Template

Respirator Fit Test Checklist

by George Hyatt, from the Community

Use this respirator fit test checklist to document qualitative fit testing for tight-fitting masks such as N95s and half-face respirators. Capture mask make, model, and size, conduct a sensitivity test, and record exercise results including normal and deep breathing, head movements, talking, bending, and repeat tests if required. Note assistance provided to the wearer, training needs, and assessor name, signature, date, and time. Suitable for healthcare infection control and occupational safety across construction, manufacturing, and other workplaces requiring respiratory protection.

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With SafetyCulture you can

Digitize any process, procedure or policy

Eliminate mistakes made by paper-based processes

Create and share professional reports instantly

Confirm accountability and compliance with a digital log

About author

Community

This community page makes available free workplace checklists and templates created by other users within the SafetyCulture community. SafetyCulture has re-published this content and where possible, has credited the original author. SafetyCulture has not verified the accuracy, reliability or suitability of any community content. You agree that your use of any of this content is in accordance with SafetyCulture’s Terms and Conditions.

Template
Face Fit Certificate
This Face Fit Certificate template helps you document and certify respirator fit tests. Record mask details (type, make, model, size, condition), company and site, wearer and assessor names, sensitivity score, retest frequency, test date, and test exercises including normal and deep breathing, head movements, talking, bending, and final normal breathing. Capture number of repeat tests, assistance required, overall result, and obtain wearer and tester signatures for compliance records.
by Phillip Sparks, from the Community
Downloads: 0
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Template
Face Fit Testing Record Template
This Face Fit Testing Record template helps teams document respirator fit tests for workers. Record site details, test date, make and model of the mask, and mask condition. Log the type of fit test performed and the required exercises, including normal and deep breathing, turning and tilting the head, talking, bending, and final normal breathing. Capture whether assistance was required to place the mask, test results, and any need for re-testing. Include names, company details, and signatures of the person tested and the advisor. Designed to support respiratory protection programs and compliance requirements across high-risk environments.
by Scott Bundy, from the Community
Downloads: 30+
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Template
Respiratory Fit Test (QLFT) Form
This ready-to-use Respiratory Fit Test (QLFT) form helps teams conduct and document qualitative respirator fit testing. Capture employee details, respirator make and model, testing media, and perform positive and negative pressure checks. Follow step-by-step exercises such as normal and deep breathing, head movements, talking, and bending over. Record pass or fail results and obtain the tester’s certification and signature. Use this checklist to support PPE compliance and annual fit testing requirements across workplaces.
by Patrick OSullivan, from the Community
Downloads: 30+
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Template
Qualitative Face Fit Test Certificate
Use this qualitative face fit test certificate to document RPE fit testing for workers. Record wearer details, make and model, size and ID, test method and sensitivity, eyewear use, facial hair, and repeat tests. Capture results for normal and deep breathing, head movements, talking, bending, final seal check, and overall result. Include tester name, test date, expiry, and comments. Keep records for at least five years and retest when equipment or facial features change to meet HSE guidance.
by Dean Crowe, from the Community
Downloads: 30+
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Respirator Fit Test Checklist

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Face Fit Certificate

Face Fit Testing Record Template

Respiratory Fit Test (QLFT) Form

Qualitative Face Fit Test Certificate

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Face Fit Certificate

Face Fit Testing Record Template

Respiratory Fit Test (QLFT) Form

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