N95 fit test form pdf 2025

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The NOAA Form 57-17-03 is a record for conducting qualitative fit tests for respirators, detailing the procedures and requirements for ensuring proper fit and comfort of respiratory protective devices. It includes sections for test subject information, pre-test procedures, fit test exercises, results verification, and a disclaimer regarding the limitations of the test. The form aims to ensure that respirators provide adequate protection by confirming a tight seal on the user's face.

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How to make sure an N95 mask fits properly?

Make certain respirator is completely opened and edges lay flat against your face. Adjust by pulling bottom edge under chin while holding top edge on nose. Place your fingertips from both hands at the top of the nosepiece. Use both hands to bend the nosepiece to fit snugly against your nose and face.

Do N95 masks require a fit test?

Yes. The Occupational Safety and Health Administration (OSHA) (29 CFR 1910.134) requires respirator users to be fit tested to confirm the fit of any respirator that forms a tight seal on your face before using it in the workplace.

What is the pass level for the fit test for n95?

Fit factor is calculated by the PortaCount machine by dividing the concentration of particles in ambient air outside the respirator by that inside the respirator; 21 an overall fit factor exceeding 100 was deemed a pass.

How to perform the fit test?

Unfold and place the flushable collection paper on top of the water in your toilet. Using probe, scrape and collect stool sample making sure to cover the grooved portion completely. Deposit a stool sample (poop) on top of the collection paper. After inserting the probe into the tube, snap the green cap tightly.

How much does a N95 fit test cost?

How much does a respirator fit test cost? Typical charges for a fit test range from $30-50.

respirator fit test form pdf

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How to verify an N95 mask?

The easiest way to tell if your N95 is NIOSH approved is to search for it on the NIOSH Certified Equipment List (CEL). All NIOSH- approved respirators have a testing and certification (TC) approval number (e.g., TC 84A-X), which must be printed on the respirator.

How to check if an N95 mask fits well?

The respirator should draw in and slightly collapse towards the face. Leakage will result in loss of negative pressure in the respirator due to air entering through gaps in the seal. If leakage, adjust the position and/ or straps and repeat seal check. Continue to fit PPE in the recommended order.

N95 fit test form pdf 2025

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How to make sure an N95 mask fits properly?

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