Title Page

  • Department/Area Reviewed

  • Completed By

  • Date of GEMBA:

  • If any answers are NO, provide the tier board number and owner to correct the issue in the action section.

Respiratory Protection

  • Are Team Members who wear respirators with cartridges changing the cartridges regularly?

  • Corrective Action:

  • Which type of respirator do they wear?

  • Are respirators stored in a sealed plastic bag? Are they cleaned routinely?

  • Corrective Action:

  • Do TMs who wear "half face and full face respirators" perform a user seal check each time they wear a respirator?

  • Corrective Action:

  • Do TMs who wear "half face and full face respirators" maintain a clean shaven area to ensure seal is effective?

  • Corrective Action:

  • Is there a copy of the supplied air system O&M manual readily available in the area?

  • Corrective Actions:

  • Are the supplier air system filters changed in accordance with the O&M manual?

  • Corrective Action:

  • Is the supplied air filter system tagged with the due date and name of person who performed task?

  • Corrective Action:

  • Are supplied air filters inspected daily and are documented?

  • Corrective Action:

  • Is the carbon monoxide alarm on the supplied air system checked daily and inspection is documented?

  • Corrective Action:

  • Is the carbon monoxide alarm CALIBRATED per the manufacturer's recommendation and documented?

  • Corrective Action:

  • Are Team Members trained on the CO alarm and what to do if it should go off?

  • Corrective Action:

  • Have Team Members received medical clearance for wearing a respirator and also been fit tested?

  • Corrective Action:

  • Are PAPR's being stored separate from battery and not being hung up by head strap?

  • Corrective Action:

  • Are PAPR batteries lasting the entire shift?

  • Corrective Action:

  • Are the types of cartridges to be worn included on the area(s) PPE Dude?

  • Corrective Action:

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