"Personal Protective Equipment Checklist/Log - Vfis"

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Personal Protective Equipment Checklist/Log
Name: ____________________________________________________________________________
Date: ____________________________________
Title: _____________________________________________
Assignment: ______________________________________________________________
ASSIGNED EQUIPMENT
Item
Manufacturer
Year
New/Reassigned
Make
Model
Serial #
Date of Issue
Coat
Pants
Helmet
Gloves
Hood
Footwear
Routine or Advanced Inspection
“ ” Condition
In Need Of ( Mark with an “X”)
COAT
PROPER FIT (Refer to Appropriate NFPA Standard)
PASS
FAIL
CLEAN
REPLACE
REPAIR
Routine
Evaluation of fit and coat/trouser overlap (at least 2”)
Soiling
Routine
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
Loss or shifting of liner material
Advanced
Advanced
Broken or missing stitches
Material integrity: UV, chemical degradation
Advanced
Advanced
Wristlets: elasticity, stretching, cuts, thermal damage
Reflective trim: attached, reflectivity, damage
Advanced
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 NFPA Standard)
PASS
FAIL
CLEAN
REPLACE
REPAIR
Evaluation of fit and coat/trouser overlap (at least 2”)
Routine
Routine
Soiling
Contamination from hazardous materials or biological agents
Routine
Routine
Rips, tears and cuts in any layer
Damaged or missing hardware
Routine
Routine
Thermal damage such as charring, burn holes, or melting in any layer
Damaged or missing reflective trim
Routine
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
Label integrity, legibility
Advanced
Advanced
Hook and Loop functionality
Liner attachment systems
Advanced
Advanced
Closure system functionality
Action Taken:
Personal Protective Equipment Checklist/Log
Name: ____________________________________________________________________________
Date: ____________________________________
Title: _____________________________________________
Assignment: ______________________________________________________________
ASSIGNED EQUIPMENT
Item
Manufacturer
Year
New/Reassigned
Make
Model
Serial #
Date of Issue
Coat
Pants
Helmet
Gloves
Hood
Footwear
Routine or Advanced Inspection
“ ” Condition
In Need Of ( Mark with an “X”)
COAT
PROPER FIT (Refer to Appropriate NFPA Standard)
PASS
FAIL
CLEAN
REPLACE
REPAIR
Routine
Evaluation of fit and coat/trouser overlap (at least 2”)
Soiling
Routine
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
Loss or shifting of liner material
Advanced
Advanced
Broken or missing stitches
Material integrity: UV, chemical degradation
Advanced
Advanced
Wristlets: elasticity, stretching, cuts, thermal damage
Reflective trim: attached, reflectivity, damage
Advanced
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 NFPA Standard)
PASS
FAIL
CLEAN
REPLACE
REPAIR
Evaluation of fit and coat/trouser overlap (at least 2”)
Routine
Routine
Soiling
Contamination from hazardous materials or biological agents
Routine
Routine
Rips, tears and cuts in any layer
Damaged or missing hardware
Routine
Routine
Thermal damage such as charring, burn holes, or melting in any layer
Damaged or missing reflective trim
Routine
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
Label integrity, legibility
Advanced
Advanced
Hook and Loop functionality
Liner attachment systems
Advanced
Advanced
Closure system functionality
Action Taken:
Routine or Advanced Inspection
“ ” Condition
In Need Of ( Mark with an “X”)
FOOTWEAR
PROPER FIT (Refer to Appropriate NFPA 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
Closure systems damage
Routine
Routine
Damage or deformed steel toe, mid-sole and shank
Seam integrity and condition of liner
Advanced
Advanced
Heel and excessive tread wear
Closure system damage and functionality
Advanced
Advanced
Condition of lining
Action Taken:
Routine or Advanced Inspection
“ ” Condition
In Need Of ( Mark with an “X”)
GLOVES
PROPER FIT (Refer to Appropriate NFPA Standard)
PASS
FAIL
CLEAN
REPLACE
REPAIR
Routine
Evaluation of fit
Soiling
Routine
Routine
Contamination from hazardous materials or biological agents
Rips, tears, cuts or thermal damage
Routine
Routine
Inverted liner
Shrinkage
Routine
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 NFPA Standard)
PASS
FAIL
CLEAN
REPLACE
REPAIR
Routine
Evaluation for fit
Soiling
Routine
Routine
Damage to shell: cracks, dents and abrasions
Damage to liner: rips, tears or thermal damage
Routine
Routine
Suspension system
Damage or missing components to face-shield or goggle system
Routine
Routine
Damage or missing reflective trim
Face-shield/goggle functionality
Advanced
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 NFPA Standard)
PASS
FAIL
CLEAN
REPLACE
REPAIR
Routine
Evaluation of fit
Soiling
Routine
Routine
Contamination from hazardous materials or biological agents
Rips, tears, cuts or thermal damage
Routine
Routine
Loss of face opening adjustment/Shrinkage
Seam integrity
Advanced
Advanced
Elasticity
Action Taken:
Comments: ____________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________
Inspected By: ___________________________________________
Signature: _____________________________________
Date: ____/____/____
Inspection Log
Inspected by
Date
Inspection Type
P = Pass
Cleaned
Repaired
Disposition
Comments
Routine/Advanced
F = Fail
Routine/Advanced/Specialized
Yes / No
Reference Material:
NFPA 1851, Selection Care, and Maintenance of Structural Fire Fighting Protective Ensemble, 2001
Edition
NFPA 1971, Protective Ensemble for Structural Fire Fighting, 2000 Edition
Explanatory Material
Routine Inspection – This inspection shall be conducted by the individual member after each use
based on department guidelines and according to manufacturer’s recommendations.
Advanced Inspection – This inspection may be conducted by members of the organization who have
received training in the inspection of structural firefighting protective clothing and equipment based
on department guidelines and according to manufacturer’s recommendations. . It shall be conducted
at a minimum of every 12 months or whenever routine inspections indicate a problem exists.
Routine Cleaning – This type of cleaning is conducted by the end user based on department
guidelines and manufacturer’s recommendations, without taking the element out of service.
Advanced Cleaning – This type of cleaning can be conducted by a member of the organization who
has received training in the cleaning of structural fire fighting protective clothing and equipment
based on department guidelines and according to manufacturer’s recommendations. This type of
cleaning shall be conducted every six months at a minimum and advanced cleaning shall be
conducted for items that have been issued, used, and are soiled. Advanced cleaning can also be
accomplished by contract cleaning.
Specialized Cleaning – This type of cleaning can be conducted by a member of the organization who
has received training in the cleaning of structural fire fighting protective clothing and equipment
based on department guidelines and according to manufacturer’s recommendations.
This worksheet does not list all of the material contained in the referenced standards. Please refer to
the appropriate standard for additional information.
MSWord/PPE Checklist/Feb. 24, 2003
(C10:095)
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