DECLARATION ON RECEIPT OF PPE Doc.

Ref
(PENGAKUAN PENERIMAAN PPE) Rev. No. 0

Issue Date 12 December 2022

Project : Lai Meng Girls School Association
Page No. 1 of 1

I (Saya) _________________________________________ post (jawatan) ___________________________

from department/company (dari jabatan/syarikat) __________________________with this declare that I have received
protective equipment for work as listed below (dengan ini mengaku telah menerima peralatan untuk keselamatan untuk
bekerja seperti yang telah disenaraikan dibawah).

Safety Equipment Issused by Qty Usage Period SIGNATURE

Alat Keselamatan Diserah Oleh Jumlah (Tempoh Penggunaan) (TANDATANGAN)
From (Dari) Till (Sehingga)
Safety Boots ( Kasut Safety)
Safety Hat (Topi Keselamatan)
Ear Protection (Pelindung Telinga)
Apron (Apron)
Rubber Gloves (Sarung tangan getah)
Dust Mask (Penutup Mulut & Hidung)
Respirator (Bantuan Pernafasan)
Safety Goggle (Pelindung Mata)
Safety Vest
Leather Gloves (Sarung Tangan Kulit)
Safety Belt (Talipinggang Keselamatan)
Life Line (Talian Selamat)

Recipient : Verified by SSS / SHO :

Signature (Tandatangan) : ____________________ Signature (Tandatangan) : _____________________

Name (Nama) : ____________________ Name (Nama) : _____________________

Date (Tarikh) : ____________________ Date (Tarikh) : _____________________