The band intended to title the album "Metal Up Your Ass" with a cover featuring a hand clutching a dagger emerging from a toilet bowl. However, Zazula convinced them to change the title, because he thought that distributors would not stock it as it was too explicit to display. The final cover featured the shadow of a hand letting go of a bloodied hammer. Burton was credited with coming up with the name "Kill 'Em All"—referring to timid record distributors, saying, "Those record company fuckers ... kill 'em all!"—as a response to the situation. Ulrich thought "Kill 'Em All" was a good name, and Zazula agreed. Burton suggested to Gary L. Heard, also responsible for the Metallica photograph on the back cover, to feature a bloodied hammer on the album art. According to Hammett, "Cliff carried a hammer with him everywhere he went. He always had a hammer in his luggage, and he would take it out occasionally and start destroying things." Even though the original title was unused, the band did later release a "Metal Up Your Ass" T-shirt with the proposed artwork. A live bootleg recording of a 1982 performance at the Old Waldorf, titled "Metal Up Your Ass (Live)", featured the original cover artwork. Original pressings of the album came with an inner sleeve that included pictures and lyrics as well as a silver label on the vinyl. Subsequent pressings had a blank white sleeve and standard album label. The 1988 reissue re-introduced the lyrics and photos. The original release can be distinguished by the words "Bang That Head That Doesn't Bang" at the top of the back cover. This was dropped from the reissue. The phrase "Bang That Head That Doesn't Bang" was dedicated to San Francisco fan Ray Burch, known for his headbanging at the band's early shows.