Face Mask Inspection Checklist

• Face mask Owner

• Mask Number

• Conducted on

  Date

• Mask Photos

  Media

• Respiration Type

  Full face

  Half Face

• Mask Make and Model Number

• Prepared by

Air-Purifying Respirators (half mask, full face piece, hood or helmet)

• Are valve membranes damage?

  Yes

  No

  N/A

• Rubber Face Piece:

• Is there excessive dirt?

  No

  Yes

• Clean all dirt from face piece

• Area / Level

  Select External Lvl -1 Ground Lvl 1 Lvl 2 Lvl 3 Lvl 4 Lvl 5 Other *please note

  • External
  • Lvl -1
  • Ground
  • Lvl 1
  • Lvl 2
  • Lvl 3
  • Lvl 4
  • Lvl 5
  • Other *please note

• Are full face respirators cracked, scratched, or loose fitting lenses?

  No

  Yes

• Obtain new respirator

• No

  Yes

• Head Straps:

• Are there breaks or tears?

  No

  Yes

• Replace head straps

• Is there loss of elasticity?

  No

  Yes

• Replace head straps

• Broken or malfunctioning buckles?

  No

  Yes

• Obtain new straps & buckles or respirator

• Inhalation Valve and Exhalation Valve:

• Is there detergent residue, dust particles, or dirt on valve or valve seat?

  No

  Yes

• Clean with water or a weak solution of Clorox and water one cup of bleach per gallon of water

• Any cracks, tears, or lack of flexibility in the valve material?

  No

  Yes

• Obtain new valve

• Any cracks and flexibility of valve seats?

  No

  Yes

• Obtain new respirator

• Filter Element:

• Is it the proper filter for the hazard?

  Yes

  No

• Are there worn threads; both in filter and face piece?

  No

  Yes

• Replace filter or face, as applicable

• Any cracks or dents in filter housing A?

  No

  Yes

• Replace filter

• Are cartridge gaskets in place? (if applicable)

  Yes

  No

Completion

• Comments/Recommendations

• Signature

  Sign

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