Transcription of 3M Respirator Fit Test Form
1 Date:_____Fit testing conducted in compliance with OSHA Standard (F). If other local, state or federal regulations apply (such as MSHA), you may list them here:_____Company:Address:City:State:___ __Zip:_____Tel:Name of Fit Tester:Signature:Type of OSHA accepted fit test protocol used: (Qualitative): ___Saccharin ___BitrexTM ___Isoamyl Acetate ___Irritant Smoke (Quantitative): Portacount Model #_____ Occupational Health Dynamic Model #:_____Name(please print)SignatureRespirator Fit Tested (Make, Model, Style, Size)Fit TestPass FailCould not be fit tested due to:Comments: Respirator FIT TEST RECORD
