RESPIRATOR INSPECTION
Complete this inspection AT LEAST once a month.
Company:
*
Please Select
A American Custom Flooring
Acutron
Affiliated Construction
Aina Pest Control
Alcal
BEK
Bruce Matson
Bucher
Dorvin D. Leis
Harris Rebar
IG Steel
Jayco
Koga Engineering
Nordic PCL
Northwest Tower Crane
OMG/CPG
Ohana Concrete
Otis Elevator
Pacific Aquascapes
Wasa
W E Painting
Name of User:
*
Project:
*
Date:
*
-
Year
-
Month
Day
Date
Respirator Type:
*
Respirator Size:
*
Please Select
Small
Medium
Large
Work to be done:
*
INSPECTION ITEMS:
*If any inspection items fail, stop inspection, remove respirator from use, and see foreman 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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Should be Empty: