Respiratory Fit Test Booking Form
All fit testing is conducted in accordance with OSHA 190.134 protocol.
Participant Full Name
*
First Name
Last Name
Contact Number
*
Please enter a valid phone number.
Format: 0000 000 000.
Email Address
*
example@example.com
Company / Organisation Name:
Respirator Details
Will the participant be bringing their own respirator?
*
Yes
No (Corrsafe will supply one for the test)
Have you contacted Corrsafe to organise the respirator?
Yes
I will once I submit this form
Is their respirator disposable?
Yes
No
Mask Brand: (e.g., 3M, Sundstrom, Honeywell)
Mask Model: (e.g., 7502, SR 100, PC321)
Mask Size: (e.g., Small, Medium, One Size)
Mask Style: (e.g., Flat Fold, Cup, Full-Face)
If your participant is bringing a Half-Face or Full-Face Reusable Respirator for testing, a compatible P3 filter must be supplied with the mask. Will the participant be providing the P3 filter?
Yes
No (Corrsafe will supply a P3 filter)
Have you contacted Corrsafe to organise this P3?
Yes
I will once I submit this form
Fit Test Requirements
Has the participant been fit tested before?
*
Yes
No
Unsure
Will the participant be clean shaven on the day of the test?
*
Yes
No (Note: Fit Testing cannot proceed if facial hair is present in the seal zone)
Does the participant have any respiratory, psychological, or medical conditions (e.g., asthma, anxiety, claustrophobia) that may affect their ability to complete the fit test?
*
No
Yes
If YES, please specifiy:
Booking Information
Preferred Date of Fit Testing:
-
Month
-
Day
Year
Date
Any Additional Notes or Requirements?
Submit
Should be Empty: