Respirator Fit Testing Form
RESPIRATOR FIT-TESTING FORM
GENERAL | |
Worker’s name: Position: |
Time: Date: |
Does worker have or use any of the following: [ ] Eyeglassess If any of the above apply, explain the importance of respirator seal and the potential impact of the item(s) on such seal |
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Ask worker if he/she has any medical concerns about wearing a respirator: [ ] Yes Refer any worker who answers Yes for a medical assessment |
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FIT TEST PROCEDURE | |
Instructions: Fit testing must be performed before initial exposure and repeated annually to ensure that a proper face seal is achieved and maintained. Fit testing must be done and the results recorded on each make and model the respirator wears. During testing, the worker must also wear all the hearing, eye, face and other personal protective equipment required for the operation to be carried while using the respirator to simulate actual exposure conditions, and the type, make, model and size of each piece of personal protective equipment must be recorded along with the test results. Check when successfully completed: [ ] Correct positioning of respirator and strap adjustment Qualitative fit testing using: [ ] Irritant smoke with HEPA/organic vapour cartridges Quantitative fit testing: Respirator fit tested by worker: Tested respirator(s) make/model:___________________________________________________________ Type/make/model of all other PPE worn during testing:__________________________________________ |
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Points discussed with worker: [ ] Respirator selection |
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Fit test date and time: | Next fit test date: |
Fit tested by: | |
Comments:
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My signature below indicates that I have been fit tested and received instruction in the fitting, use, limitations, storage, inspection and maintenance of all the respirators listed above. |
Worker’s signature: _____________________________________________ Date: ______________________