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Respiratory Protection Program





The purpose of this program is to outline the minimum acceptable requirements for the use of respiratory protection by Central Community College (CCC) personnel.  The program delineates responsibilities, establishes respirator selection criteria and defines fit testing and training requirements.  The goal of the program is to provide appropriate respiratory protection to CCC personnel in a manner consistent with regulatory requirements mandated by OSHA 29CFR 1910.134 and accepted professional practice.



This document serves as a Standard Operating Procedure (SOP) for faculty and staff who are required to wear a respirator during work assignments.  The college shall take prudent measures to implement engineering or work practice controls to eliminate hazardous conditions.  Where such controls are inadequate or prove ineffective, respiratory protection may be required.  These guidelines permit some exemptions from requirements for respirators worn on a voluntary basis.  These exemptions are subject to the discretion of college administration.


Scope and Application



This program applies to all employees who are required to wear respirators during normal work operations and during some non-routine or emergency operations.  This includes designated employees in the following departments:


Facilities Management Services:


  1. Painters-spray painting operations and varnish refinishing
  2. Pesticide or herbicide application
  3. Boiler Cleaning and Maintenance


 Autobody Technology:

 Painting and refinishing




 Spray painting operations and varnish refinishing



Pesticide or herbicide application



Emergency Response:

Physical, Biological or Health Science Faculty for chemical release or biological exposure.



CCC will provide appropriate respiratory protection when it is necessary to protect the health and well being of an employee.  Any respirator usage by employees, either required or voluntary (for comfort purposes), shall be pre-approved by the appropriate Dean, Director or Department Chairperson.



In addition, some employees may desire to wear respirators during certain tasks that do not require respiratory protection.  As a general policy, CCC prohibits voluntary use of respirators with tight fitting facepieces.  Where voluntary use is deemed appropriate, the college will provide filtering facepiece respirators (dust masks).  Voluntary respirator use is subject to certain requirements of this program.








Deans, Directors, and Department Chairpersons have overall responsibility for implementation of the Respiratory Protection Program within their departments and must ensure the program is understood and followed by the employees under their charge. Duties include:


  • Identify work areas, processes or tasks that require workers to wear respirators and evaluate hazards.
  • Ensure that employees (including new hires) have received appropriate training, fit testing, and medical evaluations.
  • Ensure the availability of appropriate respirators and accessories.
  • Ensuring proper cleaning, storage and maintenance of respiratory equipment.
  • Maintain records required by the program and forward copies of these records to Human Resources for inclusion in the employee’s permanent file.
  • Enforce the proper use of respiratory protection, when necessary. 




Each employee is responsible to wear the respirator in the manner in which they were        trained.  Employees must also:


  • Comply with all provisions of this program.
  • Use only respirators issued or approved by CCC in accordance with the training and fit testing received.
  • Wear respirators as required for designated tasks or in specified locations.
  •  Properly use, inspect, care for and maintain respirators as instructed and store them in a clean sanitary location.
  •  Report potential exposures or respirator problems to supervisors.
  • Be clean-shaven in the area between the sealing surface of the respirator and the face.  (Facial hair must not interfere with operation of inhalation and exhalation valves.)
  • Inform their supervisor or college administration of any respiratory hazards that are not adequately addressed in the workplace or any other concerns regarding the program.


Selection and Use of Respirators



All respirators must be certified by the National Institute for Occupational Safety and Health (NIOSH) and shall only be used in accordance with the terms of that certification.  Also, all filters, cartridges and canisters must be labeled with the appropriate NIOSH approval label.  The label must not be removed or defaced while it is in use.



Based on the hazards to which workers are exposed and in accordance with OSHA standards, CCC will conduct a hazard evaluation for each operation, process or work area where airborne contaminants may be present in routine operations or during an emergency.



