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RESPIRATORY PROTECTION
PERFORMANCE TEST (Rev 1)


Inspecting, Donning, and Doffing Half-Face Air-Purifying Respirators
PERFORMANCE CHECKLIST (1)

Name:

 Date:

 Operations Performance Score:
Decision-Making Score:
Signature of trainee:  
Signature of instructor:  

(1) NOTE: For any trainee who does not have documented medical clearance to wear an air-purifying respirator, this performance test can be performed with the removal of the cartridges/filter elements from the respirator facepiece after step 4 below. Step 9, the negative pressure user seal check, will be performed by placing the palms of the hands over the inhalation valve inlets and inhaling slightly for a count of 10.

TASK RATING
  Performs Operation Correctly Makes Correct Decisions
  Yes No Yes No
         
1. Examine the face piece for:        
  • Excessive dirt.
  • Cracks, tears, holes, or distortion from improper storage.
  • Inflexibility (stretch and massage to restore flexibility).
  • Cracked or broken air-purifying element holder(s), badly worn threads, or missing gasket(s) (if required).
         
2. Examine the head straps or head harness for:        
  • Breaks.
  • Loss of elasticity and twists.
  • Broken or malfunctioning buckles and attachments.
         
3. Remove exhalation valve cover and examine valve for:        
  • Foreign material, such as detergent, residue, dust particles, or human hair under the valve seat.
  • Cracks, tears, or distortion in the valve material.
  • Improper insertion of the valve body in the facepiece.
  • Cracks, breaks, or chips in the valve body, particularly in the sealing surface.
  • Missing or defective valve cover.
  • Improper installation of the valve in the valve body.
         
4. Examine air-purifying elements for:        
  • Correct cartridge, canister, or filter.
  • Correct/incorrect installation, loose connections, missing or worn gaskets, or cross-threading in holder.
  • Expired shelf-life date on cartridge or canister.
  • Cracks or dents in outside case of filter, cartridge, or canister.
  • Evidence of prior use of sorbent cartridge or canister, indicated by absence of sealing material, tape, foil, etc., over inlet.
         
5. Attach neck strap.
         
6. Place chin in chin cup and pull crown straps or head harness across head.
         
7. Adjust straps to correct fit.
         
8. Perform positive pressure user seal check by placing palm of hand over exhalation valve cover and exhaling slightly for a count of 10. Notice any leaks.
         
9. Perform negative pressure user seal check by placing palms of hands over filter intakes and inhaling slightly for count of 10. Notice any leaks.
         
10. Readjust straps, if necessary.
         
11. Repeat steps 8 and 9 if readjustment occurs.
         
12. Check for good breathing.
         
13. Loosen straps from top to bottom. Be gentle so as not to damage elasticity of straps.
         
14. Grasp respirator on bottom and remove upward over top of head.
         
15. Remove cartridges and dispose of properly.

Adapted from Performance Checklist developed by Gary Gustafson of Laborers-AGC