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SSU PERSONAL PROTECTIVE EQUIPMENT ORDER FORM

Please complete the Size and Qty., then circle desired Bold section for each item. Obtain your

supervisor's signature and bring this form to the PPE Distribution Area (Facilities Services Corp

Yard North Central) on Tuesdays between 1:00 and 2:00 PM.

Name________________Spvr. Sig:______________ Dept. ________________ Date________

EYE PROTECTION

Brand Stock Qty Size Qty. ✔

Goggles, Non-Fogging (chemical splash

protection)

10 - 20

Brand Stock Qty Size Qty. ✔

Ear Muffs 5 - 10

Hearing Band

Replacement Plugs for Hearing Band

Earplugs, Disposable 100 - 200

Earplugs, Disposable w/ Cord 100 - 200

BODY PROTECTION

Brand Stock Qty Size Qty. ✔

* Safety Back Support 2 - 4 S M L

XL

Replacement Window for Face Shield,

Chemical or Impact resistant

5 - 10

Tyvek Coverall 50 - 100 L XL

Tyvek Pants 50 - 100 XL

Tyvek Jacket 50 - 100 L

Kleenguard Coverall 20 - 40 XL XXL

Saranex Coverall 10 - 20 XL XXL

Chemical Apron (Special Order) 0

* Requires completion of EH&S lifting training course prior to being issued.

** Steel Toed shoes are issued once a year via an on campus shoe vendor. Immediate needs can be addressed by EH&S staff.

Gloves, Solvex, Petroleum Chemicals 20 - 40 6 7 8

9 10 11

Gloves, Silver Shield, Lab Chemicals 5 - 10 S M L

XL

Gloves, Leather Palm Work Gloves 10 - 20 S M L

XL

Gloves, Leather Driver's 10 - 20 S M L

XL