The selection of respirators depends upon the concentration of airborne contaminants likely to be encountered and the NIOSH protection factor assigned to each type of respirator as shown below:





  • Filtering Face Piece Dust Mask - 10x TLV or PEL
  • Half-Mask, Air-Purifying Respirator - TLV or PEL
  • Loose-Fitting PAPR’s or Air-line Hoods or Helmets - 25x TLV or PEL
  • Full-Face (FF), Air-Purifying -  50x TLV or PEL
  • FF, Powered Air-Purifying with H-filter - 50x TLV or PEL
  • FF, Continuous Flow or Demand - 50x TLV or PEL
  • FF Supplied Air, Pressure Demand Mode - 2,000 TLV or PEL
  • Self Contained Breathing Apparatus (SCBA) or FF Air-line Mask with SCBA in Pressure Demand Mode - 10,000 TLV or PEL


Respirators meeting the above minimum protection factor requirements shall be used whenever the Threshold Limit Value (TLV) is exceeded.  Respirators with higher levels of protection may always be used if desired.


Voluntary Respirator Use:



Disposable N95 or disposable respirators are the only voluntary use respirators permitted by CCC.  Respirators not issued by the college are not permitted for use.



Departmental supervisors shall provide all employees who voluntarily choose to wear respirators with a copy of Appendix D of 29 CFR 1910.134 of the respiratory protection standard.  (Appendix D details the requirements of voluntary use of respirators by employees and is included as Appendix D of this document.)



Limitations of Respirators


  1. Air-purifying and Powered Air-Purifying Respirators (PAPR) shall only be used in atmospheres that are not oxygen-deficient, not Immediately Dangerous to Life or Health (IDLH), or in atmospheres that do not exceed the protection factors listed above.
  2. Cartridge or canister respirators for gases and vapors may only be used when the airborne hazard has a physical warning, such as odor or if the cartridge has a color “end of service life indicator” (ESLI) which demonstrates chemical saturation.  A “Respirator Change Schedule” shall be established for each type of gas or vapor cartridge or canister used based on the concentration of air contaminants present, the temperature and humidity in the work area and the exertion level of employees.  Contact Environmental Health & Safety (EH&S) for help in determining respirator service life.
  3. Airline respirators shall be used only with CCC administration approval.  If used in atmospheres that are IDLH, they must be fitted with an escape bottle.  IDLH work must be done only under written approval of CCC administration.
  4. SCBAs shall be worn for all entry into IDLH atmospheres.  Entry shall be restricted for emergency rescue only by trained and qualified personnel.  Efforts must be made to clear the confined space to eliminate IDLH atmospheres prior to entry.
  5. For supplied air respirators, compressed air must meet the requirements for Grade D breathing air.  All breathing air cylinders must be tested and maintained according to DOT 49 CFR Part 173 and 178.


Compressors that are used for supplied air must be constructed and situated to prevent contaminated air from getting into the system.  Compressors must be equipped with in-line air-purifying sorbent beds and/or filters that are maintained or replaced following the manufacturer’s instructions and are tagged with information on the most recent change date and authorizing signature.  If the compressor is oil-lubricated it must have a high temperature and/or carbon monoxide alarm.


Medical Surveillance



Medical evaluation and approval is required prior to issuance of respirators.  No employee will be assigned to a task that requires the use of a respirator, unless it has been determined that the person is physically able to perform under such conditions. In addition, once a determination is made as to physical ability to wear a respirator and perform the work task, a review of the employee’s health status will be made on an annual basis. A copy of Appendix A will be provided to be filled out by the physician who makes the initial determination and subsequent review.


Fit Testing



Fit testing is required for all CCC employees who are required to wear tight-fitting Air Purifying Respirators (APRs), Powered Air Purifying Respirators (PAPRs) and Supplied Air Respirators (SARs).  Employees will be fit tested with the make, model, and size of respirator that they will actually wear.  Employees will be provided with several models and sizes of respirators so that they may find an optimal fit.


Fit Testing Frequency


Employees shall be fit tested:


  • Prior to being allowed to wear any respirator with a tight-fitting facepiece.
  • Annually.
  • When there are changes in the employee’s physical condition that could affect respirator fit (e.g., obvious change in body weight, facial scarring, etc.).

Fit testing shall be conducted following OSHA approved methods as described in 29CFR 1910.134 Appendix A.


