Title Page

  • Project Name

  • Job Number

  • Date

  • Demo One Site Supervisor

  • Competent Person to print name and sign on completion of all mask checks

Monthly Operative/Supervisor RPE Competent Person Check Record

Employee 1: Monthly RPE Check by a Competent Person (both masks must be checked)

  • Name of Operative/Supervisor (who owns the two masks) including full face model type and serial number

  • Are the face fits for both masks and the RPE service certificate in date and for the correct make and model?

  • Full Face

  • Items which MUST be checked: Head harness, facepiece (seal & visor), inhalation/exhalation valves, threaded connectors & seals, battery charge/condition, airflow rate and condition of filter.

  • Is mask fit for work and safely stored between shifts?

  • Photo of full face mask

  • Half mask

  • Make and model

  • Items which MUST be checked: head harness, facepiece (seal), inhalation/exhalation valves and condition of filter.

  • Is mask fit for work and safely stored between shifts?

  • Photo of half mask

Employee 2: Monthly RPE Check by a Competent Person (both masks must be checked)

  • Name of Operative/Supervisor (who owns the two masks) including full face model type and serial number

  • Are the face fits for both masks and the RPE service certificate in date and for the correct make and model?

  • Full face

  • Items which MUST be checked: Head harness, facepiece (seal & visor), inhalation/exhalation valves, threaded connectors & seals, battery charge/condition, airflow rate and condition of filter.

  • Is mask fit for work and safely stored between shifts?

  • Photo of full face mask

  • Half mask

  • Make and model

  • Items which MUST be checked: head harness, facepiece (seal), inhalation/exhalation valves and condition of filter.

  • Is mask fit for work and safely stored between shifts?

  • Photo of half mask

Employee 3: Monthly RPE Check by a Competent Person (both masks must be checked)

  • Name of Operative/Supervisor (who owns the two masks) including full face model type and serial number

  • Are the face fits for both masks and the RPE service certificate in date and for the correct make and model?

  • Full face

  • Items which MUST be checked: Head harness, facepiece (seal & visor), inhalation/exhalation valves, threaded connectors & seals, battery charge/condition, airflow rate and condition of filter.

  • Is mask fit for work and safely stored between shifts?

  • Photo of full face mask

  • Half mask

  • Make and model

  • Items which MUST be checked: head harness, facepiece (seal), inhalation/exhalation valves and condition of filter.

  • Is mask fit for work and safely stored between shifts?

  • Photo of half mask

Employee 4: Monthly RPE Check by a Competent Person (both masks must be checked)

  • Name of Operative/Supervisor (who owns the two masks) including full face model type and serial number

  • Are the face fits for both masks and the RPE service certificate in date and for the correct make and model?

  • Full face

  • Items which MUST be checked: Head harness, facepiece (seal & visor), inhalation/exhalation valves, threaded connectors & seals, battery charge/condition, airflow rate and condition of filter.

  • Is mask fit for work and safely stored between shifts?

  • Photo of full face mask

  • Half mask

  • Make and model

  • Items which MUST be checked: head harness, facepiece (seal), inhalation/exhalation valves and condition of filter.

  • Is mask fit for work and safely stored between shifts?

  • Photo of half mask

Employee 5: Monthly RPE Check by a Competent Person (both masks must be checked)

  • Name of Operative/Supervisor (who owns the two masks) including full face model type and serial number

  • Are the face fits for both masks and the RPE service certificate in date and for the correct make and model?

  • Full face

  • Items which MUST be checked: Head harness, facepiece (seal & visor), inhalation/exhalation valves, threaded connectors & seals, battery charge/condition, airflow rate and condition of filter.

  • Is mask fit for work and safely stored between shifts?

  • Photo of full face mask

  • Half mask

  • Make and model

  • Items which MUST be checked: head harness, facepiece (seal), inhalation/exhalation valves and condition of filter.

  • Is mask fit for work and safely stored between shifts?

  • Photo of half mask

Employee 6: Monthly RPE Check by a Competent Person (both masks must be checked)

  • Name of Operative/Supervisor (who owns the two masks) including full face model type and serial number

  • Are the face fits for both masks and the RPE service certificate in date and for the correct make and model?

