Environmental Safety Division. Respiratory Protection Program Procedures and Instructions

Transcription

1 Environmental Safety Division Respiratory Protection Program Procedures and Instructions

2 INTRODUCTION PURPOSE This respiratory protection program was developed by the University of Georgia (UGA) Environmental Safety Division (ESD) and is based on accepted industry standards and good management practices. The Occupational Safety and Health Administration (OSHA) general industry standard for respiratory protection programs (29 CFR ) and the American National Standards Institute (ANSI) practices for respiratory protection (ANSI Z ) both provide good models for recommended practices. UGA employees are covered by the State of Georgia Public Employees Hazardous Chemical Protection and Right to Know Act. This law requires that all state employees receive training and information regarding hazardous chemicals they may be exposed to in their workplace and that they be provided with adequate personal protection protective equipment, such as respirators, where needed. It is the University s objective to control occupational diseases and injuries at the point of operation, particularly where the air may be contaminated with harmful dust, fogs, fumes, mists, gases, smokes, sprays or vapors. Most of the time this may be accomplished by using engineering controls and good work practices. When effective engineering controls are not feasible or while they are being instituted, good work practices shall be used. The use of respirators as the primary means of protecting employees from airborne hazards is considered acceptable only in very specific situations. When it has been determined that respiratory protection is needed, it is the responsibility of both ESD and subsequent department to work together to protect the health of employees. RESPONSIBILITIES University faculty, staff, or employees who are potentially exposed to hazardous environments are required to contact the ESD respiratory program administrator for an evaluation. The administrator will contact the supervisor to schedule an evaluation of the work area to determine if engineering controls, respiratory equipment, or both, are appropriate. The respiratory program administrator can be contacted at The University of Georgia is responsible for the establishment and maintenance of the

3 respiratory protection program which shall include respirator selection, training, cleaning and sanitization, storage, inspection, surveillance of work areas, and assessment of employee exposure or stress. The University of Georgia shall provide medical evaluations, respirators, spectacle kits, training and fit testing; individual departments are responsible for procuring items and for payment of any costs. The respiratory program administrator designee is the environmental safety coordinator within the Environmental Safety Division. The coordinator may choose to delegate authority for various aspects of the program to other qualified safety specialists as needed. Respiratory program administrator responsibilities shall include assisting departments and supervisors identify respiratory hazards in the work environment, identifying engineering controls, assisting supervisors in developing and implementing operating procedures, training respirator users and supervisors in proper use of respirators, performing fit testing, maintaining fit test records and notifying personnel of annual retesting, and verifying the effectiveness of the respiratory protection program by performing annual program evaluations. Principal investigators and supervisors are responsible for ensuring that personnel under their supervision seek respiratory protection when the employee s health could be compromised due to the nature of work performed. Principal investigators and supervisors responsibilities shall include identifying potentially hazardous operations and consulting with ESD, establishing written standard operating procedures for each operation, identifying employees who may need respirators, ensuring that employees are physically fit to use respirators, ensuring employees are trained in the proper use and maintenance of the respirator, ensuring that fit testing has been performed, enforcing the use of respirators according to manufacturer s instructions, monitoring the work area during respirator use, maintaining records pertaining to personnel, monitoring data, medical evaluations, and ensuring users maintain respirators properly.

4 Respirator user responsibilities include informing their supervisor or ESD of any working conditions for which they feel a respirator may be needed, informing their supervisor of any personal health problems that could be aggravated when wearing a respirator, properly wearing and using respirators in accordance with instructions, ensuring proper cleaning, inspection, and storage of respirators, reporting any ill-fitting or malfunctioning respirators to supervisors, and reporting any adverse health effects to supervisors or ESD. All respirator users are required to have a medical evaluation, training, and a respirator fit test performed before beginning the assigned work task. ESD will provide the information needed to schedule a medical evaluation. Those respirator users who discontinue participation in the respiratory protection program are required to submit the Respiratory Protection Program Termination Notification form.