Maintenance and Care of Respirators


1. Cleaning and Disinfection



Respirators will be regularly cleaned and disinfected.  Those issued for the exclusive use of one person will be cleaned after each days use, or more often if necessary.  Those used by more than one employee will be thoroughly cleaned and disinfected after each use.  The supervising department shall ensure that respirators are cleaned and disinfected according to the guidelines in Appendix B.



2. Storage


Each respirator will be stored in a convenient, clean, and sanitary location.  These locations should protect the respirator from dust, sunlight, heat, extreme cold, excessive moisture or damaging chemicals that could accelerate deterioration.  Storage should be in a plastic bag within a rigid container or suitable container with a resealable lid.



3. Inspection


Where practicable, the respirators will be assigned to individuals for their exclusive use.  These employees will inspect their respirators before each use and during cleaning.  Worn or deteriorated parts will be replaced immediately.  Respirators for emergency use will be inspected at least once a month and after each use.  Inspection guidelines are shown in Appendix C.



Filter Cartridge Change Schedule


Air-purifying respirators use various types of filtration systems to remove air contaminants prior to inhalation. 


These systems range from cartridges and canisters that remove complex mixtures of chemicals to ones, which remove dust and smoke particles. These types of cartridges and canisters may endure multiple uses; however employees need to know just how long they may be used under a wide variety of circumstances. 


To ensure that these cartridges are changed before they are spent a change out schedule or end of service life indicator (ESLI) is necessary. NIOSH approved ESLI cartridges shall be used whenever possible.  ESLI cartridges change color when it is time to replace the cartridge.  If there is no ESLI cartridge available for the contaminants identified in the work area, the employee must follow the manufacturer’s recommendations regarding the change out schedule. 


Documentation of the manufacturer’s recommendations and change out schedule must be completed on the form in Appendix F.





All respirator users and their supervisors will be trained on the contents of the CCC’s Respiratory Protection Program, their responsibilities under it, and on the OSHA Respiratory Protection standard. Training must be conducted prior to the employee’s use of a respirator in the workplace. Training will cover the following topics:

    •  CCC’s Respiratory Protection Program
    • OSHA Respiratory Protection standard
    • Respiratory hazards encountered at CCC and their health effects
    • Proper selection and use of respirators
    • Limitations of respirators
    • Donning and user seal (fit) checks
    • Fit testing
    • Maintenance and storage
    • Medical signs and symptoms limiting the effective use of respirators


Documentation and Recordkeeping




The Human Resources (HR) department maintains copies of training and fit test records.  These records will be updated as new employees are trained, as existing employees receive refresher training and as new fit tests are conducted.


The HR department will also maintain copies of the medical clearance records for all employees covered under the respiratory protection program.  The completed medical questionnaire and documented findings are confidential and will remain with the appropriate medical practitioner.  HR will only retain written recommendation regarding each employee’s ability to wear a respirator.





Central Community College


Medical Questionnaire for Respirator Users



To the employee: Can you read (circle one): Yes/No



Your employer must allow you to answer this questionnaire during normal working hours, or at a time and place that is convenient to you. To maintain your confidentiality, your employer or supervisor must not look at or review your answers, and your employer must tell you how to deliver or send this questionnaire to the health care professional who will review it.


Part A. Section 1. (Mandatory) The following information must be provided by every employee who has been selected to use any type of respirator (please print).


Today’s Date:___________   


Name:____________________________________ Employee ID:________________________


Supervisor:________________________________ Job title:_____________________________


Age: _________       Height:__________      Weight:________      Sex (circle one):Male/Female


A phone number where you can be reached by the health care professional who reviews this questionnaire: _________________best time to reach you at this number___________________


Has your employer told you how to contact the health care professional who will review this questionnaire (circle one): Yes/No


Have you ever worn a respirator before (circle one): Yes/No


If "yes," what type(s):____________________________________________________________


Please describe any apparent difficulties noted with respirator use:  (If additional space is needed, please attach a separate sheet of paper ____________________________________________________________________________________________________________




Part A. Section 2. (Mandatory) Questions 1 through 9 below must be answered by every employee who has been selected to use any type of respirator (please circle "yes" or "no").


