Title Page
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Site conducted
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Employee Name
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Employee Company
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Location
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Conducted on
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Prepared by
Employee Qualitative Fit Test Record
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Instructions:
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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.
Details
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Employee Name and Signature:
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Respirator Make:
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Respirator Model:
Hazard various Construction Dust/ Fiber Particles
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Is the user free from facial hair interfering with the seal on the respirator?
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Did the wearer fit the respirator without assistance?
Sensitivity Test
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Sensitivity Test:
Fit Test
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Normal breathing
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Deep breathing
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Turning head side to side
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Moving head up and down
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Bending over
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Talking
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Normal breathing
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PLEASE NOTE:
*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:
