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Employee Name
Specify the date when the fit test will expire, indicating the need for a retest.
Specify the date when you (the employee) will receive retraining on fit testing.
Employee Acknowledgment
Clear Signature

At WPForms, we understand the importance of maintaining a safe and healthy work environment. That’s why we offer a customizable Respirator Fit Test Form template to ensure the proper use of respiratory protection equipment.

The Respirator Fit Test Form is designed to gather all the necessary details for accurate fit tests. With a few simple steps, you can streamline the fit test process and enhance workplace safety.

Using the Respirator Fit Test Form Template

The first section of the form focuses on employee information, including their full name, employee ID, department/job title, date of birth, gender, phone number, and email address. These details help ensure accurate record-keeping and effective communication throughout the fit test process.

After that, we move on to the respirator information section, which allows employees to specify the respirator model and size being tested. Additionally, they can enter the date of the fit test, the fit test method employed, the fit test administrator’s name, and the fit test equipment used.

Following this section is a fit test result section that enables employees to record whether they passed or failed the fit test. One can also include the fit factor obtained during the test, the fit test expiration date, and the date for fit test retraining.

For any additional notes or comments related to the fit test, there is a designated section to capture specific observations or relevant information. This allows for comprehensive documentation and communication regarding the fit test process.

Finally, the employee acknowledgment section includes a statement of understanding and acknowledgment that the employee agrees to the fit test procedure and outcome. The employee can provide their signature and the date of signature, signifying their commitment to workplace safety.

Please note that this form template does not constitute an entirely written and usable respirator fit test form. It serves as an illustrative example only. It is essential to consult with legal and occupational health professionals to develop a comprehensive and legally compliant form tailored to your specific needs.