1. Do you currently smoke tobacco, or have you smoked tobacco in the last month: Yes/No


2. Have you ever had any of the following conditions?


  1. Seizures (fits): Yes/No
  2. Diabetes (sugar disease): Yes/No
  3. Allergic reactions that interfere with your breathing: Yes/No
  4. Claustrophobia (fear of closed-in places): Yes/No
  5. Trouble smelling odors: Yes/No


3. Have you ever had any of the following pulmonary or lung problems?


  1. Asbestosis: Yes/No
  2. Asthma: Yes/No
  3. Chronic bronchitis: Yes/No
  4. Emphysema: Yes/No
  5. Pneumonia: Yes/No
  6. Tuberculosis: Yes/No
  7. Silicosis: Yes/No
  8. Pneumothorax (collapsed lung): Yes/No
  9. Lung cancer: Yes/No
  10. Broken ribs: Yes/No
  11. Any chest injuries or surgeries: Yes/No
  12. Any other lung problem that you've been told about: Yes/No


4. Do you currently have any of the following symptoms of pulmonary or lung illness?


  1. Shortness of breath: Yes/No
  2. Shortness of breath when walking fast on level ground or walking up a slight hill or incline: Yes/No
  3. Shortness of breath when walking with other people at an ordinary pace on level ground: Yes/No
  4. Have to stop for breath when walking at your own pace on level ground: Yes/No
  5. Shortness of breath when washing or dressing yourself: Yes/No
  6. Shortness of breath that interferes with your job: Yes/No
  7. Coughing that produces phlegm (thick sputum): Yes/No
  8. Coughing that wakes you early in the morning: Yes/No
  9. Coughing that occurs mostly when you are lying down: Yes/No
  10. Coughing up blood in the last month: Yes/No
  11. Wheezing: Yes/No
  12. Wheezing that interferes with your job: Yes/No


m.  Chest pain when you breathe deeply: Yes/No


  1. Any other symptoms that you think may be related to lung problems: Yes/No


5. Have you ever had any of the following cardiovascular or heart problems?


  1. Heart attack: Yes/No
  2. Stroke: Yes/No
  3. Angina: Yes/No
  4. Heart failure: Yes/No
  5. Swelling in your legs or feet (not caused by walking): Yes/No
  6. Heart arrhythmia (heart beating irregularly): Yes/No
  7. High blood pressure: Yes/No
  8. Any other heart problem that you've been told about: Yes/No


6. Have you ever had any of the following cardiovascular or heart symptoms?


  1. Frequent pain or tightness in your chest: Yes/No
  2. Pain or tightness in your chest during physical activity: Yes/No
  3. Pain or tightness in your chest that interferes with your job: Yes/No
  4. In the past two years, have you noticed your heart skipping or missing a beat: Yes/No
  5. Heartburn or indigestion that is not related to eating: Yes/ No
  6. Any other symptoms that you think may be related to heart or circulation problems: Yes/No


7. Do you currently take medication for any of the following problems?


  1. Breathing or lung problems: Yes/No
  2. Heart trouble: Yes/No
  3. Blood pressure: Yes/No
  4. Seizures (fits): Yes/No


8. If you've used a respirator, have you ever had any of the following problems? (If you've never used a respirator, check the following space and go to question 9:)


  1. Eye irritation: Yes/No
  2. Skin allergies or rashes: Yes/No
  3. Anxiety: Yes/No
  4. General weakness or fatigue: Yes/No
  5. Any other problem that interferes with your use of a respirator: Yes/No


9. Would you like to talk to the health care professional who will review this questionnaire about your answers to this questionnaire: Yes/No


Questions 10 to 15 below must be answered by every employee who has been selected to use either a full-facepiece respirator or a self-contained breathing apparatus (SCBA). For employees who have been selected to use other types of respirators, answering these questions is voluntary.


