Train the Trainer Questionnaire The Moldex Train-the-Trainer Program Syllabus was developed to certify a designated Moldex user as qualified to fit test and train others in the proper use and maintenance of the Moldex 7000, 8000, 9000 Series and/or our disposable respirators. Please take a moment and answer the questions below.Select your country*USACanadaUSADo you have a written respiratory program in place?* Yes No Have your employees completed the OSHA Respirator Medical Evaluation Questionnaire?* Yes No What method of fit-testing do you have written in your respiratory program?* Select All Qualitative “Bitrex” Quantitative “TSI Porta-Count” What model(s) of Moldex or other respirators are you currently using?*How many employees are in your respiratory program? and Do you have any other locations or facilities using Moldex respirators?*What distributor do you buy from?Name of your distributor Sales Person:What is your use/purchasing volume for the Moldex model(s) used?CanadaDo you have a written respiratory program in place per CSA Z94.4-11?* Yes No 8.1.3 - Respirator user screening and medical assessment.* Yes No 12.1 - Health surveillance* Yes No What method of fit-testing do you have written in your respiratory program?* Select All Qualitative “Bitrex” Quantitative “TSI Porta-Count” What model(s) of Moldex or other respirators are you currently using?*How many employees are in your respiratory program? and Do you have any other locations or facilities using Moldex respirators?*What distributor do you buy from?Name of your distributor Sales Person:What is your use/purchasing volume for the Moldex model(s) used?
