Form-0061 - Respirator Maintenance Log. Employer's report of injury or occupational disease-2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering the user name and respirator make in the designated fields at the top of the form.
  3. Fill in the issue date, model, log begin date, and size options (S, M, M/L, L, Other) as applicable.
  4. Record the fit test date and manufacture date for accurate tracking.
  5. For each month listed, check the condition of various components such as facepiece integrity and inhalation valves. Mark '✓' for satisfactory or '' for unsatisfactory.
  6. Complete the monthly respirator cleaning record by noting any inspections and changes made to cartridges/filters.
  7. Ensure that a supervisor reviews and initials the monthly review section for compliance.

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