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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
Safety Glasses, Clear or Blue/Gray (impact
resistant)
10 - 20
Safety Glasses, Clear or Blue/Gray
(impact resistant, fits over prescription glasses)
10 - 20
Case for Safety Glasses 5 - 10
HEARING PROTECTION
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
* Safety Back Support, Rigid 2 - 4 S M L
XL
Kneepads, Rubberized Foam 5 - 10
Safety Helmet (Hard Hat) 2 - 4
** Steel Toed Shoes (Special Order) 0
Face Shield, Chemical or Impact resistant 2 - 4
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.
HAND PROTECTION
Brand Stock Qty Size Qty. ✔
Gloves, Nitrile Disposable (4 mil) 5 - 10 bx S M L
XL
Gloves, Nitrile Disposable (8 mil) 5 - 10 bx S M L
XL
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