PPE and Safety Items Request Form
Enter in the quantities for each item to be ordered. For any additional items not on the list add the item description in the last comment box. 
Project Name & Number
Email
Address for shipping
Phone
MSA Full Brim V-Gard Hard Hat White
Orange, Class 2 mesh vest with E Light Electric Logos Small
Orange, Class 2 mesh vest with E Light Electric Logos Medium
Orange, Class 2 mesh vest with E Light Electric Logos Large
Orange, Class 2 mesh vest with E Light Electric Logos X Large
Orange, Class 2 mesh vest with E Light Electric Logos 2X Large
Orange, Class 2 mesh vest with E Light Electric Logos 3X Large
Orange, Class 2 mesh vest with E Light Electric Logos 4X Large
Great White Cut Gloves All Purpose Small (1=12 pairs)
Great White Cut Gloves All Purpose Medium (1=12 pairs)
Great White Cut Gloves All Purpose Large (1=12 pairs)
Great White Cut Gloves All Purpose XL (1=12 pairs)
Standard Clear Safety Glasses 12pr/bx (1=12 pairs)
Standard Dark Safety Glasses 12pr/bx (1=12 pairs)
Over Glasses Clear Safety Glasses 12pr/bx (1=12 pairs)
Over Glasses Dark Safety Glasses 12pr/bx (1=12 pairs)
Foam Safety Glasses, Clear 12pr/bx (1=12 pairs)
Foam Safety Glasses, Smoke 12pr/bx (1=12 pairs)
Lens cleaning towelettes, 100/bX, 10bx/Cs (1=1 box)
N95 Respirator, disposable 20/bx (1=1box)
Eye Wash Station 2-16 Ounce Bottles
100 Person First Aid Station, Bulk
10 Person Unitized First Aid Kit
Fire Extingusher 20 pound( for office and fuel station)
Fire Extingusher 10 pound (smoking pen, connexes)
Fire Extinguisher Inspection tags
Describe any additional items that may be needed.
Project Manager
Personal LOTO Lock
Name
Green, Class 2 Engineer Vest with E Light Electric Logo small (Supervisor Vest)
Green, Class 2 Engineer Vest with E Light Electric Logo Med (Supervisor Vest)
Green, Class 2 Engineer Vest with E Light Electric Logo Large (Supervisor Vest)
Green, Class 2 Engineer Vest with E Light Electric Logo XL (Supervisor Vest)
Green, Class 2 Engineer Vest with E Light Electric Logo 2XL (Supervisor Vest)
Great White Cut Gloves All Purpose 2XL (1=12 pairs)
Ear Plugs - No Cord 200pr/bx
Submit