10. Have you ever lost vision in either eye (temporarily or permanently): Yes/No


11. Do you currently have any of the following vision problems?


  1. Wear contact lenses: Yes/No
  2. Wear glasses: Yes/No
  3. Color blind: Yes/No
  4. Any other eye or vision problem: Yes/No


12. Have you ever had an injury to your ears, including a broken ear drum: Yes/No


13. Do you currently have any of the following hearing problems?


  1. Difficulty hearing: Yes/No
  2. Wear a hearing aid: Yes/No
  3. Any other hearing or ear problem: Yes/No


14. Have you ever had a back injury: Yes/No


15. Do you currently have any of the following musculoskeletal problems?


  1. Weakness in any of your arms, hands, legs, or feet: Yes/No
  2. Back pain: Yes/No
  3. Difficulty fully moving your arms and legs: Yes/No
  4. Pain or stiffness when you lean forward or backward at the waist: Yes/No
  5. Difficulty fully moving your head up or down: Yes/No
  6. Difficulty fully moving your head side to side: Yes/No
  7. Difficulty bending at your knees: Yes/No
  8. Difficulty squatting to the ground: Yes/No
  9. Climbing a flight of stairs or a ladder carrying more than 25 lbs: Yes/No
  10. Any other muscle or skeletal problem that interferes with using a respirator: Yes/No


Part B Any of the following questions, and other questions not listed, may be added to the questionnaire at the discretion of the health care professional who will review the questionnaire.


1. In your present job, are you working at high altitudes (over 5,000 feet) or in a place that has lower than normal amounts of oxygen: Yes/No


If "yes," do you have feelings of dizziness, shortness of breath, pounding in your chest, or other symptoms when you're working under these conditions: Yes/No


2. At work or at home, have you ever been exposed to hazardous solvents, hazardous airborne chemicals (e.g., gases, fumes, or dust), or have you come into skin contact with hazardous chemicals: Yes/No


If "yes," name the chemicals if you know them:_________________________________________________________________________


3. Have you ever worked with any of the materials, or under any of the conditions, listed below:


  1. Asbestos: Yes/No
  2. Silica (e.g., in sandblasting): Yes/No
  3. Tungsten/cobalt (e.g., grinding or welding this material): Yes/No
  4. Beryllium: Yes/No
  5. Aluminum: Yes/No
  6. Coal (for example, mining): Yes/No
  7. Iron: Yes/No
  8. Tin: Yes/No
  9. Dusty environments: Yes/No
  10. Any other hazardous exposures: Yes/No


If "yes," describe these exposures___________________________________________________ ______________________________________________________________________________


4. List any second jobs or side businesses you have:____________________________________ _____________________________________________________________________________


5. List your previous occupations:__________________________________________________


6. List your current and previous hobbies:_______________________________________________________________________


7. Have you been in the military services? Yes/No


If "yes," were you exposed to biological or chemical agents (either in training or combat): Yes/No


8. Have you ever worked on a HAZMAT team? Yes/No


9. Other than medications for breathing and lung problems, heart trouble, blood pressure, and seizures mentioned earlier in this questionnaire, are you taking any other medications for any reason (including over-the-counter medications): Yes/No


If "yes," name the medications if you know them:_____________________________________ _____________________________________________________________________________


10. Describe the work you'll be doing while you're using your respirator(s):


CEntral Community College




  1. _____________________________   ____________________________   ________________________
  2.         Employee                                  Employee ID Number                              Date of Birth


  1. _________________________________________   __________________________________________
  2.        Supervisor                                                                        Department


Circle Type or Types of Respirator(s) to be Used:


Atmosphere-supplying Respirator                                  Continuous Flow Respirator


Open-circuit SCBA                                                              Closed-circuit SCBA


Supplied Air Respirator                                                    Combination Air-line and SCBA


Air-Purifying (nonpowered)                                               Air-Purifying (powered)


N, R, or P disposable respirator (filter-mask, non- cartridge type only).


Level of Work Effort (circle one):


  1. Light                Moderate               Heavy                 Strenuous


Extent of Usage: (Circle One)


  1. On a daily basis.
  2. Occasionally -- but more than once a week.8/14/2008
  3. Infrequently—but more than once a month
  4. Rarely -- or for emergency situations only.


