stephen carulli

FFT - RESPIRATOR / DUST MASK QUALITATIVE FACE FIT TEST EMPLOYEE RECORD

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Title Page

Ref number
Conducted on
Employee name
Assessor name

Mask Details

Make
Model
Hazard
- Dust
- Mist
- Fume
- Gas
- Vapour
Ownership
Condition

Details of Test Resuts

Normal Breathing
Deep Breathing
Turn Head to the Side
Move Head up and Down
Talking
Bending Over
Normal Breathing
Overall

Information

Sensitivity Level
Was Proper Fit Training Provided
PPE Worn During Test
- LEP
- Goggles
- Helmet
- Hearing Protection
Break Seal Test

Sign Off

Assessor
Date
Employee
Date

stephen carulli

FFT - RESPIRATOR / DUST MASK QUALITATIVE FACE FIT TEST EMPLOYEE RECORD

Use this Template

Print as PDF

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.