5 UNIVERSITY OF GEORGIA RESPIRATORY PROTECTION PROGRAM TABLE OF CONTENTS 1.0 Enrollment 2.0 Respirator Selection 3.0 Respirator Use 4.0 Respirator Cleaning 5.0 Detailed Inspection and Storage 6.0 Fit Testing 7.0 Program Evaluation

6 UNIVERSITY OF GEORGIA ENVIRONMENTAL SAFETY DIVISION RESPIRATOR ENROLLMENT INSTRUCTIONS AND REQUIREMENTS

7 TABLE OF CONTENTS SECTION PAGE NUMBER 1.0 PURPOSE DISCUSSION OF SIGNIFICANCE AND USE RESPONSIBILITY HAZARD ANALYSIS AND CONTROLS PRE-JOB PLANNING 5.1 Prerequisites INSTRUCTIONS 6.1 Enrollment Respiratory Protection Training Respirator Fit Testing Respirator User Authorization Respirator User Requirements RECORDS REVIEW AND DISPOSITION REFERENCES FORMS AND APPENDICES...6 1

8 1.0 PURPOSE 1.1 This procedure establishes the requirements for participate in the UGA respiratory protection program. 2.0 DISCUSSION OF SIGNIFICANCE AND USE 2.1 This is significant because respirators may be the best and last line of defense for employees exposed to potentially harmful work atmospheres. It is to be used by certain UGA employees as described herein. 2.2 This procedure implements the requirements of the American National Standards Institute Z and is designed to maintain respirator program efficiency, ensure the proper respirator is issued to personnel requiring respiratory protection, and provides a documented record of program activities. 3.0 RESPONSIBILITY 3.1 The environmental safety coordinator and the Environmental Safety Division (ESD) will oversee administration of this respiratory protection program. 3.2 The respiratory protection program administrator is responsible for the implementation and revision of this program. 3.3 All ESD personnel qualified to issue respirators are responsible for compliance with this procedure. 4.0 HAZARD ANALYSIS AND CONTROLS 4.1 The issuance of an inappropriate respirator may compromise the health and safety of individuals required to wear respiratory protection. 4.2 The improper use and/or maintenance of a respirator may compromise the health and safety of the user. 2

9 5.0 PRE-JOB PLANNING 5.1 Prerequisites The following prerequisites shall be satisfied by each proposed user prior to being issued a respirator An Evaluation of Respiratory Hazards in the Work Environment (Appendix A of respirator selection module) must be completed and reviewed by the respiratory protection administrator A valid Respirator Selection Checklist (Appendix B of respirator selection module) with the approval signature of the respiratory program administrator must be available for justification of the respirator to be used A Respirator Medical Evaluation Questionnaire (Appendix A of this module) must be filled out and submitted to a qualified physician, documented within the past 12 months Successful completion of a Respirator Physical Examination (Appendix B of this module) by a qualified physician documented within the past 12 months must be available for justification to the respiratory program administrator Successful completion of UGA Respiratory Protection Training (Appendix C of this module) documented within the past 12 months Successful completion of a Respirator Fit Test (Appendix A of respirator fit testing module) for the required respirator within the last 12 months or within 6 months if the respirator is to be used for protection against asbestos, acrylonitrile, lead, benzene, or formaldehyde. 6.0 INSTRUCTIONS 6.1 Enrollment To become enrolled into the respiratory protection program, contact ESD at

10 6.1.2 An evaluation of respiratory hazards in the work environment form (Appendix A of Respirator Selection module) must be completed by the potential respirator user. Once the form is completed, return it to the UGA Environmental Safety Division, 240A Riverbend Road, Athens GA for review by the respiratory program administrator. NOTE: Once the evaluation of respiratory hazards in the work environment form has been reviewed, it may be deemed necessary to conduct an onsite evaluation. The evaluation will indicate if engineering control measures are in place/needed or if personal monitoring is needed to determine if respirator protection is required The respiratory protection program administrator will then assign a control number and utilize the Evaluation of Respiratory Hazards in the Work Environment form to complete a respirator selection checklist and provide a recommendation for the proper respirator protection, filter media, and any special instructions The potential respirator user will then be provided a respirator medical evaluation questionnaire and a respirator physical examination form to be completed and submitted to a qualified physician who will review the questionnaire and conduct a respirator physical The principal investigator and/or supervisor will coordinate a respiratory medical evaluation for the employee with a qualified physician. Individual departments are responsible for procuring items and for payment of any costs The physician will sign the respirator physical examination form indicating if the potential respirator user is limited or restricted in the use of a respirator. The physician will then forward a copy of the results to the appropriate department The potential respirator user will forward a copy of the of respirator physical examination form signed by the physician to the UGA Environmental Safety Division The respiratory protection program administrator will review the respirator physical examination form and schedule the potential respirator user for respiratory protection training and a respirator fit test. 6.2 Respiratory Protection Training Once training has been received, the potential user will acknowledge (by signing the respiratory protection training sign-in sheet) that he/she 4

