Atwell Specialty PPE Request

Specialty PPE Request

For Fleet Items see fleet request form on AtwellSafe.com
Name*

First NameLast Name
Date

MonthDayYear
Date
Phone Number*

Area CodePhone Number
Employee Email*
example@example.com
Company

AtwellRVi
Department*

Oil & GasPower & EnergyRE & Land DevelopmentOther
Supervisor Name (for approval)*

First NameLast Name
Supervisor Email*
example@example.com
Supervisor Phone #

Area CodePhone Number
Item #1
Use arrow to select items
Quantity
Size (if applicable)
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Item #2 (if applicable)
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Quantity
Size (if applicable)
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Item #3 (if applicable)
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Quantity
Size (if applicable)
Use arrow to select items
Item #4 (if applicable)
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Quantity
Size (if applicable)
Use arrow to select items
FR Jeans Size
Ex: 32 X 34
Quantity
Other Items
Brand and item# if possible
Quantity
Size (if applicable)
Use arrow to select items
Comments about order:
Item # and brand name if requesting specific item.
Shipping Address *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employee PPE Responsibility
The employee is responsible for following the requirements of the PPE policy. This involves:
• Properly wearing PPE as required
• Attending training sessions
• Properly caring for, cleaning, maintaining, and inspecting PPE as required
• Following Atwell, LLC’s PPE policy and regulations
• Informing the supervisor of the need to repair or replace PPE
• Returning any FR items if leaving the company before being employed for 6 months
Note: Employees who repeatedly disregard and do not follow the PPE policy and rules will be subject to Atwell, LLC’s disciplinary policy up to and including termination.
Signature*

Clear
Should be Empty: