Transcription of RESPIRATOR FIT TEST RECORD
1 Company: RESPIRATOR FIT TEST RECORD Address: City: State:_____Zip:_____Tel: Date:_____. Name of Fit Tester: 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: Signature: _____. Type of OSHA accepted fit test protocol used: (Qualitative): ___Saccharin ___BitrexTM ___Isoamyl Acetate ___Irritant Smoke (Quantitative): Portacount Model #_____ Occupational Health Dynamic Model #:_____. Name RESPIRATOR Fit Tested Fit Test Could not be Signature (please print) (Make, Model, Style, Size) Pass Fail fit tested due to: Comments.
