Respirator User Health Screening Form Page 2
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43. Types of Respirators to be Used
disposable/filtering facepiece (e.g. N95)
supplied-air, pressure demand
tight fitting (half or full face piece)
SCBA - escape
non-tight fitting face piece (e.g. hood)
SCBA - open circuit
mouth piece
SCBA - closed circuit
combination - pressure demand/supplied air
air purifying -non-powered
with escape
combination - supplied-air with air purifying
air-purifying - powered
elements
supplied-air, demand
supplied-air suit
supplied-air, continuous flow
other, please specify
supplied-air, pressure demand
___________________________________
Signature of Supervisor:
Date:
EHS-RP-F6-R1
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Parent category: Medical