Quantitative Fit Test Form, PortaCount Loan Program Request Form and Probed Cartridge Test Instruction

Topic Progress:

Following are the forms that should be used when performing a quantitative fit test or when borrowing any of the PORTACOUNT equipment. Also listed are the instructions for the Probed Cartridge Test. Please read them carefully.

A. PORTACOUNT LOAN PROGRAM

1. To borrow a Moldex PORTACOUNT read the Policies and Requirements memorandum.

2. Fill out the Request Form.

3. Fax it back to Moldex Technical Services, who will process your request and then contact you via telephone.

B. 8006 PROBED CARTRIDGE KIT INSTRUCTION

1. To quantitatively fit test the Moldex 8000 Respirator follow the Probed Kit instructions.

C. 7006 PROBED CARTRIDGE KIT INSTRUCTIONS

1. To quantitatively fit test the Moldex 7000, 7800 or 9000 series respirators.

D. PORTACOUNT FIT TEST RECORD

1. Fill out the top half of the form.

2. Begin performing the fit test and enter the fit factor for each exercise.

3. After the test record the overall fit factor. If the subject received a 100 or greater this is considered a Pass, for a half facepiece respirator. 500 or greater for full face respirator an APF at 50.

4. The person performing the test should sign the form.

5. The employee should also sign the form once a Pass has been achieved, and they have been fully instructed on the use of Moldex respirators.

E. RESPIRATORY FIT TEST CARD

1. Once an employee has passed the fit test and been assigned a respirator, fill out the Respiratory Fit Test Card and issue it to the employee.

2. The employee should retain this card as proof that they have been properly fit tested.

F. CERTIFICATE OF RESPIRATORY TRAINING

1. When an employee has been fit tested, trained and assigned a respirator fill out the certificate completely with all of the appropriate information.

2. Have the employee sign the certificate.

3. Issue the certificate to the employee.

4. Keep a signed copy in the employee’s record or with the company’s RespiratoryProgram records.

 

Click here for the PortaCount Fit Test Record.

Click here for PortaCount Loan Form and Probed Cartridge Test Instruction.

 

 

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