Respirator Fit Test Worksheet printable pdf download

Respirator Fit Test Worksheet

Qualitative Respirator Fit Test

Name:

Employee #:

 Yes

 No

 Yes

 No

Clean Shaven?

Spectacle Kit?

 S

 M

 L

Manufacturer/Model:

Size:

 Pass

 Fail

 Pass

 Fail

Irritant Smoke:

Isoamyl Acetate:

 S

 M

 L

Manufacturer/Model:

Size:

 Pass

 Fail

 Pass

 Fail

Irritant Smoke:

Isoamyl Acetate:

Fit Test Talking Exercise:

When the sunlight strikes raindrops in the air, they act like a prism and form a rainbow. The rainbow is a

division of white light into many beautiful colors. These take the shape of a long round arch, with its path

high above, and its two ends apparently beyond the horizon. There

is, according to legend, a boiling pot of gold at one end. People look, but no one ever finds it. When a man

looks for something beyond his reach, his friends say he is looking for the pot of gold at the end of the

rainbow.

Examiner:

Date:

Employee:

Date:

Quantitative Respirator Fit Test Report

Last Name:

First Name:

ID No.:

Next Test Due:

Operator Name:

Respirator Model:

Size:

Manufacturer:

Approval No.:

Notes:

Test Date:

Test Time:

(Continued on reverse side)

Respirator Fit Test Worksheet

Related Articles

Related forms

Related Categories