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PPE checklist template

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Preview — Classic labelled lines

PPE Checklist

Department: Department – Date: Inspection Date

Inspector: Inspector Name

| Item | Available | Good condition | Used correctly | Note |

| Gloves | | | | Gloves Note |

| Surgical masks | | | | Masks Note |

| N95 respirators | | | | N95 Note |

| Goggles or face shield | | | | Goggles Note |

| Gowns | | | | Gowns Note |

| Safety shoes | | | | Shoes Note |

| Helmets | | | | Helmets Note |

Inspector: Inspector Signature

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