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Respiratory Protection Self-Inspection Checklist Mobile App

This checklist applies to the use of either atmosphere-supplying or air-purifying respirators being worn, voluntarily or otherwise, for comfort or to protect health. The checklist is divided into three sections. Section One should be used if filtering dust mask respirators are used. Section Two should be used if respirators other than dust masks are used. Section Three should be used if respirators are required to protect individuals from exposure to air contaminants above applicable limits.

  • Lendlease
  • The Cooperative
  • PG&E
  • Red Bull
  • Mirvac

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Take a peek inside the Respiratory Protection Self-Inspection Checklist Mobile App

Included Features

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Included Fields

Customize to add, remove, or edit any of the fields below.

  • Ico textbox

    Name of Location:

  • Ico date

    Date of inspection:

  • Ico multiline

    Career-Technical program/course/room:

  • Ico signature

    Signature:

  • Ico statictext

    Guidelines: This checklist applies to the use of either atmosphere-supplying or air-purifying res...

  • Ico dropdown

    Are filtering facepieces (dust masks) provided which are clean and uncontaminated?

  • Ico dropdown

    Does the use of the dust mask not interfere with the individual's ability to work safely?

  • Ico dropdown

    Has a copy of Appendix D been given to each voluntary wearer?

  • Ico statictext

    Note: A copy of Appendix D is included in this checklist.

  • Ico dropdown

    Does the use of the respirator not interfere with the individual's ability to work safely?

  • Ico dropdown

    Has a copy of Appendix D been given to each voluntary wearer?

  • Ico dropdown

    Is there a written respiratory protection program that includes the following?

  • Ico statictext

    a.

  • Ico statictext

    b.

  • Ico dropdown

    Was a medical evaluation performed, before a respirator was used in the workplace, that determin...

  • Ico dropdown

    Are respirators which are issued for the exclusive use of an individual cleaned and disinfected ...

  • Ico statictext

    Note: Exclusive use means the respirator is used only by one person and is not shared.

  • Ico dropdown

    Are respirators which are issued to more than one individual cleaned and disinfected before bein...

  • Ico dropdown

    Are respirators stored so as to be protected from damage, contamination, dust, sunlight, extreme...

  • Ico dropdown

    Are respirators which are used in routine situations inspected before each use and during cleaning?

  • Ico dropdown

    Are respirators that fail an inspection or are otherwise found to be defective removed from serv...

  • Ico dropdown

    Have engineering controls been employed, where possible, to prevent or reduce atmospheric contam...

  • Ico statictext

    Note: Measures may include enclosure or confinement of an operation, general and local ventilatio...

  • Ico dropdown

    Is there a written respiratory protection program?

  • Ico dropdown

    Does the written respiratory protection program include procedures for selecting respirators for...

  • Ico dropdown

    Does the written respiratory protection program include medical evaluations of individuals who w...

  • Ico dropdown

    Does the written respiratory protection program include fit testing procedures for tight-fitting...

  • Ico dropdown

    Does the written respiratory protection program include procedures for proper use of respirators...

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