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PERSONAL PROTECTIVE EQUIPMENT (ICS-208-CG SSP-F) Purpose: The Personal Protective Equipment form is a list of personal protective equipment to be used in operations. The listing of personal protective equipment is required by Title 29 Code of Federal Regulations Part 1910.120. Preparation: The Personal Protective Equipment form is completed by the Site Safety Officer, or his/her staff. Personal protective equipment common to all ICS Operations personnel is addressed first. Jobs with unique personal protective equipment requirements (fall protection) are addressed next. When the form is delivered on site, the ICS Director, Supervisor, or Leader may amend the list to ensure personnel are adequately protected from job hazards. It must be completed prior to the onset of any operations,unless addressed elsewhere by Standard Operating Procedures. Distribution: This form must be located with Site Safety Plan (ICS-208-CG SSP-B). It therefore follows the same distribution route. Instructions: Item# Item Title Instructions 1 Incident Name Print the name assigned to the incident. 2 Date/Time Prepared Enter date (month, day, year)prepared. 3 Operational Period Enter the time interval for which the assignment applies. 4 Safety Officer Enter the name of the Safety Officer and means of contact. 5 Supervisor/Leader The Supervisor/Leader who receives this form will enter their name here. 6 Location& size of site Enter the geographical location of the site and the approximate square area. 7 Hazards Addressed: Enter the hazards that need to be safeguarded. 8 For Emergencies Enter the name and way to contact the individual who handles emergencies. Contact 9 Equipment List the equipment needed to address the hazards. If pre-designed Safe Work Practices are used, indicate here and attach to form. 10 References consulted List the references used in making the selection for PPE. 11 Inspection Procedures Enter the procedures for inspecting the Personal Protective Equipment prior to donning. If pre-designed Safe Work Practices are used, indicate here and attach to form. 12 Donning Procedures Enter the procedures for putting on the PPE. If pre-designed Safe Work Practices are used, indicate here and attach to form. 13 Doffing Procedures Enter the information for removing the PPE. If pre-designed Safe Work Practices are used, indicate here and attach to form. 14 Limitations and List the limitations and precautions when using PPE. Include the maximum time to be inside the PPE, Heat Precautions Stress concerns,psychomotor skill detraction and other factors. 15 Prepared by Enter the name and position of the person completing the worksheet. 16 Date/Time Briefed: I Enter the date/time the document was briefed to the appropriate workers and by whom.