11 understands and agrees to comply with the respiratory protection program s policies, procedures and requirements. Respiratory protection training will be conducted by the Environmental Safety Division and will consist of the following: 6.3 Respirator Fit Testing Watching a video from North Safety Equipment, Your Air Purifying Respirator A Piece of Good News Instruction in donning and doffing the respirator, performing positive and negative pressure fit checks, proper respirator use, detailed inspection, maintenance, storage, cleaning and sanitization of the respirator Once respiratory protection training is completed, the potential respirator user will be required to pass a respirator fit test conducted by the Environmental Safety Division. The certified fit test conductor must review all documentation to ensure that the potential user has meet all required qualifications One of three methods of respirator fit testing may be utilized: bitrex solution, stannic chloride (irritant smoke) and isoamyl acetate (banana oil). Once the potential respirator user passes the respirator fit test, the fit test conductor and the respirator wearer must sign and date the respirator fit test record. 6.4 Respirator User Authorization The respirator user will then be accepted into the respiratory protection program. The respirator user will be provided a copy of the respirator fit test record and is authorized to purchase only the respirator specific to the respirator fit test record. NOTE: If the potential respirator user does not have a current respirator physical, training, and fit test record, the purchase and use of a respirator is not authorized. 6.5 Respirator User Requirements All personnel assigned to wear a respirator shall: Guard the respirator against damage at all times. Proper storage and maintenance is the key. 5

12 In the event a respirator malfunction occurs, leave the area, remove the respirator, and notify the Environmental Safety Division at Inform the respiratory program administrator of any change in medical or physical status that may impede the ability to safely wear a respirator Successfully pass (annually) a respirator physical examination, a respirator fit test and complete respirator training within the past 12 months or 6 months if the respirator is to be used for protection against asbestos, acrylonitrile, lead, benzene, or formaldehyde Upon termination of participation in the respiratory protection program, submit a Respiratory Protection Program Termination Notification (Appendix D of this module) to the respiratory program administrator. 7.0 RECORDS REVIEW AND DISPOSITION 7.1 All records shall receive a documented review by the respiratory program administrator or designee. 7.2 All evaluation of respiratory hazards in the work environment records shall be retained for a period of 30 years. 7.3 All respirator selection checklist records shall be retained for a period of 30 years. 7.4 All respirator physical examination records shall be retained for a period of 30 years. 7.5 All UGA respiratory protection training records shall be retained for a period of 30 years. 7.6 All respirator fit test records shall be retained for a period of 30 years. 7.7 All respiratory protection program termination notification records shall be retained for a period of 30 years. 6

13 8.0 REFERENCES 8.1 ANSI Z , Practices for Respiratory Protection CFR , Respiratory Protection 8.3 NIOSH Publication No , Guide to Industrial Respiratory Protection 9.0 FORMS AND APPENDICES Appendix A Respirator Medical Evaluation Questionnaire Appendix B Respirator Physical Examination Appendix C Respiratory Protection Training Sign-in Sheet Appendix D Respiratory Protection Program Termination Notification 7

14 Appendix A Respirator Medical Evaluation Questionnaire

15 University of Georgia Environmental Safety Division To the employee: RESPIRATOR MEDICAL EVALUATION QUESTIONNAIRE Can you read (circle one): Yes / No Your employer must allow you to answer this questionnaire during normal working hours, or at a time and place that is convenient to you. To maintain your confidentiality, your employer or supervisor must not look at or review your answers, and your employer must tell you how to deliver or send this questionnaire to the health care professional who will review it. Part A. Section 1. The following information must be provided by every employee who has been selected to use any type of respirator (please print). 1. Today s date: 2. Your name: 3. Your age (to nearest year): 4. Sex (circle one): Male / Female 5. Your height: ft. in. 6. Your weight: lbs. 7. Your job title: 8. A phone number where you can be reached by the health care professional who reviews this questionnaire (include the area code): 9. The best time to phone you at this number: 10. Has your employer told you how to contact the health care professional who will review this questionnaire (circle one): Yes / No Page 1 of 8

16 11. Check the type of respirator you will use (you can check more than one category): N, R, or P disposable respirator (filter-mask, non- cartridge type only). Other type (e.g., half- or full-face piece type, powered-air purifying, supplied-air, self-contained breathing apparatus). 12. Have you worn a respirator (circle one): Yes / No If yes, what type(s): Part A. Section 2. Questions 1 through 9 below must be answered by every employee who has been selected to use any type of respirator (please circle yes or no ). 1. Do you currently smoke tobacco, or have you smoked tobacco in the last month: Yes / No 2. Have you ever had any of the following conditions? a. Seizures (fits): Yes / No b. Diabetes (sugar disease): Yes / No c. Allergic reactions that interfere with your breathing: Yes / No d. Claustrophobia (fear of closed-in places): Yes / No e. Trouble smelling odors: Yes / No 3. Have you ever had any of the following pulmonary or lung problems? a. Asbestosis: Yes / No b. Asthma: Yes / No c. Chronic bronchitis: Yes / No d. Emphysema: Yes / No e. Pneumonia: Yes / No f. Tuberculosis: Yes / No g. Silicosis: Yes / No h. Pneumothorax (collapsed lung): Yes / No i. Lung cancer: Yes / No j. Broken ribs: Yes / No k. Any chest injuries or surgeries: Yes / No l. Any other lung problem that you ve been told about: Yes / No Page 2 of 8

