Title Page
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Company:
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Please state company name
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Location:
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Conducted on:
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Fit Tester:
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Please state name
Details
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Candidate's Name:
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Company:
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Please state company name
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Address:
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Mask Type:
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Make:
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Model:
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Size:
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Hazard:
- Dust
- Mist
- Fumes
- Gas
- Vapour
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Condition:
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PPE Worn:
- Safety Spectacles
- Goggles
- Hard Hat
- Ear Defenders
- Other
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Please state details:
Tests
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Sensitivity Level
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Exercise: Normal Breathing
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Exercise: Deeper Breathing
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Exercise: Turning Head Side to Side
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Exercise: Moving Head Up and Down
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Exercise: Talking
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Exercise: Leaning Forwards
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Exercise: Normal Breathing
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Break Seal Test
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If any of the exercises result in a fail, then the WHOLE of the Face Fit Test is a Fail
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Overall Result
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Was proper fit training provided?
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Please state what training will be given before the next test
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Face Seal:
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Assessor's Signature:
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Candidate's Signature:
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Expiry Date:
Comments
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Please add comments below if necessary
