Title Page
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
Disposable Respirators
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Are the filters free of any holes and/or any other damage?
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Are the straps in working order and do they display elasticity when stretched out?
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Is the nose clip damaged or deteriorated?
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Air Purifying Respirators
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Is the face piece clean and free of cracks, tears, or holes.
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Are the straps clean and free of breaks, tears, loss of elasticity or damaged attachments.
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Are the valves clean and free of holes, warn page, cracks and dirt.
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Are the filter cartridges and canisters clean and free of dents and corrosion.
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Is this the proper protection type?
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Has the filter exceeded its expiration date?
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Atmosphere - Supplying Respirators
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Is the Hood/Helmet/Blouse/Suit clean and free of any cracks, tears, worn seams, and abrasions?
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Is the Face shield clean and free of cracks, breaks, abrasions or distortions?
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Are the Air Supply Hoses free of breaks or kinks?
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Are the Air Supply regulators/valves in good condition?
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Does the Breathing Air meet the breathable air standard?
Self-Contained Breathing Apparatus
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Are the Cylinder/Harness/Straps and Buckles clean and in good condition?
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Does the Regulator and Warning Device function properly and clean?
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Miscellaneous Information
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Has the user been properly trained?
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Has the user been approved by a medical professional to use respirator? (Fit Tested)
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