17 4. Do you currently have any of the following symptoms of pulmonary or lung illness? a. Shortness of breath: Yes / No b. Shortness of breath when walking fast on level ground or walking up a slight hill or incline: Yes / No c. Shortness of breath when walking with other people at an ordinary pace on level ground: Yes / No d. Have to stop for breath when walking at your own pace on level ground: Yes / No e. Shortness of breath when washing or dressing yourself: Yes / No f. Shortness of breath that interferes with your job: Yes / No g. Coughing that produces phlegm (thick mucus or sputum): Yes / No h. Coughing that wakes you early in the morning: Yes / No i. Coughing that occurs mostly when you are lying down: Yes / No j. Coughing up blood in the last month: Yes / No k. Wheezing: Yes / No l. Wheezing that interferes with your job: Yes / No m. Chest pain when you breathe deeply: Yes / No n. Any other symptoms that you think may be related to lung problems: Yes / No 5. Have you ever had any of the following cardiovascular or heart problems? a. Heart attack: Yes / No b. Stroke: Yes / No c. Angina: Yes / No d. Heart failure: Yes / No e. Swelling in your legs or feet (not caused by walking): Yes / No f. Heart arrhythmia (heart beating irregularly): Yes / No g. High blood pressure: Yes / No h. Any other heart problem that you ve been told about: Yes / No 6. Have you ever had any of the following cardiovascular or heart symptoms? a. Frequent pain or tightness in your chest: Yes / No b. Pain or tightness in your chest during physical activity: Yes / No c. Pain or tightness in your chest that interferes with your job: Yes / No d. In the past two years, have you noticed your heart skipping or missing a beat: Yes / No e. Heartburn or indigestion that is not related to eating: Yes/ No f. Any other symptoms that you think may be related to heart or circulation problems: Yes / No Page 3 of 8

18 7. Do you currently take medication for any of the following problems? a. Breathing or lung problems: Yes / No b. Heart trouble: Yes / No c. Blood pressure: Yes / No d. Seizures (fits): Yes / No 8. If you ve used a respirator, have you ever had any of the following problems? (If you ve never used a respirator, skip to question 9:) a. Eye irritation: Yes / No b. Skin allergies or rashes: Yes / No c. Anxiety: Yes / No d. General weakness or fatigue: Yes / No e. Any other problem that interferes with your use of a respirator: Yes / No 9. Would you like to talk to the health care professional who will review this questionnaire about your answers to this questionnaire: Yes / No Questions 10 to 15 below must be answered by every employee who has been selected to use either a full-face piece respirator or a self-contained breathing apparatus (SCBA). For employees who have been selected to use other types of respirators, answering these questions is voluntary. 10. Have you ever lost vision in either eye (temporarily or permanently): Yes / No 11. Do you currently have any of the following vision problems? a. Wear contact lenses: Yes / No b. Wear glasses: Yes / No c. Color blind: Yes / No d. Any other eye or vision problem: Yes / No 12. Have you ever had an injury to your ears, including a broken ear drum: Yes / No 13. Do you currently have any of the following hearing problems? a. Difficulty hearing: Yes / No b. Wear a hearing aid: Yes / No c. Any other hearing or ear problem: Yes / No 14. Have you ever had a back injury: Yes / No Page 4 of 8

