Following are the forms that should be used when performing a qualitative fit test.
A. Qualitative Fit Test Record – Click here to view form.
1. Fill out the top half of the form.
2. Determine the number of squeezes to sensitivity (ie 10, 20 or 30).
3. Begin performing the fit test and fill in “Yes” or “No” for each exercise. If the subject detects the Bitter during any exercise, mark “Yes”, terminate test and mark overall results as a Failure.
4. If subject does not detect the Bitter
during each exercise, mark “No” and continue on to next exercise. If all of the exercises are completed without tasting the Bitter, mark overall results as a Pass.
5. The person performing the test should sign the form.
6. The employee should also sign the form once a Pass has been achieved and they have been fully instructed on the use of Moldex respirators.
B. RESPIRATORY FIT TEST CARD – Click here to view form.
1. Once an employee has passed the fit test and been assigned a certain respirator fill out the Respirator Fit Test Card and issue it to the employee.
2. The employee should retain this card as proof that they have been properly fit tested.
C. CERTIFICATE OF RESPIRATOR TRAINING – Click here to view form.
1. When an employee has been fit tested, trained and assigned a respirator, fill out the certificate completely with all of the appropriate information.
2. Have the employee sign the certificate.
3. Issue the certificate to the employee.
4. Keep a signed copy in the employee’s record or with the company’s Respiratory Program records.
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