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face fit test certificate template

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N95 Respirator Training and Fit Testing Verification Facility: Date: Employee: Has successfully passed a qualitative/quantitative fit test and completed training in the appropriate use, limitations
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this program will provide instructions on how to perform qualitative fit testing for half face filtering facepiece respirators such as 3m healthcare particulate respirators and surgical masks please note the qualitative fit testing instructions for the 3m 1870 respirator and surgical masks are the same or other 3m particulate respirators there are two types of fit test solutions for qualitative fit testing available from 3m a suite solution as found in the 3m ft 10 fit test kit and a bitter solution as found in the 3m ft 30 fit test kit either of these solutions can be used however certain employees may be more sensitive to one solution over the other during this training we will be using the suite solution the procedure is the same for the bitter solution both the 3m ft 10 sweet and ft 30 bitter qualitative fit test apparatus meet the performance criteria for fit testing respirators under the current OSHA standard for respiratory protection 29 CFR 19 101 3 4 if crystals are present within the container of test solution hold closed bottle under a warm stream of water or shake vigorously to dissolve the material if there is evidence of solution contamination immediately discard the bottle OSHA requires that a medical evaluation be conducted prior to fit testing a fit test should only be conducted if there is no hair growth apparel jewelry or any other condition or object that may compromise the fit or prevent contact of the respirator with the skin subject should be informed of the ingredients of the fit test solution and that they will be exposed to a fine mist to prepare the qualitative fit test apparatus attach the hood to the collar by placing the drawstring between the flanges on the collar tighten the drawstrings and tie it with a square knot or bow pour approximately 1 teaspoonful or 5 milliliters of the sensitivity solution into the nebulizer labeled sensitivity test solution for the same amount of fit test solution into the second nebulizer labeled fit test solution immediately recap the bottles a sensitivity test is conducted before the fit test to determine if the healthcare worker being tested can detect the test aerosol at very low levels the sensitivity test solution is a very dilute version of the fit test solution the subject must avoid eating smoking drinking or chewing gum for at least 15 minutes before the test and during the test at all times this does not include water to conduct the sensitivity test instruct the test subject to place the hood and collar assembly over their head without a respirator position the hood assembly forward so there is about 6 inches or 15 centimeters between the subjects face and the hood window instruct the test subject to breathe normally through their mouth with their tongue slightly extended both plugs on the nebulizer must be removed during use the nebulizer must be held in an upright position to ensure aerosol generation using the first nebulizer with the sensitivity solution inject the...