19 15. Do you currently have any of the following musculoskeletal problems? a. Weakness in any of your arms, hands, legs, or feet: Yes / No b. Back pain: Yes / No c. Difficulty fully moving your arms and legs: Yes / No d. Pain or stiffness when you lean forward or backward at the waist: Yes / No e. Difficulty fully moving your head up or down: Yes / No f. Difficulty fully moving your head side to side: Yes / No g. Difficulty bending at your knees: Yes / No h. Difficulty squatting to the ground: Yes / No i. Climbing a flight of stairs or a ladder carrying more than 25 lbs: Yes / No j. Any other muscle or skeletal problem that interferes with using a respirator: Yes / No Part B. Any of the following questions, and other questions not listed, may be added to the questionnaire at the discretion of the health care professional who will review the questionnaire. 1. In your present job, are you working at high altitudes (over 5,000 feet) or in a place that has lower than normal amounts of oxygen: Yes / No If yes, do you have feelings of dizziness, shortness of breath, pounding in your chest, or other symptoms when you re working under these conditions: Yes / No 2. At work or at home, have you ever been exposed to hazardous solvents, hazardous airborne chemicals (e.g., gases, fumes, or dust), or have you had skin contact with hazardous chemicals: Yes / No If yes, name the chemicals if you know them: 3. Have you ever worked with any of the materials, or under any of the conditions, listed below: a. Asbestos: Yes / No b. Silica (e.g., in sandblasting): Yes / No c. Tungsten/cobalt (e.g., grinding or welding this material): Yes / No d. Beryllium: Yes / No e. Aluminum: Yes / No f. Coal (e.g., mining): Yes / No g. Iron: Yes / No h. Tin: Yes / No i. Dusty environments: Yes / No j. Any other hazardous exposures: Yes / No If yes, describe these exposures: Page 5 of 8

20 4. List any second jobs or side businesses you have: 5. List your previous occupations: 6. List your current and previous hobbies: 7. Have you been in the military services? Yes / No If yes, were you exposed to biological or chemical agents (either in training or combat): Yes / No 8. Have you ever worked on a HAZMAT team? Yes / No 9. Other than medications for breathing and lung problems, heart trouble, blood pressure, and seizures mentioned earlier in this questionnaire, are you taking any other medications for any reason (including over-the-counter medications): Yes / No If yes, name the medications if you know them: 10. Will you be using any of the following items with your respirator(s)? a. HEPA Filters: Yes / No b. Canisters (e.g., gas masks): Yes / No c. Cartridges: Yes / No 11. How often are you expected to use the respirator(s) (circle yes or no for all answers that apply to you): a. Escape only (no rescue): Yes / No b. Emergency rescue only: Yes / No c. Less than 5 hours per week: Yes / No d. Less than 2 hours per day: Yes / No e. 2 to 4 hours per day: Yes / No f. Over 4 hours per day: Yes / No Page 6 of 8

21 12. During the period you are using the respirator(s), is your work effort: a. Light (less than 200 kcal per hour): Yes / No If yes, how long does this period last during the average shift: hrs. mins. Examples of a light work effort are sitting while writing, typing, drafting, or performing light assembly work; or standing while operating a drill press (1-3 lbs.) or controlling machines. b. Moderate (200 to 350 kcal per hour): Yes / No If yes, how long does this period last during the average shift: hrs. mins. Examples of moderate work effort are sitting while nailing or filing; driving a truck or bus in urban traffic; standing while drilling, nailing, performing assembly work, or transferring a moderate load (about 35 lbs.) at trunk level; walking on a level surface about 2 mph or down a 5-degree grade about 3 mph; or pushing a wheelbarrow with a heavy load (about 100 lbs.) on a level surface. c. Heavy (above 350 kcal per hour): Yes / No If yes, how long does this period last during the average shift: hrs. mins. Examples of heavy work are lifting a heavy load (about 50 lbs.) from the floor to your waist or shoulder; working on a loading dock; shoveling; standing while bricklaying or chipping castings; walking up an 8-degree grade about 2 mph; climbing stairs with a heavy load (about 50 lbs.). 13. Will you be wearing protective clothing and/or equipment (other than the respirator) when you re using your respirator: Yes / No If yes, describe this protective clothing and/or equipment: 14. Will you be working under hot conditions (temperature exceeding 77/ F): Yes / No 15. Will you be working under humid conditions: Yes / No 16. Describe the work you ll be doing while you re using your respirator(s): Page 7 of 8

22 17. Describe any special or hazardous conditions you might encounter when you re using your respirator(s) (e.g, confined spaces, life-threatening gases): 18. Provide the following information, if you know it, for each toxic substance that you ll be exposed to when you re using your respirator(s): Name of the first toxic substance: Estimated maximum exposure level per shift: Duration of exposure per shift: Name of the second toxic substance: Estimated maximum exposure level per shift: Duration of exposure per shift: Name of the third toxic substance: Estimated maximum exposure level per shift: Duration of exposure per shift: Name of the fourth toxic substance: Estimated maximum exposure level per shift: Duration of exposure per shift: Name of the fifth toxic substance: Estimated maximum exposure level per shift: Duration of exposure per shift: Name of the sixth toxic substance: Estimated maximum exposure level per shift: Duration of exposure per shift: The name of any other toxic substances that you ll be exposed to while using your respirator: 19. Describe any special responsibilities you ll have while using your respirator(s) that may affect the safety and well-being of others (e.g, rescue, security): Page 8 of 8

