Information

  • Client / Site

  • Conducted on

  • Prepared by

  • Sensitivity Test:
    1. Put some bitter sensitivity solution (red label) into the nebuliser
    2. Ask the test subject to sit down
    3. Place the hood over their head and follow the instructions below

  • 3 sets of 10 squeezes of the bitter sensitivity solution (red label) are to be administered. If the test subject has not detected the taste after 30 squeezes, change to the sweet sensitivity solution (red label) and repeat. If the test subject has not detected the sweet solution taste after 30 squeezes, their taste buds are not sensitive enough for the qualitative test. It should be recommended that they undertake quantitative testing.

  • Face Fit Test:
    1. Clean out the nebuliser with water and wipe dry
    2. Change to the black label solution
    3. Instruct the test subject on how to fit a mask correctly - ensuring that a tight seal is achieved.
    4. Place the hood over the head of the individual
    5. Administer 10 squeezes of the nebuliser through the opening in the hood and ask the test subject to undertake the following exercise

    Note: you must administer 10 squeezes of the nebuliser before each exercise

  • If any of the tests fail, the exercise should be stopped and re-started at test “1” with a different make / model of mask

  • Name:

  • Age:

  • Smoker:

  • In the last 15 minutes has the test subject:

  • Eaten?

  • Smoked?

  • Had a drink (except water)?

  • Chewed gum?

  • Number of squeezes if the nebuliser until the test subject detected the substance? <br><br>

Mask 1

  • Make of Mask:

  • Model of Mask:

  • 1. Normal Breathing (60 seconds)

  • 2. Deep Breathing (60 seconds)

  • 3. Moving Head from Side to Side (60 seconds)

  • 4. Moving Head Up and Down (60 seconds)

  • 5. Talking or Counting (60 seconds)

  • 6. Bending Up and Down (60 seconds)

  • 7. Normal Breathing (60 seconds)

Mask 2

  • Make of Mask:

  • Model of Mask:

  • 1. Normal Breathing (60 seconds)

  • 2. Deep Breathing (60 seconds)

  • 3. Moving Head from Side to Side (60 seconds)

  • 4. Moving Head Up and Down (60 seconds)

  • 5. Talking or Counting (60 seconds)

  • 6. Bending Up and Down (60 seconds)

  • 7. Normal Breathing (60 seconds)

Mask 3

  • Make of Mask:

  • Model of Mask:

  • 1. Normal Breathing (60 seconds)

  • 2. Deep Breathing (60 seconds)

  • 3. Moving Head from Side to Side (60 seconds)

  • 4. Moving Head Up and Down (60 seconds)

  • 5. Talking or Counting (60 seconds)

  • 6. Bending Up and Down (60 seconds)

  • 7. Normal Breathing (60 seconds)

Mask 4

  • Make of Mask:

  • Model of Mask:

  • 1. Normal Breathing (60 seconds)

  • 2. Deep Breathing (60 seconds)

  • 3. Moving Head from Side to Side (60 seconds)

  • 4. Moving Head Up and Down (60 seconds)

  • 5. Talking or Counting (60 seconds)

  • 6. Bending Up and Down (60 seconds)

  • 7. Normal Breathing (60 seconds)

Mask 5

  • Make of Mask:

  • Model of Mask:

  • 1. Normal Breathing (60 seconds)

  • 2. Deep Breathing (60 seconds)

  • 3. Moving Head from Side to Side (60 seconds)

  • 4. Moving Head Up and Down (60 seconds)

  • 5. Talking or Counting (60 seconds)

  • 6. Bending Up and Down (60 seconds)

  • 7. Normal Breathing (60 seconds)

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.