Safety Footwear (PPE) Request Form

Footwear Request Form

This form is used to request Personal Protective Equipment (PPE), either for first-time issuance or replacement.
1. Employee Information
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Hour MinutesAM/PM Option
Employee Name

First NameLast Name
Email:
Please enter a valid email address that you can access (Personal or Work Email)
Job Title
Area
Select your main area
Supervisor or Manager
Name and Last Name of your Supervisor or Manager
Branch
Employee Type
2. Request Type
Type of request:
3. PPE Requested
The maximum replacement of items due to wear & tear will only be covered ONCE annually under company expense. A second replacement request within the same year will be subject to management approval. Any replacements exceeding the allowable limit, or any lost items, will be charged to the employee.

If you have any questions, please let HR know.

Shoes

Rows	I'm requesting:	Option	Size	Comments
Steel-toe shoes

4. Reason / Task Description
If this request is for a replacement, please upload a photo of your current safety shoes.

Cancelof
Reason for requesting PPE
Briefly describe the task, hazard, or reason this PPE is required. (New Hire, Replacement, Lost, New task, etc..)
5. Approvals
Employee Signature
Should be Empty:

Footwear Request Form