23 Appendix B Respirator Physical Examination

24 UNIVERSITY HEALTH CENTER NAME: The University of Georgia SSN: Athens, GA GENDER: (706) DOB: Phone: UGA OCCUPATIONAL HEALTH HISTORY (To Be Completed by UGA Occupational Health Patient) Dept.: Job Title: Bldg: How Long on Present Job? Specific Job Description: EXPOSURE HISTORY: In jobs you have held in the past 10 years, have you been exposed to any of the following? If so, give details, including type of exposure, frequency, and duration. Dusts Fumes Radiation Microorganisms Animals Chemicals Noise Temperature Extremes Other: Other: Other: Frequency Duration Length of Time Daily Weekly Monthly Seasonally < 1 Hr. 1-8 Hrs. > 8 Hrs. Are you exposed to any of the above (i.e. dusts, fumes, animals, etc.) in any other jobs or any hobbies you have? Yes No If yes, please specify: Have you experienced any job related illnesses or injuries since being employed by the University? Yes No If yes, give details including month and year. Details: Month/Year Was it Reported? Yes No Yes No Yes No

25 UGA Occupational Health History (Page Two) MEDICAL HISTORY: Current Medications (include over-the-counter medications): Allergies: Hospitalizations (include problem & approximate date): Significant past illnesses (include problem & approximate date): Chronic health problems: Tobacco Use: Have you ever used tobacco? Yes No Cigarettes: Frequency Duration Smokeless Tobacco: Frequency Duration Alcohol (type and amount): IMMUNIZATION HISTORY: Date of Initial Immunization Date of Last Booster Tetanus Polio MMR Hepatitis A / Hepatitis B Rabies Date of Last TB Skin Test: Positive? Yes No If positive, did you have a chest x-ray? Yes No Were you placed on medications? Yes No PERSON TO NOTIFY IN AN EMERGENCY SITUATION: Name: Relationship: Address: Phone: (H) (W) PERMISSION FOR DIAGNOSTIC AND TREATMENT PROCEDURES: I hereby authorize Medical Services and CAPS staff of the University Health Center, their agents or consultants, to perform diagnostic and treatment procedures, which in their judgement may become necessary while at the University of Georgia. If I require specialized and/or emergency care, I will be referred to the appropriate medical facility or professional. I understand that a person listed above will be notified if considered necessary by the professional staff of he University of Georgia. Signature Date

26 UNIVERSITY HEALTH CENTER NAME: The University of Georgia SSN: Athens, GA GENDER: (706) DOB: Phone: UGA OCCUPATIONAL HEALTH PHYSICAL PHYSICAL EXAMINATION: Height: Weight: Temp: Pulse: BP: Resp: Vision: R L Corrected Uncorrected Normal Abnormal Comments General Appearance HEENT Neck Lungs Heart Abdomen Extremities GU Rectal Neurological Musculoskeletal Other Diagnostic Tests: Assessment: RECOMMENDATION(S) TO EMPLOYEE RECOMMENDATION(S) REGARDING JOB REQUIREMENTS Further evaluation by private physician. No limitation of duties and activities. No further evaluation at this time. Limitation of duties and responsibilities as follows: Unable to meet physical/mental requirements for the following reason(s): Clinician/Physician Signature Date UGA OCCUPATIONAL HEALTH EMPLOYEE: To the best of my knowledge, the information I have given is complete and accurate. The above clinician/physician has explained to me all the findings and recommendations of this health assessment/physical evaluation. UGA Occ. Health Employee Signature Date

