RESPIRATOR INSP ECTION
Respiratory Protection: HSEOP-12-04
Complete inspection daily BEFORE respirator use.
Company:
*
Please Select
American Electric
American Standard
BEK
Berkel & Company Contractors, Inc.
CMC Steel Fabricators
Commercial Plumbing
Geo Solutions
GIMA
Hawaiian Crane
Honolulu Fire Protection
Heide & Cook
KOGA Engineering
Kone, Inc
Nordic PCL
Northwest Demolition
Northwest Tower Crane
Oahu Metal and Glazing
Swanson Steel
Name of User:
*
Project:
*
Date:
*
-
Year
-
Month
Day
Date
Respirator Type:
*
Respirator Size:
*
Please Select
Small - 6100/07024
Medium - 6200/07025
Large - 6300/07026
Work to be done:
*
INSPECTION ITEMS:
*If any inspection items fail, stop inspection, remove respirator from use, and see Lohi immediately for a new respirator.
Facepiece:
*
CHECKED
Inhalation Valve:
*
CHECKED
Exhalation Valve:
*
CHECKED
Headbands:
*
CHECKED
Filters:
*
CHECKED
Gaskets:
*
CHECKED
Disinfected/Cleaned?
*
CHECKED
Disassembled and stored in container?
*
CHECKED
Comments:
Signature:
*
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