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
2 digit month, 2 digit day, 4 digit yearDate
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?
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?
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?
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