  • Full face

  • Items which MUST be checked: Head harness, facepiece (seal & visor), inhalation/exhalation valves, threaded connectors & seals, battery charge/condition, airflow rate and condition of filter.

  • Is mask fit for work and safely stored between shifts?

  • Photo of full face mask

  • Half mask

  • Make and model

  • Items which MUST be checked: head harness, facepiece (seal), inhalation/exhalation valves and condition of filter.

  • Is mask fit for work and safely stored between shifts?

  • Photo of half mask

Employee 7: Monthly RPE Check by a Competent Person (both masks must be checked)

  • Name of Operative/Supervisor (who owns the two masks) including full face model type and serial number

  • Are the face fits for both masks and the RPE service certificate in date and for the correct make and model?

  • Full face

  • Items which MUST be checked: Head harness, facepiece (seal & visor), inhalation/exhalation valves, threaded connectors & seals, battery charge/condition, airflow rate and condition of filter.

  • Is mask fit for work and safely stored between shifts?

  • Photo of full face mask

  • Half mask

  • Make and model

  • Items which MUST be checked: head harness, facepiece (seal), inhalation/exhalation valves and condition of filter.

  • Is mask fit for work and safely stored between shifts?

  • Photo of half mask

Employee 8: Monthly RPE Check by a Competent Person (both masks must be checked)

  • Name of Operative/Supervisor (who owns the two masks) including full face model type and serial number

  • Are the face fits for both masks and the RPE service certificate in date and for the correct make and model?

  • Full face

  • Items which MUST be checked: Head harness, facepiece (seal & visor), inhalation/exhalation valves, threaded connectors & seals, battery charge/condition, airflow rate and condition of filter.

  • Is mask fit for work and safely stored between shifts?

  • Photo of full face mask

  • Half mask

  • Make and model

  • Items which MUST be checked: head harness, facepiece (seal), inhalation/exhalation valves and condition of filter.

  • Is mask fit for work and safely stored between shifts?

  • Photo of half mask

Employee 9: Monthly RPE Check by a Competent Person (both masks must be checked)

  • Name of Operative/Supervisor (who owns the two masks) including full face model type and serial number

  • Are the face fits for both masks and the RPE service certificate in date and for the correct make and model?

  • Full face

  • Items which MUST be checked: Head harness, facepiece (seal & visor), inhalation/exhalation valves, threaded connectors & seals, battery charge/condition, airflow rate and condition of filter.

  • Is mask fit for work and safely stored between shifts?

  • Photo of full face mask

  • Half mask

  • Make and model

  • Items which MUST be checked: head harness, facepiece (seal), inhalation/exhalation valves and condition of filter.

  • Is mask fit for work and safely stored between shifts?

  • Photo of half mask

Employee 10: Monthly RPE Check by a Competent Person (both masks must be checked)

  • Name of Operative/Supervisor (who owns the two masks) including full face model type and serial number

  • Are the face fits for both masks and the RPE service certificate in date and for the correct make and model?

  • Full face

  • Items which MUST be checked: Head harness, facepiece (seal & visor), inhalation/exhalation valves, threaded connectors & seals, battery charge/condition, airflow rate and condition of filter.

  • Is mask fit for work and safely stored between shifts?

  • Photo of full face mask

  • Half mask

  • Make and model

  • Items which MUST be checked: head harness, facepiece (seal), inhalation/exhalation valves and condition of filter.

  • Is mask fit for work and safely stored between shifts?

  • Photo of half mask

Employee 11: Monthly RPE Check by a Competent Person (both masks must be checked)

  • Name of Operative/Supervisor (who owns the two masks) including full face model type and serial number

  • Are the face fits for both masks and the RPE service certificate in date and for the correct make and model?

  • Full face

  • Items which MUST be checked: Head harness, facepiece (seal & visor), inhalation/exhalation valves, threaded connectors & seals, battery charge/condition, airflow rate and condition of filter.

  • Is mask fit for work and safely stored between shifts?

  • Photo of full face mask

  • Half mask

  • Make and model

  • Items which MUST be checked: head harness, facepiece (seal), inhalation/exhalation valves and condition of filter.

  • Is mask fit for work and safely stored between shifts?

  • Photo of half mask

Competent person to sign page 1 to confirm all masks have been checked

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