MCFRS PPE Quarterly Inspection Form

MCFRS PPE Quarterly Inspection Form
For reference:
- Personal Protective Gear Inspection Checklist (PDF)
- PPE Cleaning and Inspection Guide (PDF)
Inspector Information
Inspection Date*

MonthDayYear
Date
Inspection Month
Inspected by*

First NameLast Name
Work Site*
Is this a 'self submission'?*
For Chief Officers, Float Officers, EMS-DO, SA700 and PSTA Staff ONLY
Employee Information
Name*

First NameLast Name
Email*
Assigned Work Site*
Rank*
Assigned Shift*
FSID*
Have you received ANY new PPE since last quarter?*

YesNo
Supervisor's Email*
Supervisor's Email*
First Set of Gear
Turnout Coat

10 year expiration from manufacture date
Condition*
Manufacture Date*
Do the liner serial numbers match?*
Inner Liner Serial Number*
Outer Liner Serial Number*
Cleaning Date*
Turnout Pants

10 year expiration from manufacture date
Condition*
Manufacture Date*
Do the liner serial numbers match?*
Inner Liner Serial Number*
Outer Liner Serial Number*
Cleaning Date*
Turnout Boots

10 year expiration from manufacture date
Condition*
Manufacture Date*
Nomex Hood

10 year expiration from manufacture date
Condition*
Manufacture Date*
Helmet

10 year expiration from manufacture date
Condition*
Manufacture Date*
Turnout Gloves

10 year expiration from manufacture date
Condition*
Manufacture Date*
Extrication Gloves
Condition*
Hearing Protection
Condition*
Eye Protection
Condition*
Face Piece
Condition*
Has this set of gear been cleaned within the past 6 months?*

YesNo
Please send this gear to MD fire ASAP for cleaning.
Do you have a second set of gear?*
Second Set of Gear
Turnout Coat

10 year expiration from manufacture date
Condition*
Manufacture Date*
Do the liner serial numbers match?*
Inner Liner Serial Number*
Outer Liner Serial Number*
Cleaning Date*
Turnout Pants

10 year expiration from manufacture date
Condition*
Manufacture Date*
Do the liner serial numbers match?*
Inner Liner Serial Number*
Outer Liner Serial Number*
Cleaning Date*
Turnout Boots

10 year expiration from manufacture date
Condition*
Manufacture Date*
Nomex Hood

10 year expiration from manufacture date
Condition*
Manufacture Date*
Helmet

10 year expiration from manufacture date
Condition*
Manufacture Date*
Turnout Gloves

10 year expiration from manufacture date
Condition*
Manufacture Date*
Extrication Gloves
Condition*
Hearing Protection
Condition*
Eye Protection
Condition*
Has this set of gear been cleaned within the past 6 months?*

YesNo
Please send this gear to MD fire ASAP for cleaning.
Upload photo of gear cleaning tag

Cancelof
Comments/Concerns for this employee:
Should be Empty:

MCFRS PPE Quarterly Inspection Form

Inspector Information

Employee Information

First Set of Gear

Turnout Coat

Turnout Pants

Turnout Boots

Nomex Hood

Helmet

Turnout Gloves

Extrication Gloves

Hearing Protection

Eye Protection

Face Piece

Second Set of Gear

Turnout Coat

Turnout Pants

Turnout Boots

Nomex Hood

Helmet

Turnout Gloves

Extrication Gloves

Hearing Protection

Eye Protection