PERSONAL PROTECTIVE EQUIPMENT CARE COMMITMENT

PPE RECEIVED (tick box √)

□Hard hat □Safety glasses □Safety Boots

□Safety Gloves □Overalls □Rain suit
□Gum boots □Welding gloves □Welding apron
□Spats □Face shield □Welding helmet
□Safety harness □Chin strap □Reflective vest
□Other: ________________________

LEGISLATIVE REFERENCES:
Mine Health and Safety Act
22(c) - Every employee at a mine must use and take proper care of protective clothing and other Health and Safety
facilities.
Occupational Health and Safety Act
14(a) – Every employee at work shall take reasonable care of the health and safety of himself.
15 – No person shall intentionally or recklessly interfere with, misuse or damage anything which is provided in the
interest of health and safety.

COMMITMENT:
I hereby commit to take proper care of the Personal Protective Equipment and Health and Safety facilities issued to
me.

I will use, maintain and store the equipment in a manner that prevents damage, misuse or theft.

In the event of accidental damage to or wear and tear of the equipment I understand that I may exchange the
equipment for new or suitable equipment.

Should I loose or intentionally damage the equipment I will be held responsible for the replacement value of that
equipment with the possibility of disciplinary action instituted against me.

NAME: _____________________

SURNAME: __________________

DATE: ______________________

SIGNATURE ______________________