Employee Qualitative Fit Test Record

1. Fill out the details needed and for the "Fit Test", answer "Pass" or "Fail".
2. Add photos and notes by clicking on the paperclip icon.
3. To add a Corrective Measure click on the paperclip icon then "Add Action", provide a description, assign to a member, set priority and due date.
4. Complete audit by providing digital signature.
5. Share your report by exporting as PDF, Word, Excel or Web Link.

Employee Name and Signature:

Respirator Make:

Respirator Model:

Hazard various Construction Dust/ Fiber Particles

Is the undertaker free from facial hair interfering with the seal on the respirator?

Did the wearer fit the respirator without assistance?

Sensitivity Test

Sensitivity Test:

Fit Test

Normal Breathing

Deep Breathing

Turning head side to side

Moving head up and down

Bending over


Normal Breathing


*This person must undertake a further Qualitative face test if they gain or lose a significant amount of weight, develop Moles/Scars in the area where the respirator touches the skin or undergo major dental treatment.
*Fit test reports should be available for all employees who wear RPE incorporating tight-fitting face pieces. Fit test records should be retained by the employer. These records must be kept and made available upon request.

Assessor Signature:
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.