Encore Electric Executive Audit - Respiratory Protection

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Respiratory Protection - - (If respiratotrs will not be used answer is N/A for all respirator related questions.)

• Will respirators be used on site?

  Yes

  No

  N/A

• Add media

  Media

• Have employees been medically examined for respirator use?

  Yes

  No

  N/A

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  Media

• Have employees been trainined on respirator use?

  Yes

  No

  N/A

• Add media

  Media

• Have employees been fit tested?

  Yes

  No

  N/A

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  Media

• Yes

  No

  N/A

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  Media

Signatures

• Person performing the audit

  Sign

• Add signature

  Sign