27 UNIVERSITY HEALTH CENTER UGA OCCUPATIONAL HEALTH APPROVAL FOR PHYSICAL EXAMS, EYE EXAMS, LAB WORK, IMMUNIZATIONS AND X-RAYS Employee Name: UGA ID: M F Date: Address: City: State: Zip: Date of Birth: Marital Status: Single Married Divorced Widow Widower Student: Yes No Faculty/Staff: Yes No UGA Employment: Full-Time Part-Time New to Occupational Health Program? Yes No Dept.: Bldg.: Work #: Home #: Dept. Acct. Name to be Charged: Dept. Acct. # to be Charged: Dept. Contact Person: Dept. Contact Phone #: Dept. Contact Days/Times Available for Appointment: Please check off the appropriate services being requested for the above employee: Physical & Diagnostics Laboratory Vaccinations X-Ray Complete physical Urinalysis (full) Rabies vaccination series Chest (PA) TST (consider QFG-TB) CBC Hepatitis A series Chest (Lateral) Pulmonary function Rabies titer Hepatitis B series Other International Travel Lyme titer Tetanus Consultation RBC Cholinesterase International Travel Other Reticulocyte count Medications Executive profile Smallpox Vision Clinic EKG Botulism Safety Eyewear Quantiferon Gold TB Other Comprehensive Eye Other H1N1 Inactivated Influenza Vaccine Examination H1N1 Live Attenuated Intranasal Vaccine Contact Lens Fitting Vision Screening Color Screening Depth Perception Screening Peripheral Vision Screening Department Head Signature (Required in order to process) Comments: The approval form is valid up to 1 year from the date submitted. (Please contact Shirley Billups at the University Health Center at if you have any questions regarding the completion of this form.) uoh-1 frm.approvalugaocchlth.gen DMS Admin Specialist Effective: 08/93 Reviewed: 06/94; 07/95; 06/96; 06/01; 10/02; 05/04; 09/05; 07/08; 07/09; 09/09 Revised: 11/97; 11/98; 02/99; 05/99; 08/00; 06/03; 09/06; 11/06; 07/07; 09/07; 11/09; 05/10

28 Appendix C Respiratory Protection Training Sign-in Sheet

29 University of Georgia Environmental Safety Division RESPIRATORY PROTECTION TRAINING SIGN-IN SHEET All individuals listed below have received pre-fit respirator training. Pre-fit respiratory training consists of the following: Watching a video from North Safety Equipment, Your Air Purifying Respirator A Piece of Good News Demonstrations of how the respirator works, how to remove cartridges, how to inspect the face piece, how to don the respirator, how to doff the respirator, how to perform negative pressure fit test, how to perform positive pressure fit test, how to disassemble the respirator, how to inspect the respirator, how to clean and sanitize the respirator, and how to reassemble the respirator. Name Department Location Date UGA ESD Trainer s Signature Date

30 Appendix D Respiratory Protection Program Termination Notification

31 University of Georgia Environmental Safety Division RESPIRATORY PROTECTION PROGRAM TERMINATION NOTIFICATION The purpose of this notification is to aid the Environmental Safety Division in the tracking of participants in the respiratory protection program. Please fill out completely and forward to the Environmental Safety Division upon completion. This will serve to inform you that I, Print Name Here, of the Department will no longer participate in the UGA respiratory protection program. Please delete me from your data reporting system after. Date of Deletion Here Employee s Signature Supervisor s Signature Date Date Page 1 of 1

32 UNIVERSITY OF GEORGIA ENVIRONMENTAL SAFETY DIVISION RESPIRATOR SELECTION

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34 TABLE OF CONTENTS SECTION PAGE NUMBER 1.0 PURPOSE DISCUSSION OF SIGNIFICANCE AND USE RESPONSIBILITY HAZARD ANALYSIS AND CONTROLS PRE-JOB PLANNING 5.1 Prerequisites Requirements INSTRUCTIONS 6.1 Selection of Respirators for Routine Use Selection of Respirators for Use in Atmospheres Immediately Dangerous to Life and Health (IDLH) or Confined Spaces Additional Considerations RECORDS REVIEW AND DISPOSITION REFERENCES FORMS AND APPENDICES KEYWORDS...7 8

35 1.0 PURPOSE 1.1 This procedure establishes the method that personnel operating under the UGA Respiratory Program shall use to select the appropriate respiratory protection for subsequent use in potentially hazardous atmospheres. 2.0 DISCUSSION OF SIGNIFICANCE AND USE 2.1 Since it is not always possible to remove respiratory hazards by implementing engineering and administrative controls, this procedure provides for analysis, definition, and designation of protection practices for the respirator hazard(s) that may exist or be encountered. The use of any respiratory protection device shall be implemented only after all engineering and administrative controls have been pursued. Continuous efforts shall be made to remove the respiratory hazard(s) throughout the duration of the project. This procedure implements the requirements of the American National Standards Institute (ANSI) Z and provides documentation for respirator and filter selection. 3.0 RESPONSIBILITY 3.1 The environmental safety coordinator and the Environmental Safety Division (ESD) shall administrate the respiratory protection program. 3.2 The respiratory protection program administrator is responsible for the implementation and revision of this procedure. 3.3 Supervisors and ESD personnel are responsible for assessing potential job tasks that may require respiratory protection. Before the proper respirator can be selected, an evaluation of the potential hazard must be completed. The supervisor will be responsible for providing technical information to ESD by providing a Material Safety Data Sheet (MSDS) or, where an MSDS does not exist, a review of potential health hazards based on chemical structural analogy or other toxicological information. This may be accomplished by completing the Evaluation of Respiratory Hazards in the Work Environment form (Appendix A) of this document. 4.0 HAZARD ANALYSIS AND CONTROLS 1

