Respirator Fit Test Form

Respirator Fit Test Form - Individual is medically cleared for the respirator fit test. Deep breathing fit no fit. You will be exposed to a harmless irritant while standing under a fit test hood. How improper fit, use, cleaning and storage can compromise the protection provided by the respirator; Yes / no (please tick) sensitivity test: This fit test is required annually. Individual selected the respirator with the most acceptable fit.

A fit check without assistance?: Yes / no (please tick) sensitivity test: Head up and down fit no fit. Deep breathing fit no fit.

Individual conducted a seal check. 10 20 30 (please tick) fit test exercise : Head side to side 4. I understand that is my responsibility to maintain and care for the respirator issued to me. _____ yes _____ no does employee have facial hair, dentures or other attributes that will prevent a positive face fit? Yes / no (please tick) sensitivity test:

A respirator fit test must be completed by an individual trained in respiratory fit testing procedures. This fit test is required annually. If you cannot detect the odor, you will have. Yes / no (please tick) sensitivity test: Normal breathing fit no fit.

Head side to side 4. This fit test is required annually. Head up and down fit no fit. If the respirator is uncomfortable or does not fit properly, another respirator must be selected.

Head Up And Down Fit No Fit.

Respirator fit test form this is a qualitative fit test. Fit test must be performed on the same make, model, and size of the respirator to be used. I understand that is my responsibility to maintain and care for the respirator issued to me. A respirator fit test must be completed by an individual trained in respiratory fit testing procedures.

Individual Conducted A Seal Check.

Deep breathing fit no fit. Individual received a description of the fit test. Individual selected the respirator with the most acceptable fit. Head side to side 4.

The Respirator You Are Wearing Should Remove The Test Agent From The Air.

How to recognize medical signs and symptoms that may limit respirator use; How to properly put on and take off the respirator and perform respirator positive and negative seal checks Individual instructed on techniques to don, adjust and remove respirator. The use and limitations of the respirator;

_____ Yes _____ No Does Employee Have Facial Hair, Dentures Or Other Attributes That Will Prevent A Positive Face Fit?

If you cannot detect the odor, you will have. This fit test is required annually. Normal breathing fit no fit. How improper fit, use, cleaning and storage can compromise the protection provided by the respirator;

Fit test must be performed on the same make, model, and size of the respirator to be used. Individual instructed on techniques to don, adjust and remove respirator. Head up and down fit no fit. Yes / no (please tick) sensitivity test: A fit check without assistance?: