APPENDIX “15” SIGN DESIGN &FABRICATION, INC. QUALITATIVE RESPIRATOR FIT TEST WORKSHEET
Clean Shaven? __Yes __No Spectacle Kit? ___Yes ___No Manufacturer/Model _____________________________ Size: ___S ___M ___L Irritant Smoke ___Pass ___Fail Isoamyl Acetate ___Pass ___Fail Manufacturer/Model______________________________ Size: ___S___M___L Irritant Smoke ___Pass ___Fail Isoamyl Acetate ___Pass ___Fail
Examiner ___________________________________ Date __________________
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