Pic Of N95 Mask Card Form – Fill Out and Use This PDF

The Pic Of N95 Mask Card form is a comprehensive document designed to verify the training and fit testing of individuals using N95 respirators, essential personal protective equipment (PPE). It covers key safety tips, donning and doffing instructions, and requires annual fit testing to ensure the respirator's effectiveness. For those in need of completing or updating their verification, click the button below to fill out the form.

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Pic Of N95 Mask Card Form PDF Details

In the world of healthcare and safety, the "Pic Of N95 Mask Card" form plays a pivotal role, serving as a comprehensive document that underscores the significance of proper training and fit testing for N95 respirators—a crucial piece of Personal Protective Equipment (PPE). Crafted through the collaboration between the Occupational Safety and Health Administration (OSHA) and the Association of Occupational Health Professionals (AOHP), this card offers detailed guidelines on the correct donning and doffing procedures, ensuring that the user achieves an optimal seal to prevent leakage. It underscores the necessity of handwashing before and after the use of PPE, the sequence in which PPE should be worn and removed, and the importance of conducting a face seal check following the manufacturer’s recommendations. Moreover, it records the successful completion of a fit test—whether qualitative or quantitative—by an employee, alongside the specific respirator model and size, thereby ensuring the respirator’s effectiveness in protecting the wearer. Highlighting the trainer’s signature, it also serves as a verification tool that the individual has been duly trained in the proper use, limitations, and application of the N95 respirator. Further, it brings to attention the annual requirement for fit testing to verify the continued appropriateness of the respirator fit. Although developed for informational purposes, the card does not necessarily reflect OSHA’s official stance or that of the U.S. Department of Labor but stands as a critical reminder of the ongoing commitment to safety and health in environments where airborne hazards are a concern.

Question	Answer
Form Name	Pic Of N95 Mask Card Form
Form Length	1 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	15 sec
Other names	mask test documentation, n95 mask certificate, respirator verification, verification card

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N95 Respirator Training and Fit Testing Verification		Personal Protective Equipment (PPE) Safety Tips
Facility:___________________________	Date:____________			Donning Instructions
Facility:___________________________	Date:____________		Wash hands
Employee:___________________________________________			Don	PPE	in	proper	order	(gown, mask/respirator,
Employee:___________________________________________		goggles/face shield, gloves)
Has successfully passed a qualitative/quantitative fit test and completed		goggles/face shield, gloves)
			Always perform a face seal check before entering room
training in the appropriate use, limitations and application of this respirator.			Always perform a face seal check before entering room
		(follow manufacturer’s recommendations to check for leakage)

Manufacturer:________________________________________			Doffing/Removal Instructions
			Doffing/Removal Instructions
Model:_________________________________Size:_________			Remove PPE in proper order (gloves, goggles/face shield,
Model:_________________________________Size:_________		gown, mask/respirator)
		gown, mask/respirator)
Trainer Signature:____________________________________			Dispose of PPE in designated container
Trainer Signature:____________________________________			Wash hands
			Wash hands
Through the OSHA and AOHP Alliance, AOHP developed this card for informational purposes only. It		Note: Annual fit testing is required to re-verify appropriate respirator fit
does not necessarily reflect the official views of OSHA or the U.S. Department of Labor. 8/2009


N95 Respirator Training and Fit Testing Verification		Personal Protective Equipment (PPE) Safety Tips
Facility:___________________________	Date:____________			Donning Instructions
Facility:___________________________	Date:____________		Wash hands
Employee:___________________________________________			Don	PPE	in	proper	order	(gown, mask/respirator,
Employee:___________________________________________		goggles/face shield, gloves)
Has successfully passed a qualitative/quantitative fit test and completed		goggles/face shield, gloves)
			Always perform a face seal check before entering room
training in the appropriate use, limitations and application of this respirator.			Always perform a face seal check before entering room
		(follow manufacturer’s recommendations to check for leakage)

Manufacturer:________________________________________			Doffing/Removal Instructions
			Doffing/Removal Instructions
Model:_________________________________Size:_________			Remove PPE in proper order (gloves, goggles/face shield,
Model:_________________________________Size:_________		gown, mask/respirator)
		gown, mask/respirator)
Trainer Signature:____________________________________			Dispose of PPE in designated container
Trainer Signature:____________________________________			Wash hands
			Wash hands
Through the OSHA and AOHP Alliance, AOHP developed this card for informational purposes only. It		Note:	Annual fit testing is required to re-verify appropriate respirator fit
does not necessarily reflect the official views of OSHA or the U.S. Department of Labor. 8/2009		Note:


N95 Respirator Training and Fit Testing Verification		Personal Protective Equipment (PPE) Safety Tips
Facility:___________________________	Date:____________			Donning Instructions
Facility:___________________________	Date:____________		Wash hands
Employee:___________________________________________			Don	PPE	in	proper	order	(gown, mask/respirator,
Employee:___________________________________________		goggles/face shield, gloves)
Has successfully passed a qualitative/quantitative fit test and completed		goggles/face shield, gloves)
			Always perform a face seal check before entering room
training in the appropriate use, limitations and application of this respirator.			Always perform a face seal check before entering room
		(follow manufacturer’s recommendations to check for leakage)

Manufacturer:________________________________________			Doffing/Removal Instructions
			Doffing/Removal Instructions
Model:_________________________________Size:_________			Remove PPE in proper order (gloves, goggles/face shield,
Model:_________________________________Size:_________		gown, mask/respirator)
		gown, mask/respirator)
Trainer Signature:____________________________________			Dispose of PPE in designated container
Trainer Signature:____________________________________			Wash hands
			Wash hands
Through the OSHA and AOHP Alliance, AOHP developed this card for informational purposes only. It		Note:	Annual fit testing is required to re-verify appropriate respirator fit
does not necessarily reflect the official views of OSHA or the U.S. Department of Labor. 8/2009		Note:


N95 Respirator Training and Fit Testing Verification		Personal Protective Equipment (PPE) Safety Tips
Facility:___________________________	Date:____________			Donning Instructions
Facility:___________________________	Date:____________		Wash hands
Employee:___________________________________________			Don	PPE	in	proper	order	(gown, mask/respirator,
Employee:___________________________________________		goggles/face shield, gloves)
Has successfully passed a qualitative/quantitative fit test and completed		goggles/face shield, gloves)
			Always perform a face seal check before entering room
training in the appropriate use, limitations and application of this respirator.			Always perform a face seal check before entering room
		(follow manufacturer’s recommendations to check for leakage)

Manufacturer:________________________________________			Doffing/Removal Instructions
			Doffing/Removal Instructions
Model:_________________________________Size:_________			Remove PPE in proper order (gloves, goggles/face shield,
Model:_________________________________Size:_________		gown, mask/respirator)
		gown, mask/respirator)
Trainer Signature:____________________________________			Dispose of PPE in designated container
Trainer Signature:____________________________________			Wash hands
			Wash hands
Through the OSHA and AOHP Alliance, AOHP developed this card for informational purposes only. It		Note: Annual fit testing is required to re-verify appropriate respirator fit
does not necessarily reflect the official views of OSHA or the U.S. Department of Labor. 8/2009

Pic Of N95 Mask Card Form – Fill Out and Use This PDF

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