ࡱ> ,/+y R bjbj <{{D (((8`t(".ccc$PccccccjcF0"ccccccc+ccc"ccccccccccccc :  Sample Respirator Fit Test and Training Record Date: ____________ Number of Squeezes (circle one):10 20 30 Respirator Users Name/ phone: ____________________________________________ Job Title/ Department: ____________________________________________________ Supervisors Name/ phone: ________________________________________________ Description of Inhalation Hazard: ___________________________________________ Fit Test Type of Respirator Selected: _______________________________________________ Manufacturer of Respirator: _______________________________________________ Size and Model of Respirator Selected: _______________________________________ Qualitative Protocol Used: ____ Isoamyl Acetate Pass _____ Fail _____ ____ Saccharin Pass _____ Fail _____ ____ Bitrex Pass _____ Fail _____ ____ Irritant smoke Pass _____ Fail _____ Training Limitations _____ Storage _____ Donning _____ Filter/Cartridge Changing _____ Adjustment _____ Eye Protection _____ Fit Check _____ Facepiece to Face Issues _____ Maintenance _____ Odor Threshold _____ Date Training Completed: _____ Date Fit Test Completed: _____ Employee Signature: ________________________________________________ Fit Tester Signature: ________________________________________________     )0CPi{  ) , I J R V Z [ d e  # H P o p / 3 T  ͺͬͨͨͨͤͤͤͤͰhsrh9qhfh?oh?o5>* h?o5>*hjhschJ2h?ohTh)hhc9 h0[5>*h0[h?o5>* h(xN5>* h5>*@01/ 0 { | " # p q  / T gdc9^gdJ2$a$gd0[gd  G u v D F G I J L M O P Q R   D E G H J K M N Q R h{kyjh{kyUhsrh?oh9q :P&P1h:pJ2/ =!"#$% ^ 02 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~_HmH nH sH tH @`@ NormalCJ_HaJmH sH tH DA D Default Paragraph FontRiR  Table Normal4 l4a (k (No List 44 |0Header  !4 4 |Footer  !6o6 0 Header CharCJaJH@"H  Balloon TextCJOJQJ^JaJNo1N Balloon Text CharCJOJQJ^JaJPK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭V$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! I_TS 1?E??ZBΪmU/?~xY'y5g&΋/ɋ>GMGeD3Vq%'#q$8K)fw9:ĵ x}rxwr:\TZaG*y8IjbRc|XŻǿI u3KGnD1NIBs RuK>V.EL+M2#'fi ~V vl{u8zH *:(W☕ ~JTe\O*tHGHY}KNP*ݾ˦TѼ9/#A7qZ$*c?qUnwN%Oi4 =3N)cbJ uV4(Tn 7_?m-ٛ{UBwznʜ"Z xJZp; {/<P;,)''KQk5qpN8KGbe Sd̛\17 pa>SR! 3K4'+rzQ TTIIvt]Kc⫲K#v5+|D~O@%\w_nN[L9KqgVhn R!y+Un;*&/HrT >>\ t=.Tġ S; Z~!P9giCڧ!# B,;X=ۻ,I2UWV9$lk=Aj;{AP79|s*Y;̠[MCۿhf]o{oY=1kyVV5E8Vk+֜\80X4D)!!?*|fv u"xA@T_q64)kڬuV7 t '%;i9s9x,ڎ-45xd8?ǘd/Y|t &LILJ`& -Gt/PK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 0_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!0C)theme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK] R  R   R  8@0(  B S  ?4:'0DFGIJLMOSDFGIJLMOS3001IJRVZ[#o /34SCDDFGGIJLMOS00C /3SCDDFGGIJLMOS)(scTSn(/(/L/J2&6_9c97A3D(xNZ0[=grbhsru{kykzLx)9qP|1tqgjf?o@c8F;boJDF@R@UnknownG*Ax Times New Roman5Symbol3. *Cx Arial5. .[`)TahomaA$BCambria Math"qh!^+' { { !24BB3HX ??o2!xx .Sample Respirator Fit Test and Training RecordECS Bracker, AnneOh+'0 , L X d p|0Sample Respirator Fit Test and Training RecordECS Normal.dotmBracker, Anne12Microsoft Office Word@d@@1\X@{՜.+,0 hp  UCHC B /Sample Respirator Fit Test and Training Record Title  !"$%&'()*-.1Root Entry F01Table WordDocument <SummaryInformation(DocumentSummaryInformation8#MsoDataStore YLLG5QES0LFE14Q==2 Item PropertiesUCompObj r   F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q