Jyssica Murphy

Face fit Testing Record

Qualitative Face Fit Record

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Information

Client / Site
Conducted on
Prepared by

Name of person being face fit tested
Company
Face-piece used
Add media
Make/Model of face-piece used
Exercises performed during the test
- Normal breathing
- Deep breathing
- Turning head side to side
- Moving head up and down
- Talking
- Bending over
- Normal breathing
Sweet or bitter test?
Condition of face-piece (If it is wearers own)
Was assistance required donning and fit che checking the face piece before the test?
Final result of test
Was a re-test required?
Signature of person being fit tested
Signature of person carrying out the fit test

Jyssica Murphy

Face fit Testing Record

Qualitative Face Fit Record

Use this Template

Print as PDF

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