Sabre Respirator Inspection Checklist

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Disposable Respirators

• Are the filters free of any holes and/or any other damage?

  Needs Repair

  Conditions Ok

  Non Applicable

• Add media

  Media

• Are the straps in working order and do they display elasticity when stretched out?

  Needs Repair

  Conditions Ok

  Non Applicable

• Add media

  Media

• Is the nose clip damaged or deteriorated?

  Needs Repair

  Conditions Ok

  Non Applicable

• Add media

  Media

Air Purifying Respirators

• Is the face piece clean and free of cracks, tears, or holes.

  Needs Repair

  Conditions Ok

  Non Applicable

• Add media

  Media

• Are the straps clean and free of breaks, tears, loss of elasticity or damaged attachments.

  Needs Repair

  Conditions Ok

  Non Applicable

• Add media

  Media

• Are the valves clean and free of holes, warn page, cracks and dirt.

  Needs Repair

  Conditions Ok

  Non Applicable

• Add media

  Media

• Are the filter cartridges and canisters clean and free of dents and corrosion.

  Needs Repair

  Conditions Ok

  Non Applicable

• Add media

  Media

• Is this the proper protection type?

  Yes

  No

  N/A

• Add media

  Media

• Has the filter exceeded its expiration date?

  Yes

  No

  N/A

• Add media

  Media

Atmosphere - Supplying Respirators

• Is the Hood/Helmet/Blouse/Suit clean and free of any cracks, tears, worn seams, and abrasions?

  Needs Repair

  Conditions Ok

  Non Applicable

• Add media

  Media

• Is the Face shield clean and free of cracks, breaks, abrasions or distortions?

  Needs Repair

  Conditions Ok

  Non Applicable

• Add media

  Media

• Are the Air Supply Hoses free of breaks or kinks?

  Needs Repair

  Conditions Ok

  Non Applicable

• Are the Air Supply regulators/valves in good condition?

  Needs Repair

  Conditions Ok

  Non Applicable

• Does the Breathing Air meet the breathable air standard?

  Needs Repair

  Conditions Ok

  Non Applicable

Self-Contained Breathing Apparatus

• Are the Cylinder/Harness/Straps and Buckles clean and in good condition?

  Needs Repair

  Conditions Ok

  Non Applicable

• Add media

  Media

• Does the Regulator and Warning Device function properly and clean?

  Needs Repair

  Conditions Ok

  Non Applicable

• Add media

  Media

Miscellaneous Information

• Has the user been properly trained?

  Yes

  No

  N/A

• Has the user been approved by a medical professional to use respirator? (Fit Tested)

  Yes

  No

  N/A

• Add signature

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