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Fit Test - Option 1

Note: only complete this form if you have completed the full Respiratory Fit Questionnaire in a previous calendar year. If you have not you go to Fit Test - Option 2.
 
Have you developed any medical problems or symptoms that may limit your ability to use a respirator? :
Have you been told by a health care professional, your supervisor, or the respiratory program administrator that you should be medically evaluated? :
Has there been a change in workplace conditions, e.g., physical work effort, protective clothing, temperature, that has resulted in a substantial increase in the physical burden on you? :
Have you previously been fit in a PAPR (Powered Air-Purifying Respirator - This is not an N95 mask)?:
If yes, do you know what size to wear and how to order a PAPR (Powered Air-Purifying Respirator)?:
It is your responsibility to report to your supervisor any change in health status that may affect your ability to use a respirator :
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