Length of Time of Anticipated Use in Hours: ____________________________________________


Special Work Considerations (i.e., high places, temperature, hazardous material, protective clothing, etc.) (If additional space is needed, please attach a separate sheet of paper)______________________________________________________________________________________






  1. _____________________        _______
  2. Supervisor                                 Date




                        _____ No restrictions on respirator use.


_____ Some specific use restrictions.


_____ No respirator use permitted.


Restrictions: (If additional space is needed, please attach a separate sheet of paper)




  1. ______________________      _______


Examining Physician                Date






                                  FOR REUSABLE AIR-PURIFYING RESPIRATORS


Respirators that are used routinely by the same person should be cleaned as often as necessary, usually daily.  Respirators that are used by more than one person must be cleaned after each use.


Recommended procedures for cleaning and sanitizing respirators are as follows:


Remove the following components of respiratory-inlet covering assemblies before cleaning and sanitizing:


-   Filters, cartridges, canisters


-   Speaking diaphragms


-   Valves, valve assemblies


-   Straps, etc.


Wash the facepiece and accessories as recommended by the manufacturer in warm soapy water (Maximum temperature of 120 degrees F) or in a commercial cleaner.  Use a soft brush if necessary.  Rinse well with clear water.


Sanitize by immersing the respirator body in sanitizing solution for two minutes and then rinse with clean water.  Clean and sanitize all parts removed from respirator as recommended by manufacturer.  Then air dry.


Inspect parts and replace any which are defective immediately.  Order replacement parts from the original manufacturer.  Each respirator is approved as a unit with its own specified components.  The use of any other respirator parts invalidates its approval.  Only trained personnel should repair respirators.


Reassemble the respirator and store properly.


Strong cleaning and sanitizing agents and many solvents can damage rubber or elastomeric respirator parts.  These materials must be used with caution and only with specific approval of the manufacturer.  Never use lubricants on any part of the respirator.  Keep all parts free from oil and grease.




Respirator Inspections


  1. Check all disposable respirators for:


  1. Holes in the filter.
  2. Deterioration or loss of elasticity in the straps.
  3. Deterioration of metal clip.


  1. Check all air purifying respirators for:


  1. Dirt, cracks, checking, tears and holes in the rubber facepiece.
  2. Distortion of the facepiece.
  3. Cracked, scratched or loose fitting face shields.
  4. Breaks, tears, or loss of elasticity in the head straps or harness.
  5. Broken or malfunctioning buckles.
  6. Dirt or detergent residues on the inhalation and exhalation valves or valve seat.
  7. Cracks, tears, or distortion of the valves or valve seats.
  8. Correct filter, cartridge, and facepiece.
  9. Worn threads on the filter, cartridge, or facepiece.
  10. Cracks or dents in the filter housing.
  11. Service life indicator or end of service date in the cartridge or canister.
  12. Cracks, checking, tears, or holes in gas mask breathing hoses.
  13. Broken, loose, or missing clamps or end connectors or breathing hose.


  1. Check both supplied air respirators and SCBAs for:


  1. Dirt, cracks, checking, tears, and holes in the rubber facepiece.
  2. Distortion of the facepiece.
  3. Cracked, scratched, or loose fitting face shields.
  4. Breaks, tears, or loss of elasticity in the head straps or harness.
  5. Broken or malfunctioning buckles.
  6. Dirt or detergent residues on the inhalation and exhalation valves or valve seat.
  7. Cracks, tears, or distortion of the valves or valve seats.
  8. Correct filter, cartridge or facepiece.
  9. Worn threads on the filter, cartridge and facepiece.
  10. Cracks or dents in the filter housing.
  11. Proper and intact protective screens (such as for abrasive blasting).
  12. Integrity of the air quality.  (Grade D minimum)
  13. Air leaks.
  14. Correct setting of regulators and valves.
  15. Correct setting of air purifying elements, carbon monoxide or high temperature alarms.


  1. Check SCBAs as above for supplied air respirators, plus:


  1. The air or oxygen pressure in the cylinder.
  2. Cylinder approvals.
  3. SCBAs should be checked at least monthly




Employee Voluntary Use of Respirators


Appendix D to Sec. 1910.134 (Mandatory) Information for Employees Using Respirators


When Not Required Under the Standard


Respirators are an effective method of protection against designated hazards when properly selected and worn.  Respirator use is encouraged, even when exposures are below the exposure limit, to provide an additional level of comfort and protection for workers.


