Title Page
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Department/Area Reviewed
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Completed By
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Date of GEMBA:
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If any answers are NO, provide the tier board number and owner to correct the issue in the action section.
Respiratory Protection
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Are Team Members who wear respirators with cartridges changing the cartridges regularly?
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Corrective Action:
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Which type of respirator do they wear?
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Are respirators stored in a sealed plastic bag? Are they cleaned routinely?
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Corrective Action:
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Do TMs who wear "half face and full face respirators" perform a user seal check each time they wear a respirator?
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Corrective Action:
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Do TMs who wear "half face and full face respirators" maintain a clean shaven area to ensure seal is effective?
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Corrective Action:
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Is there a copy of the supplied air system O&M manual readily available in the area?
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Corrective Actions:
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Are the supplier air system filters changed in accordance with the O&M manual?
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Corrective Action:
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Is the supplied air filter system tagged with the due date and name of person who performed task?
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Corrective Action:
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Are supplied air filters inspected daily and are documented?
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Corrective Action:
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Is the carbon monoxide alarm on the supplied air system checked daily and inspection is documented?
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Corrective Action:
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Is the carbon monoxide alarm CALIBRATED per the manufacturer's recommendation and documented?
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Corrective Action:
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Are Team Members trained on the CO alarm and what to do if it should go off?
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Corrective Action:
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Have Team Members received medical clearance for wearing a respirator and also been fit tested?
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Corrective Action:
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Are PAPR's being stored separate from battery and not being hung up by head strap?
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Corrective Action:
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Are PAPR batteries lasting the entire shift?
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Corrective Action:
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Are the types of cartridges to be worn included on the area(s) PPE Dude?
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Corrective Action:
