Template

Respiratory Fit Test (QLFT) Form

by Patrick OSullivan, from the Community

30+

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.

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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
Respirator Fit Test Report
This respirator fit test report template helps supervisors and safety officers record key details for qualitative or quantitative fit testing. Capture employee and tester names, respirator make, model and size, fit test kit used, test method, pass or fail results, retest requirements, dates, and signatures. Use it to standardize respiratory protection documentation, demonstrate PPE compliance, and maintain records across worksites in construction and other high-risk industries.
by Lee Wheatley, from the Community
Downloads: 30+
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Template
Respirator Fit Test Checklist
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.
by George Hyatt, from the Community
Downloads: 0
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Template
Respirator Face Fit Testing Checklist
Use this respirator face fit testing checklist to document essential information during qualitative or quantitative fit tests. Capture the users name, site, date conducted, tester details, respirator make and model, filter type, test results, and any comments. Include signatures from the tester and user to validate completion and support regulatory compliance. This template helps standardize PPE fit testing records across teams and improves safety documentation.
by Eddie Harris, from the Community
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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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Respiratory Fit Test (QLFT) Form

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