Elite Comfort Solutions Elite PPE Agreement 9 Name(Required) First Last Last 4 of SS#(Required) Date(Required) MM slash DD slash YYYY I understand that my assignment at Elite will require that I wear the required personal protective equipment listed below. Failure to wear the required personal protective equipment may result in disciplinary action up to and including termination.(Required) I AgreeI have been issued the PPE and understand that it is the property of TEC Staffing. Failure to return these items will result in a payroll deduction in the amount listed below.(Required) I AgreeI understand that it is my responsibility to arrive for my shift with the proper PPE.(Required) I AgreeI understand that if I arrive without PPE, I will be required to purchase the missing items at the cost listed below or I may be sent home.(Required) I AgreeIt is your responsibility to bring any PPE that needs to be replaced, due to damage or wear, to the Fort Smith Industrial office for replacement.(Required) I Agree PPE Description Deduction Amt. EMP Couns Safety Vest $5.00 Cut Gloves $10.00 Heat Gloves $5.00 General Gloves $5.00 Safety Glasses $5.00 Signature: ____________________________________________________________________________ Pages: 1 2 3 4 5 6 7 8
