make me a respirator fit testing form for the actual testing

Respirator Fit Testing Form ===========================

This form is designed to document the practical execution of respirator fit testing, ensuring proper respiratory protection and compliance with safety regulations. It covers essential steps and observations during the fit test procedure, whether Qualitative Fit Testing (QLFT) or Quantitative Fit Testing (QNFT).

Employee Information

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Employee Details

Enter the employee's full name, employee ID, and job title.

Respirator Information

Record the respirator's make, model, size, and type (e.g., N95, half-face, full-face).

Medical Evaluation

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Medical Clearance

Confirm that the employee has been medically evaluated and cleared to wear a respirator. Note the date of the medical evaluation and any limitations.

The medical evaluation shall obtain the information requested by the questionnaire in Sections 1 and 2, Part A of Appendix C of this section. [2]

Respirator Selection

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Selection Process

The test subject shall be allowed to pick the most acceptable respirator from a sufficient number of respirator models and sizes so that the respirator is acceptable to, and correctly fits, the user. [3]

Record the models and sizes tried, and indicate the final selection.

Pre-Fit Test Check

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Facepiece Seal

Verify that the employee does not have any facial hair or other conditions that interfere with the face-to-facepiece seal or valve function.

The employer shall not permit respirators with tight-fitting facepieces to be worn by employees who have: Facial hair that comes between the sealing surface of the facepiece and the face or that interferes with valve function; or Any condition that interferes with the face-to-facepiece seal or valve function. [1]

Corrective Lenses/PPE

Ensure that corrective glasses or goggles or other personal protective equipment are worn in a manner that does not interfere with the seal of the facepiece to the face of the user. [1]

Fit Test Type

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Qualitative Fit Test (QLFT)

Note: QLFT may only be used to fit test negative pressure air-purifying respirators that must achieve a fit factor of 100 or less. [1]

Record the QLFT agent used (e.g., saccharin, Bitrex) and the employee's response during the test exercises.

Quantitative Fit Test (QNFT)

Record the QNFT equipment used (e.g. PortaCount) and the fit factor achieved.

If the fit factor, as determined through an OSHA-accepted QNFT protocol, is equal to or greater than 100 for tight-fitting half facepieces, or equal to or greater than 500 for tight-fitting full facepieces, the QNFT has been passed with that respirator. [1]

Fit Test Procedure

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General Requirements

Prior to the selection process, the test subject shall be shown how to put on a respirator, how it should be positioned on the face, how to set strap tension and how to determine an acceptable fit. A mirror shall be available to assist the subject in evaluating the fit and positioning of the respirator. This instruction may not constitute the subject's formal training on respirator use, because it is only a review. [3]

The test subject shall be informed that he/she is being asked to select the respirator that provides the most acceptable fit. Each respirator represents a different size and shape, and if fitted and used properly, will provide adequate protection. [3]

The test subject shall be instructed to hold each chosen facepiece up to the face and eliminate those that obviously do not give an acceptable fit. [3]

The more acceptable facepieces are noted in case the one selected proves unacceptable; the most comfortable mask is donned and worn at least five minutes to assess comfort. Assistance in assessing comfort can be given by discussing the points in the following item A.6\. If the test subject is not familiar with using a particular respirator, the test subject shall be directed to don the mask several times and to adjust the straps each time to become adept at setting proper tension on the straps. [3]

Assessment of comfort shall include a review of the following points with the test subject and allowing the test subject adequate time to determine the comfort of the respirator: Position of the mask on the nose Room for eye protection Room to talk Position of mask on face and cheeks [3]

The following criteria shall be used to help determine the adequacy of the respirator fit: Chin properly placed; Adequate strap tension, not overly tightened; Fit across nose bridge; Respirator of proper size to span distance from nose to chin; Tendency of respirator to slip; Self-observation in mirror to evaluate fit and respirator position. [3]

The test subject shall conduct a user seal check, either the negative and positive pressure seal checks described in appendix B-1 of this section or those recommended by the respirator manufacturer which provide equivalent protection to the procedures in appendix B-1\. Before conducting the negative and positive pressure checks, the subject shall be told to seat the mask on the face by moving the head from side-to-side and up and down slowly while taking in a few slow deep breaths. Another facepiece shall be selected and retested if the test subject fails the user seal check tests. [3]

The test shall not be conducted if there is any hair growth between the skin and the facepiece sealing surface, such as stubble beard growth, beard, mustache or sideburns which cross the respirator sealing surface. Any type of apparel which interferes with a satisfactory fit shall be altered or removed. [3]

If a test subject exhibits difficulty in breathing during the tests, she or he shall be referred to a physician or other licensed health care professional, as appropriate, to determine whether the test subject can wear a respirator while performing her or his duties. [3]

If the employee finds the fit of the respirator unacceptable, the test subject shall be given the opportunity to select a different respirator and to be retested. [3]

Prior to the commencement of the fit test, the test subject shall be given a description of the fit test and the test subject's responsibilities during the test procedure. The description of the process shall include a description of the test exercises that the subject will be performing. The respirator to be tested shall be worn for at least 5 minutes before the start of the fit test. [3]

The fit test shall be performed while the test subject is wearing any applicable safety equipment that may be worn during actual respirator use which could interfere with respirator fit. [3]

Test Exercises

Record the exercises performed during the fit test (e.g., reading, head movements, bending over, jogging in place) and any observations.

Fit Test Results

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Pass/Fail

Indicate whether the employee passed or failed the fit test. If the employee failed, document the reasons and any corrective actions taken.

Fit Test Record

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Documentation

Record the test subject's name; overall fit factor; make, model, style, and size of respirator used; and date tested. [4]

Include the date of the test, the name of the person who conducted the test, and the results.

Retesting

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Annual Retesting

The employer shall ensure that an employee using a tight-fitting facepiece respirator is fit tested prior to initial use of the respirator, whenever a different respirator facepiece (size, style, model or make) is used, and at least annually thereafter. [1]

Additional Fit Testing

The employer shall conduct an additional fit test whenever the employee reports, or the employer, PLHCP, supervisor, or program administrator makes visual observations of, changes in the employee's physical condition that could affect respirator fit. Such conditions include, but are not limited to, facial scarring, dental changes, cosmetic surgery, or an obvious change in body weight. [1]

If after passing a QLFT or QNFT, the employee subsequently notifies the employer, program administrator, supervisor, or PLHCP that the fit of the respirator is unacceptable, the employee shall be given a reasonable opportunity to select a different respirator facepiece and to be retested. [1]

Recordkeeping

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Maintain records of all fit tests, including the date of the test, the name of the employee, the type of respirator, and the results of the test.

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