Personal Protective Equipment for Safety and Infection Control Acknowledgement

PERSONAL PROTECTIVE EQUIPMENT
I understand a Personal Protective Equipment (PPE Kit) is available in the office and contains the following:
- Gloves
- Disposable Mask
- Anti-bacterial soap/sanitizer
- Instructions for proper hand washing
I understand that PPE is to be used at all times for the safety of myself and the clients I provide services to.

I have been instructed in the use of this equipment and understand that I must comply with Policies and Procedures regarding use of personal protective equipment.
Employee Name*

First NameLast Name
Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty: