Form
Form - Fit Test Record
Document FSSMS-FRM-13Stage 1Revision 4Version 0.3.3
Topic pages open on your jurisdiction, and requirements tables show its line. You can change this on any page.
One record per member per respirator make, model and size. Completed by the fit tester at the time of the test; signed by the tester and the member; filed by the program administrator in {{Records system}}; the next-due date entered in the fit-test register. The fields follow CSA Z94.4’s fit-test records annex as reflected in Canadian regulator guidance (CCOHS, n.d.-b; CSA Z94.4-18; WorkplaceNL, 2023). The test is annual for every tight-fitting respirator by this program’s rule, inside the two-year maximum of the respirator standard (CSA Z94.4-18, cl. 9) and meeting the annual requirement of the health and safety standard (NFPA 1550, 2024, s. 9.14). Some jurisdictions require an annual test by regulation, and some require a quantitative method for SCBA; others set a longer maximum (J14 Respiratory Protection, Fit Testing and Breathing Air).
| Field | Entry |
|---|---|
| Record number | |
| Date of test | |
| Member identifier and station | |
| Member’s rank or role | |
| Medical clearance confirmed before test (date of outcome; outcome: fit / fit with restriction) | |
| Respirator training confirmed before test (date) | |
| Respirator type (SCBA facepiece / full-facepiece APR / half-facepiece APR / tight-fitting PAPR / N95 filtering facepiece / other) | |
| Make | |
| Model | |
| Size | |
| Reason for test (initial / annual / change of make, model or size / weight change / dental or facial change / discomfort or failed seal check / change of interfacing PPE / other) | |
| Test method (qualitative: saccharin / Bitrex; quantitative: ambient aerosol / controlled negative pressure) | |
| Protocol and exercise set used | |
| Qualitative: sensitivity screen result; solution lot and expiry | |
| Quantitative: instrument make, model and serial; daily check passed (time); last calibration date | |
| Pass criterion (qualitative: no taste or smell; quantitative: overall fit factor 100 or more half-facepiece, 500 or more full-facepiece and SCBA) | |
| Fit factor per exercise (quantitative) | 1: 2: 3: 4: 5: 6: 7: 8: |
| Overall fit factor (quantitative) | |
| Result (pass / fail) | |
| Interfacing PPE worn during test (helmet, hood, eyewear insert, radio strap, other) | |
| Observations affecting seal (facial hair, eyewear, dentures, scars, jewellery, cosmetics, other); clean-shaven confirmed | |
| Member comfort assessment (acceptable / not acceptable; comments) | |
| Seal check competence demonstrated (negative and positive pressure) | |
| Failed attempts and cause (strap, size, nose bridge, chin, hair, scar, other) and what was tried next | |
| Restriction resulting from the test (none / no IDLH entry pending re-test / loose-fitting PAPR only) and who was notified (date) | |
| Facepiece issued and marked with member identifier (yes / no; facepiece serial) | |
| Next test due (12 months from this date, or earlier on any trigger) | |
| Fit tester name and competency record reference | |
| Fit tester signature and date | |
| Member signature and date | |
| Entered in fit-test register (by, date) |
| Field | Type | Required | Who completes |
|---|---|---|---|
| Record number | Text, unique | Yes | Program administrator or system |
| Date of test | Date | Yes | Fit tester |
| Member identifier and station | Text | Yes | Fit tester |
| Member’s rank or role | Text | Yes | Fit tester |
| Medical clearance confirmed | Date plus outcome from list | Yes (test does not proceed without it) | Fit tester, from the clearance status list |
| Respirator training confirmed | Date | Yes | Fit tester, from the training record |
| Respirator type | Single choice | Yes | Fit tester |
| Make, model, size | Text | Yes | Fit tester |
| Reason for test | Single choice plus text | Yes | Fit tester |
| Test method | Single choice | Yes | Fit tester |
| Protocol and exercise set | Text | Yes | Fit tester |
| Qualitative screen, solution lot and expiry | Text | Yes if qualitative | Fit tester |
| Quantitative instrument, daily check, calibration | Text, time, date | Yes if quantitative | Fit tester |
| Pass criterion | Text | Yes | Fit tester |
| Fit factor per exercise | Number per exercise | Yes if quantitative | Fit tester or instrument printout attached |
| Overall fit factor | Number | Yes if quantitative | Fit tester |
| Result | Pass / fail | Yes | Fit tester |
| Interfacing PPE worn | Multiple choice | Yes | Fit tester |
| Observations affecting seal; clean-shaven confirmed | Text; yes | Yes | Fit tester |
| Comfort assessment | Choice plus text | Yes | Member, recorded by tester |
| Seal check competence | Yes / no | Yes | Fit tester |
| Failed attempts and cause | Text | Yes if any attempt failed | Fit tester |
| Restriction and notification | Choice, text, date | Yes if result is fail or restriction | Fit tester; program administrator confirms notification |
| Facepiece issued and marked | Yes / no; serial | Yes for personal-issue facepieces | Fit tester or issuer |
| Next test due | Date | Yes | Fit tester |
| Tester name and competency reference | Text | Yes | Fit tester |
| Tester signature and date | Signature | Yes | Fit tester |
| Member signature and date | Signature | Yes | Member |
| Entered in register | Initials, date | Yes | Program administrator |
Retention. Duration of the member’s service plus 30 years, the period the department keeps every record bearing on exposure or health, or longer where your jurisdiction’s retention rule requires it (J09 Records Retention). Privacy. The form carries no health information beyond the clearance outcome; the medical file stays with the occupational health provider.
This chapter relies on the following legal requirements, which differ by province and territory. Check your jurisdiction’s section on each topic page before adopting it.
| Topic | What to check in your jurisdiction | Page |
|---|---|---|
| Records Retention | Any retention period the law sets for fit-test and other exposure-linked records | J09 Records Retention |
| Respiratory Protection, Fit Testing and Breathing Air | How often SCBA and other respirator users must be fit tested, whether the test must be quantitative, and which edition of CSA Z94.4 the regulation names (the 12-month next-test-due field is this program’s rule) | J14 Respiratory Protection, Fit Testing and Breathing Air |
Canadian Centre for Occupational Health and Safety [CCOHS]. (n.d.-b). Respirator fit testing (OSH Answers). https://www.ccohs.ca/oshanswers/prevention/ppe/respirator-respirator-fit-testing.html
CSA Group. (2018). CAN/CSA-Z94.4-18 (R2023), Selection, use, and care of respirators (5th ed.). https://www.csagroup.org/store/product/2426374/
National Fire Protection Association. (2024). NFPA 1550, Standard for emergency responder health and safety (consolidates NFPA 1500, 1521 and 1561). https://www.nfpa.org/codes-and-standards/nfpa-1550-standard-development/1550
WorkplaceNL. (2023). Respiratory protection program guideline. https://workplacenl.ca/site/uploads/2023/06/20230515-Resp.-Protection-Program-Guideline.pdf