BMSF-159 Qualitative Face Fit

• Conducted on

  Date

• Fit tester

• Candidates name

• Location
  Address

• Covid-19 Precautions - Tester must wear FFP3/P3 mask and nitrile gloves while conducting test on colleague. Test hood must be cleaned with disinfectant wipes, inside and out , in sight of the candidate

• Acceptable types of facial hair

  

• Mask type

  FFP Disposable

  Half Mask

• Model and Size

• Hazard

  Select Dust Mist Fume Gas Vapour

  • Dust
  • Mist
  • Fume
  • Gas
  • Vapour

• Condition

  New

  Used

  Poor

• PPE worn

  Select Safety spectacles Goggles Hard hat Ear defenders

  • Safety spectacles
  • Goggles
  • Hard hat
  • Ear defenders

• Sensitivity Level

  Select 10 20 30

  • 10
  • 20
  • 30

Exercise

• Normal breathing

  Pass

  Fail

• Deeper breathing

  Pass

  Fail

• Turning head side to side

  Pass

  Fail

• Moving head up and down

  Pass

  Fail

• Talking

  Pass

  Fail

• Leaning forwards

  Pass

  Fail

• Normal breathing

  Pass

  Fail

• BREAK SEAL TEST

  Pass

  Fail

Summary

• OVERALL RESULT

  Pass

  Fail

• Was proper fit training provided?

  Yes

  No

• Face Seal

  Select Clean Shaven Goatee in Seal Moustache Ladies (N/A)

  • Clean Shaven
  • Goatee in Seal
  • Moustache
  • Ladies (N/A)

• Fit tester's signature

  Sign

• Candidate's signature

  Sign

• Expiry date

  Date