Qlft Form PDF Details

Are you familiar with the QLFT form? It stands for quick look feedback and is an efficient way to get meaningful input from customers. This simple five step process can give small businesses a leg up on customer service, as it provides much-needed insight into what customers like or don't like about their products and services. In this blog post, we will review the components of the QLFT form and discuss how using it can help your business provide top-notch customer satisfaction. Read on to learn more about this helpful tool!

QuestionAnswer
Form NameQlft Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesAdministering, 2004, qlft, TTY

Form Preview Example

Qualitative Fit Test (QLFT) Form

Employee Name

Date of Birth (Year) Height

Weight

Work Unit

Supervisor Name

A respirator fit test must be completed by an individual trained in respiratory fit testing procedures. This fit test is required annually.

Does employee wear glasses? _____ Yes _____ No

Does Employee have facial hair, dentures or other attributes that will prevent a positive face fit? _____ Yes _____ No

Respirator Type (Make Model and Certification Number) Testing media Compatible with eye glasses Positive pressure fit check Negative pressure fit check Head Stationary Normal Breathing (60 seconds)

Head Stationary Deep

Breathing (60 seconds)

Head Turning Side To Side (60 seconds)

Head Moving Up and Down (60 seconds)

Talking (recite Rainbow Passage or count backwards)

Bending Over (60 seconds) Head Stationary Normal Breathing (60 seconds)

Respirator fit test result

 

 

 

 

 

 

____Yes____No

____Yes____No

____Yes ____No

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Based on information provided on this form, I certify that the employee named on this form can wear the respiratory protective equipment listed above.

Signature of Person Administering Test _________________________ Date _________

Infectious Disease Epidemiology, Prevention and Control

612-676-5414 – TDD/TTY 651-215-8980 – www.health.state.mn.us

If you require this document in another format, such as large print, please call 612-676-5414.

Revision 5/2004