VERSION 1

HUMAN TALENT MANAGEMENT DEPARTMENT

CODE:
LOGO
SECURITY AND HEALTH AT WORK PAGE 1 OF 1

FORMAT FOR INDIVIDUAL DELIVERY OF PERSONAL PROTECTION ELEMENTS (PPE) AND SUPPLY
DATA OF THE WORKER TO WHOM THE ITEM IS GIVEN
NO.
WORKER NAME: IDENTIFICATION
CARD:
POST: PROJECT:

FUNCTIONS:

PERSONAL PROTECTION ELEMENTS (PPE) AND EQUIPMENT DELIVERED

DATE DESCRIPTION OF DELIVERED ITEMS AMOUNT SIGNATURE RECEIVED

DATA OF THE RESPONSIBLE FOR THE DELIVERY OF THE ITEMS

NAME IDENTIFICATION No.

POST SIGNATURE

COMMITMENT
I undertake to properly use the personal protective equipment and elements (including work clothing) received during the work day and keep them in good
condition, complying with occupational health standards that contribute to my physical, psychological and social well-being. I declare that I have received
information about the proper use of them and restitution in case of loss or non-use of them.

This commitment applies to the personal protection elements and equipment delivered.

SIGNATURE OF WHO RECEIVES THE ITEM AND READS THE

COMMITMENT:
No. Identification card:

Page 1 of 3
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 Version

Excel 97-2003