However, if a respirator is used improperly or not kept clean, the respirator itself can become a hazard to the worker.  Sometimes, workers may wear respirators to avoid exposure to hazards, even if the amount of hazardous substance does not exceed the limits set by OSHA standards.


If your employer provides respirators for your voluntary use, or if you provide your own respirator, you need to take certain precautions to be sure that the respirator itself does not present to be a hazard.


You should do the following:


  1. Read and heed all instructions provided by the manufacturer on use, maintenance, cleaning and care, and warnings regarding the respirators limitations.


  1. Choose respirators certified for use to protect against the contaminant of concern. NIOSH, the National Institute for Occupational Safety and Health of the U.S. Department of Health and Human Services, certifies respirators.  A label or statement of certification should appear on the respirator or respirator packaging.  It will tell you what the respirator is designed for and how much it will protect you.


  1. Do not wear your respirator into atmospheres containing contaminants for which your respirator is not designed to protect against.  For example, a respirator designed to filter dust particles will not protect you against gases, vapors, or very small solid particles of fumes or smoke.


  1. Keep track of your respirator so that you do not mistakenly use someone else’s respirator.




Central Community College




EMPLOYEE NAME (PRINT) ______________________________________________________


EMPLOYEE (SIGNATURE) ______________________________________________________


EMPLOYEE ID NUMBER ________________________________________________________


JOB FUNCTION/TITLE __________________________________________________________


WORK DEPARTMENT __________________________________________________________


BUILDING __________________________  WORK PHONE NO. ________________________


DATE OF FIT TEST _____________________________________________________________


RESPIRATOR:    MANUFACTURE _________________________________________________






FREQUENCY OF USE _____________________________________




FACIAL HAIR ____________________________________________


MUSTACHE ______________________________________________


BEARD GROWTH _________________________________________


SCARS/MOLES ___________________________________________


WRINKLES ______________________________________________


GLASSES ________________________________________________


OTHERS _________________________________________________


SACCHARIN SENSITIVITY:          PASS _____         FAIL _____          DID NOT RUN _____


IA/BIT SENSITIVITY TEST:          PASS _____         FAIL _____          DID NOT RUN _____


SMOKE SENSITIVITY TEST:        PASS _____         FAIL _____          DID NOT RUN _____


QUALITATIVE TEST:                                                      (PASS)                   (FAILED)              (DID NOT RUN)


                (PP)=      POSITIVE PRESSURE                      _______                                ________             ______________


                (NP) =     NEGATIVE PRESSURE                    _______                                ________             ______________


                (SA) =     SACCHARIN                                       _______                                ________             ______________


                (BIT) =   BITREX                                                _______                                ________             ______________


                (IA) =     ISOMYL ACETATE                           _______                                ________             ______________


                (IS) =      IRRITANT SMOKE                           _______                                ________             ______________


QUANITIATIVE TEST:                    PASS _____           FAIL_____             DID NOT RUN _____


Equivalent Fit Factor   ________________             Average % Leakage _______________


PERFORMED BY (SIGNATURE)___________________________________________________






Use the following log form to determine when respirator cartridges have reached their end of service and should be changed for new cartridges.


Respirator Model:___________________                   Cartridge Model:_______________________


Manufacturers Recommended Cartridge Life_________________________________________








Time 1+ Time 2+ Time 3, etc.


















































































_________ Min. Manufacturer’s recommended time to change cartridge.






 Each time you use a respirator when working with approved chemicals, record the time worn under "Amount of Time"; add that amount to the time in the "Cumulative Time" column.  Change out of cartridges is dependent on the specific chemicals and environment.  Organic vapor cartridges for painting, varnishing, and lacquer, should not exceed 3 days or 1440 minutes of cartridge use. Pesticide and herbicide application should not exceed 3 consecutive days of use (for intermittent pesticide or herbicide application, a new cartridge should be used- do not reuse cartridges over a period of time).   Your supervisor should keep new cartridges in stock.


 NOTE: This log is only for air purifying respirators fitted with chemical vapor cartridges. It is not meant for use with HEPA filters.


Written by Lenore Koliha   
Last Updated on Thursday, 14 June 2012 20:42