefy Shoes = Php 1,000.00, Safety Vest = Php 150.00. In case of lost or
damage, salary deduction applies under the same cost as stated.

Quantity Issued Remarks

Blue - Polo jacket

Yellow - T-Shirt (Long Sleeves)

Safety Shoes 1 pair Size 6

Safety Goggles

Safety Helmet

Others, if any :

Issued by:

Signature Over Printed Name/Desination/Date

Agreed & Received By:

Signature Over Printed Name

Date :
NE 2019-002
Cc:201 File
 PERSONALPROTECTIVE EQUIPMENT ISSUANCE FORM

Name of Worker: Ryan A. De Leon

Designation:

Date Hired/ Started: October 25, 2019

Project Assignment: CSB-Sports & Dorm

Conditions:

1. Yellow Shirt Long Sleeve & Safety Goggles - Free of charge after three (3) months from the date of
issuance. Salary deduction if not completed the three (3) months period. Cost as follows:
Yellow Shirt = Php 200.00, Safety Googles = Php 50.00

2. Safety Helmet, Safety Shoes & Safety Vest - Free of charge after six (6) months from the date of
issuance. Must surrender after finish contract or replace same item. In the absence of both, cost
of each items less the number of months usage will be deducted on final pay as folows:
Safety Helmet = Php 700.00, Satefy Shoes = Php 1,000.00, Safety Vest = Php 150.00. In case of lost or
damage, salary deduction applies under the same cost as stated.

Quantity Issued Remarks

Blue - Polo jacket

Yellow - T-Shirt (Long Sleeves)

Safety Shoes 1 pair Size 7

Safety Goggles

Safety Helmet

Others, if any :

Issued by:

Signature Over Printed Name/Desination/Date

Agreed & Received By:

Signature Over Printed Name

Date :
 NE 2019-038
Cc:201 File
 PERSONALPROTECTIVE EQUIPMENT ISSUANCE FORM

Name of Worker: Renzo M. Manuel

Designation:

Date Hired/ Started: October 25, 2019

Project Assignment: CSB-Sports & Dorm

Conditions:

1. Yellow Shirt Long Sleeve & Safety Goggles - Free of charge after three (3) months from the date of
issuance. Salary deduction if not completed the three (3) months period. Cost as follows:
Yellow Shirt = Php 200.00, Safety Googles = Php 50.00

2. Safety Helmet, Safety Shoes & Safety Vest - Free of charge after six (6) months from the date of
issuance. Must surrender after finish contract or replace same item. In the absence of both, cost
of each items less the number of months usage will be deducted on final pay as folows:
Safety Helmet = Php 700.00, Satefy Shoes = Php 1,000.00, Safety Vest = Php 150.00. In case of lost or
damage, salary deduction applies under the same cost as stated.

Quantity Issued Remarks

Blue - Polo jacket

Yellow - T-Shirt (Long Sleeves)

Safety Shoes 1 pair Size 7

Safety Goggles

Safety Helmet

Others, if any :

Issued by:

Signature Over Printed Name/Desination/Date

Agreed & Received By:

 Signature Over Printed Name

Date :
NE 2019-039
Cc:201 File