Fillable Personal Protective Equipment Checklist/Log

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Personal Protective Equipment Checklist/Log

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Charlton County Fire & Rescue
The Desire to Serve
The Courage to Act
The Ability to Perform
Personal Protective Equipment Checklist/Log
Name: Date:
Title: Assignment:
ASSIGNED EQUIPMENT
Item
Manufacturer
Year
New/Reassigned
Make
Model
Serial #
Coat
Pants
Helmet
Gloves
Hood
Footwear
Eyewear
Safety Vest
Routine or Advanced Inspection Condition
In Need Of ( Mark with an “X”)
COAT/PROTECTIVE
VEST
PROPER FIT (Refer to Appropriate Standard)
PASS
FAIL
CLEAN
REPLACE
REPAIR
Routine
Evaluation of fit and coat/trouser overlap (at least 2”)
Routine
Soiling
Routine
Contamination from hazardous materials or biological agents
Routine
Rips, tears and cuts
Routine
Damaged or missing hardware
Routine
Thermal damage such as charring, burn holes, or melting in any
layer
Routine
Damaged or missing reflective trim
Advanced
Moisture barrier integrity- Rips, discoloration, thermal damage
Advanced
Loss or shifting of liner material
Advanced
Broken or missing stitches
Advanced
Material integrity: UV, chemical degradation
Advanced
Wristlets: elasticity, stretching, cuts, thermal damage
Advanced
Reflective trim: attached, reflectivity, damage
Advanced
Label integrity, legibility
Advanced
Hook and Loop functionality
Advanced
Liner attachment systems
Advanced
Closure system functionality
Action Taken:
Routine or Advanced Inspection Condition
In Need Of ( Mark with an “X”)
PANTS
PROPER FIT (Refer to Appropriate Standard)
PASS
FAIL
CLEAN
REPLACE
REPAIR
Routine
Evaluation of fit and coat/trouser overlap (at least 2”)
Routine
Soiling
Routine
Contamination from hazardous materials or biological agents
Routine
Rips, tears and cuts in any layer
Routine
Damaged or missing hardware
Routine
Thermal damage such as charring, burn holes, or melting in any layer
Routine
Damaged or missing reflective trim
Advanced
Moisture barrier integrity- Rips, discoloration, thermal damage
Advanced
Loss or shifting of liner material
Advanced
Broken or missing stitches
Advanced
Material integrity: UV, chemical degradation
Advanced
Anklets: elasticity, stretching, cuts, thermal damage
Advanced
Reflective trim: attached, reflectivity, damage
Advanced
Label integrity, legibility
Advanced
Hook and Loop functionality
Advanced
Liner attachment systems
Advanced
Closure system functionality
Action Taken:
CCFR 20.6 (1/14)
Routine or Advanced Inspection Condition
In Need Of ( Mark with an “X”)
FOOTWEAR
PROPER FIT (Refer to Appropriate Standard)
PASS
FAIL
CLEAN
REPLACE
REPAIR
Routine
Evaluation of fit
Routine
Soiling
Routine
Contamination from hazardous materials or biological agents
Routine
Rips, tears, cuts or thermal damage
Routine
Loss of water resistance
Routine
Closure systems damage
Routine
Damage or deformed steel toe, mid-sole and shank
Advanced
Seam integrity and condition of liner
Advanced
Heel and excessive tread wear
Advanced
Closure system damage and functionality
Advanced
Condition of lining
Action Taken:
Routine or Advanced Inspection Condition
In Need Of ( Mark with an “X”)
GLOVES
PROPER FIT (Refer to Appropriate Standard)
PASS
FAIL
CLEAN
REPLACE
REPAIR
Routine
Evaluation of fit
Routine
Soiling
Routine
Contamination from hazardous materials or biological agents
Routine
Rips, tears, cuts or thermal damage
Routine
Inverted liner
Routine
Shrinkage
Routine
Loss of elasticity and flexibility
Action Taken:
Routine or Advanced Inspection Condition
In Need Of ( Mark with an “X”)
HELMETS
PROPER FIT (Refer to Appropriate Standard)
PASS
FAIL
CLEAN
REPLACE
REPAIR
Routine
Evaluation for fit
Routine
Soiling
Routine
Damage to shell: cracks, dents and abrasions
Routine
Damage to liner: rips, tears or thermal damage
Routine
Suspension system
Routine
Damage or missing reflective trim
Advanced
Damage to impact cap
Action Taken:
Routine or Advanced Inspection Condition
In Need Of ( Mark with an “X”)
HOOD
PROPER FIT (Refer to Appropriate Standard)
PASS
FAIL
CLEAN
REPLACE
REPAIR
Routine
Evaluation of fit
Routine
Soiling
Routine
Contamination from hazardous materials or biological agents
Routine
Rips, tears, cuts or thermal damage
Routine
Loss of face opening adjustment/Shrinkage
Advanced
Seam integrity
Advanced
Elasticity
Action Taken:
Routine or Advanced Inspection Condition
In Need Of ( Mark with an “X”)
EYEWEAR
PROPER FIT (Refer to Appropriate Standard)
PASS
FAIL
CLEAN
REPLACE
REPAIR
Routine
Damage or missing components to face-shield or goggle system
Advanced
Face-shield/goggle functionality
Action Taken
Comments:
Inspected By: Signature: Date: / /
CCFR 20.6 (1/14)
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Personal Protective Equipment ChecklistLog

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Completed 17 July 2020

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