LOGS PPE Survey 2019

LOGISTICS MODULE

NJEMSTF members can respond to their 2018 Equipment Issued Survey electronically. Please complete ALL items. If no, enter no or n/a

2019 NJEMSTF Member PPE Survey

* Indicates required field

Last Name *

First Name *

Agency *

Module - Position *

Region *

Helmet

Helmet Manufacture *

Helmet Serial Number *

Helmet Manufacture Date *

Turnout Coats and Pants

Turnout Manufacture *

Turnout Coat Serial Number *

Turnout Coat Manufacture Date *

Turnout Pant Serial Number *

Turnout Pant Manufacture Date *

Gloves

Gloves Manufacture *

Gloves Serial Number *

Gloves Size *

Boots

Boots Manufacture *

Boots Size *

Boots Serial Number *

Boots Manufacture Date *

APR

APR Manufacture *

APR Size *

APR Serial Number *

APR CBRN Expiration Date *

APR P100 Expiration Date *

APR RZ Dusk Mask (Yes or No) *

APR RZ Dusk Mask Size if yes *

Eye Protection

EyePro Manufacture *

EyePro Serial Number *

EyePro Manufacture Date *

Notes or Comments *

Submit

LOGISTICS MODULE

2019 NJEMSTF Member PPE Survey

Helmet

Turnout Coats and Pants

Gloves

Boots

APR

Eye Protection

Telephone

eFax

Email

After Action Survey - NJ PAPAL DEPLOYMENT