Information
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Client / Site
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Conducted on
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Prepared by
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Name of person being face fit tested
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Company
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Face-piece used
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Add media
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Make/Model of face-piece used
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Exercises performed during the test
- Normal breathing
- Deep breathing
- Turning head side to side
- Moving head up and down
- Talking
- Bending over
- Normal breathing
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Sweet or bitter test?
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Condition of face-piece (If it is wearers own)
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Was assistance required donning and fit che checking the face piece before the test?
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Final result of test
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Was a re-test required?
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Signature of person being fit tested
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Signature of person carrying out the fit test
