9.1 Conducting Program Evaluations
The Office of Environmental Health and Safety will conduct periodic evaluations, as necessary, to ensure that employees of Rensselaer are following the provisions of this program. The evaluations will be used to determine the effectiveness of training programs and to ensure that respiratory protection is being utilized correctly.
9.2 Employee Consultations
Employee consultations may be utilized by the Office of Environmental Health and Safety to ascertain employee’s views on program effectiveness and to identify any problem areas. Such consultations may also include respirator inspections designed to ensure that proper usage, maintenance and selection processes are being observed.
Appendix A- Assigned Protection Factors
Table of APFs for various types of Respirators
Respirator Class and Type OSHA
. NIOSH Air Purifying Filtering Facepiece 10 10 Half-Mask 10 10 Full-Facepiece 50 50
Powered Air Purifying
Half-Mask 50 50
Full-Facepiece 250 50
Loose Fitting Facepiece 25 25
Hood or Helmet 25 25 Supplied Air Half-Mask-Demand 10 10 Half-Mask-Continuous 50 50 Half-Mask-Pressure Demand 1000 1000 Full-Facepiece Demand 50 50
Full-Facepiece Continuous Flow 250 50
Full-Facepiece Pressure Demand 1000 2000
Loose Fitting Facepiece 25 25
Hood or Helmet 25 25
Self Contained Breathing Apparatus (SCBA)
Demand 50 50
Pressure Demand >1000 10,000
Model #________________ Serial #_________________ Year__________________
Initial each box after item is inspected and deemed to be in an acceptable condition
Item JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC Mask and Hose-Examine for
contamination, damage, and deterioration
Examine Harness for wear and function of hardware
Test Unit as Worn (Regulator attached to
cylinder)
Check cylinder gauge for “full” indication
Close cylinder valve. Compare regulator gauge to
cylinder gauge (+ or- 50 P.S.I. is allowable) Watch regulator gauge for drop in reading, which would
indicate leakage. (One increment on gauge in 5
minutes is allowable)
Breathe unit down until alarm starts. Check regulator
gauge for indication of pressure. Alarm should start
at about ¼ full. Close main line valve, open
and close cylinder valve Slightly breathe on regulator
to check shut off valve. Regulator should not flow. Open main line valve full and
lock. Open by-pass and bleed off pressure Face piece. Inspect lens for
cracks or large scratches Hydrostatic Test date on air
cylinder(s)
Appendix C- Non-Mandatory Use Informational Form
In accordance with OSHA regulation 29 CFR 1910.134, the following information is provided for your review. Signing of this form indicates that you have received the regulatory appendix, and understand it’s content.
Appendix D to Sec. 1910.134 (Mandatory) Information for Employees Using Respirators When Not Required Under the Standard
Respirators are an effective method of protection against designated hazards when properly selected and worn. Respirator use is encouraged, even when exposures are below the exposure limit, to provide an additional level of comfort and protection for workers. However, if a respirator is used improperly or not kept clean, the respirator itself can become a hazard to the worker. Sometimes, workers may wear respirators to avoid
exposures to hazards, even if the amount of hazardous substance does not exceed the limits set by OSHA standards. If your employer provides respirators for your voluntary use, of if you provide your own respirator, you need to take certain precautions to be sure that the respirator itself does not present a hazard.
You should do the following:
1. Read and heed all instructions provided by the manufacturer on use, maintenance, cleaning and care, and warnings regarding the respirators limitations.
2. Choose respirators certified for use to protect against the contaminant of concern. NIOSH, the National Institute for Occupational Safety and Health of the U.S. Department of Health and Human Services, certifies respirators. A label or statement of certification should appear on the respirator or respirator packaging. It will tell you what the respirator is designed for and how much it will protect you.
3. Do not wear your respirator into atmospheres containing contaminants for which your respirator is not designed to protect against. For example, a respirator designed to filter dust particles will not protect you against gases, vapors, or very small solid particles of fumes or smoke.
4. Keep track of your respirator so that you do not mistakenly use someone else's respirator. [63 FR 1152, Jan. 8, 1998; 63 FR 20098, April 23, 1998
Employee Signature:____________________ Date:____________________ Witness:______________________________ Date:____________________
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Appendix D: Fit Test Documentation Form
Name of Employee:_________________________ Date:_________________________ Employee Signature:________________________
Fit-Test Conducted by:______________________ Date:_________________________ Signature:_________________________________
Testing Result Information
Qualitative Fit-Test Record Type of Mask:____________________ Manufacturer:____________________ Model:__________________________ Size____________________________ Irritant used: Isoamyl Acetate
Stannic Chloride Other:_____________________ Pass Fail (circle one) Additional Comments:______________ ________________________________ ________________________________ ________________________________ Next Fit-Test Due Before:
__________/__________/__________
Quantitative Fit-Test Record Type of Mask:____________________ Manufacturer:____________________ Model:__________________________ Size____________________________ Results:_________________________ ________________________________ Pass Fail (circle one) Additional Comments:______________ ________________________________ ________________________________ ________________________________ Next Fit-Test Due Before:
Appendix E: User Profile for Licensed Health Care Professional
Name of Employee:_________________________ Date:_________________________ Employee Signature:________________________
Name of Supervisor:______________________ Date:_________________________ Signature:_________________________________
Expected User Profile
1. The type and weight of the respirator to be worn by the employee: _____________________________________________________ 2. The estimated duration and frequency of respirator use:
_____________________________________________________ 3. The tasks the employee may be completing while wearing the respirator:
_____________________________________________________
4. Additional Personal Protective Equipment that the employee may be required to wear:
_____________________________________________________
5. The temperature and humidity extremes that may be encountered in the work area: ____________________________________________________
Name ofLicensed Health Care
Professional Receiving User Profile:______________________________ Date:_________________________ Signature:_____________________