HR & employment 2 signers 1 page 10 blanks to fill in

PPE Issue Acknowledgement Template

Keep a signed record of every hard hat, pair of boots and respirator you hand out, and of what the employee agreed to do with them.

Use this template — free See the agreement Signers don’t need an account
PPE issue acknowledgement
The blanks in brackets are what you fill in. FileIt adds each signer’s signature and date boxes.
PPE issue acknowledgement — page 1 of 1
Page 1 of 1
Use this template Fill in the blanks, name who signs, and send — from FileIt eSignature.

What is a pPE issue acknowledgement?

Safety inspectors, insurers and your own incident investigations all ask the same question: was the right protective equipment issued, and did the worker know how to use it? A signed PPE record answers it in seconds. It also helps on the shop floor, because everyone knows what they were given and in what size.

This template lists each item of PPE issued, with sizes and any serial or batch numbers, and records fit testing or training where it applies. The employee confirms when they will wear it, that they know how to use it, and that PPE is a last line of protection rather than a replacement for safe working. They agree to look after it, check it before use and report damage or poor fit to the person you name. Replacements are free of charge when items wear out, and reusable items go back when the employee leaves or changes role. The person issuing the equipment signs too.

Best for
Construction, warehouses, manufacturing, labs, cleaning and healthcare
Signed by
The employee and the person issuing the PPE
Records
Items, sizes, fit testing, when to wear, care, replacement, return
Length
1–2 pages

When to use a pPE issue acknowledgement

  • Issuing boots, hi-vis and a hard hat to a new site worker on day one
  • Recording a respirator issue after a face-fit test
  • Handing out fall-arrest harnesses with serial numbers for inspection tracking
  • Re-issuing PPE when a worker moves to a new task or site
  • Building a PPE register for a safety audit

What you fill in

10 blanks, then the name and email of each person who signs: employee, issued by.

1 Details

  • Employer (company name)*
  • Employee's full name*
  • Job, department or site
  • Date issued*

2 Equipment

  • PPE issued*
  • When the PPE must be worn*
  • Fit testing or training given

3 Care and replacement

  • Report damage or loss to*
  • Replacement of worn or damaged PPE* free of charge when it is worn out, damaged or no longer fits · on a set schedule, and earlier if it is worn out, damaged or no longer fits
  • Replacement schedule (optional)

4 Who signs

  • Employee signature and date · The person receiving the equipment.
  • Issued by signature and date, job title · The supervisor, store person or safety officer handing out the PPE.

What the pPE issue acknowledgement covers

  1. Using and caring for the PPE

Using the pPE issue acknowledgement, step by step

1 Add the employee and date

Enter the employee's name, their team or site and the date the PPE was handed over.

2 List what you issued

Put one item per line with its size and quantity, plus serial or batch numbers for items that need inspection. Add any fit test or training given.

3 Set the rules

Keep or edit the wording for when the PPE must be worn, name who damage should be reported to, and choose how replacements work, with an optional schedule.

4 Send it for signing

Send the envelope to the employee, who can sign on a phone before leaving the stores counter. You sign as the issuer, and the record is filed in your FileIt vault.

Tips before you send it

  • Issue PPE based on your risk assessment for the task, not just the job title.
  • Write down sizes. It saves time when replacements are ordered and shows the PPE was chosen to fit.
  • Respirators often need a face-fit test before use. Record the date in the form.
  • Set up a fresh acknowledgement each time a new item is issued, so your record stays complete.

Sign it online in minutes

  1. Fill in the blanks. Names, dates and amounts go straight into the agreement — the preview shows exactly where.
  2. Name who signs. Tick “This is me” for your own part. FileIt builds the PDF with every signature, date box on the right line, and you can check or move anything before sending.
  3. Send it. Each signer gets a secure link and signs from any device — no account needed. The signed PDF, with an audit trail and a Certificate of Completion, is filed in your vault and emailed to everyone.
Use the pPE issue acknowledgement template — it’s free

PPE issue acknowledgement: frequently asked questions

Can employees be charged for PPE?

In many places, no: employers must provide required PPE free of charge, and the template says so. Some places allow charges for optional extras or items not returned. Check the local rules before you change the wording.

Do I need a new form every time PPE is replaced?

For like-for-like replacements a simple log is often enough, but a new signed acknowledgement is useful when the type of equipment changes or new training is given.

What should the employee do if the PPE doesn't fit?

Report it straight away to the person named in the form and stop using it if it no longer protects them. Poorly fitting PPE may not do its job, so replacements for fit are free.

Is an electronic signature enough for a PPE record?

For an internal safety record like this, an e-signature is generally accepted, and it is easier to find later than a paper sheet. FileIt timestamps each signature and adds a Certificate of Completion.

Use this template — free