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Respiratory Protection Checklist

III. FIT TESTING OF RESPIRATORY PROTECTION DEVICES

1. Are employees fit-tested? All / *Some / *None
(document when and how often)

2. Are employees quantitatively fit-tested? All / *Some / *None
(attach protocol)

3. Are employees qualitatively fit-tested? All / *Some / *None
(attach protocol)

4. Who performs the respirator fit-testing?
__________________________________________

5. Are employees trained to perform a fit check with the respirator All / *Some / *None
before each use? (Explain employee user seal check procedure)
___________________________________________

IV. STORAGE, REUSE AND DISPOSAL

1. Are respirators reused? All / *Some / *None

2. If respirators are reused are there procedures in place for:

Cleaning/disinfecting:___________________________ Y / N
____________________________________________
Storage:______________________________________ Y / N
____________________________________________
Reuse:_______________________________________ Y / N
____________________________________________
Disposal:_____________________________________ Y / N
____________________________________________

3. Is there a procedure for obtaining new respirators? Y / N

4. If respirators are not reused, are there procedures for disposal? Y / N

V. RESPIRATORY PROGRAM

1. Is there a written respiratory protection program? Y / N
(attach copy of written program)

* Clarify “some” and “none” responses by number on the back of this page.

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