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Annual PPE Inspection Form

2. This Form is For Annual Inspection Only. For All PPE Repair/Replacement Request, Please Use:
   PPE Repair/Replacement Request

4. First Name*

5. Last Name*

7. Shift*

   1. A-Shift
   2. B-Shift

   1. C-Shift
   2. 40-Hour

8. Date of Inspection*
   Date of Inspection

10. For Non-Applicable Fields, Place "N/A" in Entry

12. Structure PPE
    Turnout Coat

    Turnout Coat

13. Type/Model/Size

14. Serial Number

15. Condition*
    -- Select One --GoodPassive ReplacementNeeds Replacement

17. Structure PPE
    Turnout Pants

    Turnout Pants

18. Type/Model/Size

19. Serial Number

20. Condition*
    -- Select One --GoodPassive ReplacementNeeds Replacement

22. Structure PPE
    Backup Turnout Coat

    Backup Turnout Coat

23. Type/Model/Size

24. Serial Number

25. Condition*
    -- Select One --GoodPassive ReplacementNeeds Replacement

27. Structure PPE
    Backup Turnout Pants

    Backup Turnout Pants

28. Type/Model/Size

29. Serial Number

30. Condition*
    -- Select One --GoodPassive ReplacementNeeds Replacement

32. Structure PPE
    Turnout Boots

    Turnout Boots

33. Type/Model/Size

34. Serial Number

35. Condition*
    -- Select One --GoodPassive ReplacementNeeds Replacement

37. Structure PPE
    Helmet (Department)

    Helmet (Department)

38. Type/Model/Size

39. Serial Number

40. Condition*
    -- Select One --GoodPassive ReplacementNeeds Replacement

42. Structure PPE
    Helmet (Personal)

    Helmet (Personal)

43. Type/Model/Size

44. Serial Number

45. Condition*
    -- Select One --GoodPassive ReplacementNeeds Replacement

47. Structure PPE
    Gloves

    Gloves

48. Type/Model/Size

49. Serial Number

50. Condition*
    -- Select One --GoodPassive ReplacementNeeds Replacement

52. Structure PPE
    Hood

    Hood

53. Type/Model/Size

54. Serial Number

55. Condition*
    -- Select One --GoodPassive ReplacementNeeds Replacement

57. Structure PPE
    Suspenders

    Suspenders

58. Type/Model/Size

59. Serial Number

60. Condition*
    -- Select One --GoodPassive ReplacementNeeds Replacement

62. Structure PPE
    SCBA Mask

    SCBA Mask

63. Type/Model/Size

64. Serial Number

65. Condition*
    -- Select One --GoodPassive ReplacementNeeds Replacement

67. Structure PPE
    Flashlight

    Flashlight

68. Type/Model/Size

69. Serial Number

70. Condition*
    -- Select One --GoodPassive ReplacementNeeds Replacement

72. Structure PPE
    Spanner Wrench

    Spanner Wrench

73. Type/Model/Size

74. Serial Number

75. Condition*
    -- Select One --GoodPassive ReplacementNeeds Replacement

77. Structure PPE
    Hose Strap

    Hose Strap

78. Type/Model/Size

79. Serial Number

80. Condition*
    -- Select One --GoodPassive ReplacementNeeds Replacement

84. Wildland PPE
    Brush Jacket

    Brush Jacket

85. Type/Model/Size

86. Serial Number

87. Condition*
    -- Select One --GoodPassive ReplacementNeeds Replacement

89. Wildland PPE
    Brush Pants

    Brush Pants

90. Type/Model/Size

91. Serial Number

92. Condition*
    -- Select One --GoodPassive ReplacementNeeds Replacement

94. Wildland PPE
    Helmet

    Helmet

95. Type/Model/Size

96. Serial Number

97. Condition*
    -- Select One --GoodPassive ReplacementNeeds Replacement

99. Wildland PPE
    Gloves

    Gloves

100. Type/Model/Size

101. Serial Number

102. Condition*
     -- Select One --GoodPassive ReplacementNeeds Replacement

104. Wildland PPE
     Shelter/Belt

     Shelter/Belt

105. Type/Model/Size

106. Serial Number

107. Condition*
     -- Select One --GoodPassive ReplacementNeeds Replacement

109. Wildland PPE
     Goggles

     Goggles

110. Type/Model/Size

111. Serial Number

112. Condition*
     -- Select One --GoodPassive ReplacementNeeds Replacement

114. Wildland PPE
     Footware

     Footware

115. Type/Model/Size

116. Serial Number

117. Condition*
     -- Select One --GoodPassive ReplacementNeeds Replacement

Leave This Blank:


118. 1. Receive an email copy of this form.
119. Email address

     This field is not part of the form submission.

120. Submit

* indicates a required field