Form Printable Respirator Fit Test Card Qualitative Fit Test QLFT A qualitative fit test QLFT may only be used to fit test Negative pressure air purifying respirators as long as they ll only be used in atmospheres where the hazard is at less than 10 times the permissible exposure limit PEL Tight fitting facepieces used with powered and atmosphere supplying respirators
QUALITATIVE RESPIRATOR FIT TEST RECORD Company Address City State Zip Tel Date Name of Fit Tester Fit testing conducted in compliance with OSHA Standard 1910 134 F please print Pass Signature Respirator Fit Tested Make Model Style Size Fit Test Fail Could not be fit tested due to Title Slide 1 Author The above respirator fit test was performed on the test subject named by the test administrator named The results indicate the performance of the listed respiratory protective device under controlled conditions The fit test measured the ability of the respiratory protective device to provide protection to the individual tested
Form Printable Respirator Fit Test Card
Form Printable Respirator Fit Test Card
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Printable Respirator Fit Test Cards Respirator Fit Test Card Name Respirator Make Model Size Type of Test Test Date Next Test Date Results Pass Fail Qualitative Bitrex Quantitative PortaCount Test Administrator sign Shawmut Corporation Gown mask respirator Dispose of PPE in designated container Wash hands Annual fit testing is required to re verify appropriate respirator fit N95 Respirator Training and Fit Testing Verification Facility Date Employee
Respirator Fit Test Report Test conducted using 3M FT 10 or 3M FT 30 Fit Test Kit Name Company Department A fit test is a test protocol conducted to verify that a respirator is both comfortable and provides the wearer with the expected protection Fit testing uses a test agent either qualitatively detected by the wearer s sense of taste smell or involuntary cough irritant smoke or quantitatively measured by an instrument to verify the respirator s fit
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A seal check is not a substitute for a fit test To do a seal check 1 Put your respirator on and make sure it fits snugly on your face especially around the nose 2 Place both hands over the surface of the respirator and exhale You should not feel any air leaking between your face and the respirator QUALITATIVE RESPIRATOR FIT TEST FORM Worker s name Date Does the worker use or have Eyeglasses Facial Hair Dentures Other items that may interfere with the respirator seal please specify If yes to any of the above discuss how the respirator seal will be affected Workers must
Based on information provided on this form I certify that the employee named on this form can wear the respiratory protective equipment listed above Infectious Disease Epidemiology Prevention and Control 612 676 5414 TDD TTY 651 215 8980 www health state mn us If you require this document in another format such as large print Fit Test Form Respirator Fit Test Record Conditions which could affect respirator fit Clean Shaven 1 2 day beard growth 2 days beard growth Moustache Facial Scar Dentures absent Glasses None Fit Checks Negative Pressure Positive Pressure Fit Testing Quantitative Qualitative Isoamyl Acetate Sweet Bitter Smoke Acknowledgement
Top 8 Respirator Fit Test Form Templates Free To Download In PDF Format
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Respirator Fit Testing Actsafe Safety Association
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https://www.3m.com/3M/en_US/respiratory-protection-us/support/center-for-respiratory-protection/fit-testing/
Qualitative Fit Test QLFT A qualitative fit test QLFT may only be used to fit test Negative pressure air purifying respirators as long as they ll only be used in atmospheres where the hazard is at less than 10 times the permissible exposure limit PEL Tight fitting facepieces used with powered and atmosphere supplying respirators
https://multimedia.3m.com/mws/media/342297O/3m-respirator-fit-test-form-osha-standard-1910-134-f.pdf
QUALITATIVE RESPIRATOR FIT TEST RECORD Company Address City State Zip Tel Date Name of Fit Tester Fit testing conducted in compliance with OSHA Standard 1910 134 F please print Pass Signature Respirator Fit Tested Make Model Style Size Fit Test Fail Could not be fit tested due to Title Slide 1 Author
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Printable Respirator Fit Test Form Template
Printable Respirator Fit Test Form Template
Printable Respirator Fit Test Form Template
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Form Printable Respirator Fit Test Card - Doffing Removal Instructions Remove PPE in proper order gloves goggles face shiel d gown mask respirator Dispose of PPE in designated container Wash hands Note Annual fit testing is required to re verify appropriate respirator fit N95 Respirator Training and Fit Testing Verification
