Annual Program Review - Respiratory Protection

• Audit Title

• Site Name

• Conducted on

  Date

• Auditor

• Location
  Address

• Site EHS Manager

Applicable Standards

• Select those standards that apply.

  Select 29CFR1910.134, “Respiratory Protection” EHS&S Standard 2.0, “Chemical Substance Management”

  • 29CFR1910.134, “Respiratory Protection”
  • EHS&S Standard 2.0, “Chemical Substance Management”

Documents Reviewed

• Written Program

• IH Risk Assessments / Reports

• Respirator Surveillance Records

• Training Program

• Training Records

• Fit Test Records

• List of Respirator Users

Program Execution

• Is there an IOSS program leader on site?

  Yes

  No

  N/A

• How many respirator users are on site?

  0 to 5

  5 to 10

  10 to 50

  50+

• What types of respirators are used on site? Select all that apply.

  Select Disposable N95 Half Face Full Face PAPR Supplied Air

  • Disposable N95
  • Half Face
  • Full Face
  • PAPR
  • Supplied Air

• Are the respirators being used appropriate for the hazards to which the employee is exposed?

  Yes

  No

  N/A

• Are the proper cartridges being used for the hazards to which the employee is exposed?

  Yes

  No

  N/A

• Is there a documented cartridge change out schedule?

  Yes

  No

  N/A

Voluntary use

• Is there any voluntary use of respirators on site?

  Yes

  No

  N/A

• Is Appendix D completed for all Voluntary users?

  Yes

  No

  N/A

Training

• What is the frequency of training?

  Select Initial Annual Every 3 Years Initial Only

  • Initial
  • Annual
  • Every 3 Years
  • Initial Only

• Does the training program cover the required program elements?

  Yes

  No

  N/A

Medical Evaluation

• Is the list of participants in the GOH respiratory medical surveillance program aligned with the list of employees issued respirators?

  Yes

  No

  N/A

• Does GOH utilize the Medical Surveillance questionnaire included in 1910.134 Appendix C (or equivalent)?

  Yes

  No

  N/A

• What is the system for notifying respirator users when they are due for medical surveillance?

Fit Testing

• Is quantitative fit testing completed?

  Yes

  No

  N/A

Employee Discussions

• Discussions were held with the following groups or employees on site. List number of people when applicable.

• Are respirators inspected by users prior to use and during cleaning?

  Yes

  No

  N/A

• Is there a documented cleaning and disinfecting procedure?

  Yes

  No

  N/A

• Are respirator users able to clearly explain how the clean and disinfect respirators?

  Yes

  No

  N/A

• Are PAPR's used on site?

  Yes

  No

  N/A

• Is a flow check performed prior to each use?

  Yes

  No

  N/A

Plant Tour

• Was respirator use observed?

  Yes

  No

  N/A

• Were respirators being properly worn? (donned properly, no facial hair, cartridges on, etc)

  Yes

  No

  N/A

• Do respirators fit properly and do not interfere with effective workplace performance?

  Yes

  No

  N/A

• Are respirators stored to protect them from damage, contamination, dust, sunlight, extreme temperatures, excessive moisture, and damaging chemicals, and are they packed or stored to prevent deformation of the facepiece and exhalation valve?

  Yes

  No

  N/A

• Are Emergency use respirators inspected and maintained according to the site’s procedure (SCBA’s require monthly inspections).

  Yes

  No

  N/A