PERSONALPROTECTIVE EQUIPMENT ISSUANCE FORM
Name of Worker: Ren Bryan Quirabo
Designation: Cadet Engineer
Date Hired/ Started: September 24, 2019
Project Assignment:
Conditions:
1. Yellow Shirt Long Sleeve & Safety Goggles - Free of charge after three (3) months from the date of
issuance. Salary deduction if not completed the three (3) months period. Cost as follows:
Yellow Shirt = Php 200.00, Safety Googles = Php 50.00
2. Safety Helmet, Safety Shoes & Safety Vest - Free of charge after six (6) months from the date of
issuance. Must surrender after finish contract or replace same item. In the absence of both, cost
of each items less the number of months usage will be deducted on final pay as folows:
Safety Helmet = Php 700.00, Satefy Shoes = Php 1,000.00, Safety Vest = Php 150.00. In case of lost or
damage, salary deduction applies under the same cost as stated.
Quantity Issued Remarks
Blue - Polo jacket
Yellow - T-Shirt (Long Sleeves)
Safety Shoes 1 pair Size 11
Safety Goggles
Safety Helmet
Others, if any :
Issued by:
Signature Over Printed Name/Desination/Date
Agreed & Received By:
Signature Over Printed Name
Date :
NE 2019-001
Cc:201 File
PERSONALPROTECTIVE EQUIPMENT ISSUANCE FORM
Name of Worker: Eugenio D. Caballero
Designation: Electrician-B
Date Hired/ Started: September 24, 2019
Project Assignment:
Conditions:
1. Yellow Shirt Long Sleeve & Safety Goggles - Free of charge after three (3) months from the date of
issuance. Salary deduction if not completed the three (3) months period. Cost as follows:
Yellow Shirt = Php 200.00, Safety Googles = Php 50.00
2. Safety Helmet, Safety Shoes & Safety Vest - Free of charge after six (6) months from the date of
issuance. Must surrender after finish contract or replace same item. In the absence of both, cost
of each items less the number of months usage will be deducted on final pay as folows:
Safety Helmet = Php 700.00, Satefy Shoes = Php 1,000.00, Safety Vest = Php 150.00. In case of lost or
damage, salary deduction applies under the same cost as stated.
Quantity Issued Remarks
Blue - Polo jacket
Yellow - T-Shirt (Long Sleeves)
Safety Shoes 1 pair Size 6
Safety Goggles
Safety Helmet
Others, if any :
Issued by:
Signature Over Printed Name/Desination/Date
Agreed & Received By:
Signature Over Printed Name
Date :
NE 2019-002
Cc:201 File
PERSONALPROTECTIVE EQUIPMENT ISSUANCE FORM
Name of Worker: Ryan A. De Leon
Designation:
Date Hired/ Started: October 25, 2019
Project Assignment: CSB-Sports & Dorm
Conditions:
1. Yellow Shirt Long Sleeve & Safety Goggles - Free of charge after three (3) months from the date of
issuance. Salary deduction if not completed the three (3) months period. Cost as follows:
Yellow Shirt = Php 200.00, Safety Googles = Php 50.00
2. Safety Helmet, Safety Shoes & Safety Vest - Free of charge after six (6) months from the date of
issuance. Must surrender after finish contract or replace same item. In the absence of both, cost
of each items less the number of months usage will be deducted on final pay as folows:
Safety Helmet = Php 700.00, Satefy Shoes = Php 1,000.00, Safety Vest = Php 150.00. In case of lost or
damage, salary deduction applies under the same cost as stated.
Quantity Issued Remarks
Blue - Polo jacket
Yellow - T-Shirt (Long Sleeves)
Safety Shoes 1 pair Size 7
Safety Goggles
Safety Helmet
Others, if any :
Issued by:
Signature Over Printed Name/Desination/Date
Agreed & Received By:
Signature Over Printed Name
Date :
NE 2019-038
Cc:201 File
PERSONALPROTECTIVE EQUIPMENT ISSUANCE FORM
Name of Worker: Renzo M. Manuel
Designation:
Date Hired/ Started: October 25, 2019
Project Assignment: CSB-Sports & Dorm
Conditions:
1. Yellow Shirt Long Sleeve & Safety Goggles - Free of charge after three (3) months from the date of
issuance. Salary deduction if not completed the three (3) months period. Cost as follows:
Yellow Shirt = Php 200.00, Safety Googles = Php 50.00
2. Safety Helmet, Safety Shoes & Safety Vest - Free of charge after six (6) months from the date of
issuance. Must surrender after finish contract or replace same item. In the absence of both, cost
of each items less the number of months usage will be deducted on final pay as folows:
Safety Helmet = Php 700.00, Satefy Shoes = Php 1,000.00, Safety Vest = Php 150.00. In case of lost or
damage, salary deduction applies under the same cost as stated.
Quantity Issued Remarks
Blue - Polo jacket
Yellow - T-Shirt (Long Sleeves)
Safety Shoes 1 pair Size 7
Safety Goggles
Safety Helmet
Others, if any :
Issued by:
Signature Over Printed Name/Desination/Date
Agreed & Received By:
Signature Over Printed Name
Date :
NE 2019-039
Cc:201 File
