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No Form: SKH-F-HSE-09

UNIFORM & PPE Revisi: 0


INSPECTION CHECK LIST Tgl Dikeluarkan: 3 Mei 2021
Halaman: 1 dari 1

Name :
Position :
Project :
Location :
Date of Received :

Type of PPE QTY UNIT RETUR REMARKS

Safety Shoes

Safety Helmet

Coverall / Uniform

Safety Glasses / Goggles

Hand Gloves

Earplug / Ear Muff

Dust Mask

Respirator Catridge

Chinstrap

Rain coat

Rubber Boots

Logistic SPV / Safety Officer Received

(………………………………………….) (………………………………………….) (………………………………………….)


Date : Date : Date :

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