CHECK CARD
The check card should be filled in before the first use.
All information about the personal protective equipment (name, serial number, date of purchase and
date of putting into operation, user name, periodic examination and repair history, and next periodic
examination date ) shall be noted into de check card.
All records in the check card can only be filled in by a competent person.
Do not use the personal protective equipment without a duly filled check card.
EQUIPMENT RECORD
REFERENCE
LOT, SERIAL NUMBER
YEAR OF MANUFACTURE
IT CAN BE USED WITH
DATE OF PURCHASE
DATE OF FIRST PUT INTO USE
USER NAME
COMMENTS
PERIODIC EXAMINATIONS AND REPAIR HISTORY
DATE
REASON FOR
COMPETENT
COMMENTS
NEXT DUE
ENTRY (Periodic
PERSON Name
DATE FOR
examination/Repair)
+ Signature
Periodic
Examination