36 4.1 The selection of an inappropriate respirator may compromise the health and safety of the individual wearing the respirator. 5.0 PRE-JOB PLANNING 5.1 Prerequisites Determination of contaminants that may be present in the workplace shall be performed by utilizing background information and airborne sampling data. 5.2 Requirements Only respirators approved in accordance with 30 CFR 11 and listed in the National Institute of Occupational Safety and Health (NIOSH) certified equipment list shall be used. Any change or modification will void the respirator approval and may significantly affect the performance of the respirator. 6.0 INSTRUCTIONS 6.1 Selection of Respirators for Routine Use NOTE: The form Evaluation of Respiratory Hazards in the Work Environment, (Appendix A) shall be completed prior to any respirator being issued. This form may be obtained from the respiratory program administrator Log the following information on the evaluation of respiratory hazards in the work environment form Date Name Department Telephone number List all potentially hazardous chemical(s) or substance(s) that may prompt a request for respiratory protection. 2

37 Describe the physical form of each of the chemicals during its use (gas/solid/liquid/mist/fume, etc.) What is the chemical state of each of the chemicals during use Describe the process or operation(s) in which the chemical(s) is used. Include amounts (mass/volume/concentration) of the chemical(s) in use; operating conditions; deviation from normal temperature or pressure; duration of the process; and any other factor which you think may contribute to the nature of the activity Describe the work environment: approximate dimensions; availability of general and/or local exhaust ventilation; unusual configuration of the work space; or the presence of staff or students who may also be subject to similar risk of exposure Describe the level of work activity and any possible physical stresses on the respirator user. Will the user be wearing other personal protective equipment (PPE)? What types? What is the anticipated frequency/duration of respirator use? (Estimated number of hours of use per day, per week) Describe a reasonable foreseeable emergency situation(s) that could possibly arise given the description of chemical use in the process. Would this type of situation(s) likely require a greater degree of respiratory protection? Has personal exposure monitoring or area sampling been conducted in the past by the Environmental Safety Division during this particular operation at this work location or similar work location(s)? Can real-time monitoring be conducted during the process/operation to provide an estimate of the exposure? Return the evaluation of respiratory hazards in the work environment form (Appendix A) to the respiratory program administrator for review and approval The respiratory program administrator shall assign a control number to the form. 3

38 6.1.4 The respiratory protection program administrator will review the form and meet with the potential user as part of the evaluation process, prior to making any risk assessments of contaminants present and worker activities Selection of respirators shall be performed by the respiratory program administrator taking into consideration the physical characteristics, functional capabilities, assigned protection factors, and the limitation of the various types of respirators (Appendix B and Appendix C). NOTE: The following factors shall be considered for each known contaminant prior to selecting a respirator Contaminant name The contaminant s concentration The contaminant s permissible exposure limit (PEL), threshold limit value (TLV), recommended exposure limit (REL), time weighted average (TWA), short-term exposure limit (STEL), and/or ceiling The contaminant s physical state (i.e. particle size, molecular weight, vapor pressure) Probability of an Immediately Dangerous to Life or Health (IDLH) atmosphere (yes or no) Hazard ratio (divide the measured or estimated concentration of each contaminant by the exposure limit to obtain the hazard ratio) The contaminant s warning properties (i.e. odor, taste, or irritation threshold) The nature of the hazardous operation or process including the operation or process characteristics, work area characteristics, materials used or produced during the work process, worker s duties and actions, and possible abnormal situations The activity of the workers in the hazardous area, whether the worker is in the hazardous area continuously or intermittently during the work shift, whether the work load is light, medium, or heavy. As described by American Conference of 4

39 Governmental Industrial Hygienists (ACGIH) " Threshold Limit Values for Chemical Substances and Physical Agents and Biological Exposure Indices. 6.2 Selection of Respirators for Use in Immediately Dangerous to Life or Health (IDLH) Atmospheres or Confined Spaces IDLH atmospheres are: Known or expected to have contaminant concentrations above the IDLH concentration A confined space that contains less than 19.5% oxygen. NOTE: Confined spaces continue to be the cause of numerous deaths and serious injuries. Therefore, any confined space containing less than 19.5% oxygen is to be considered IDLH, unless the source of the oxygen reduction is understood and controlled. This restriction is imposed because any reduction in the percentage of oxygen present is proof, at a minimum, that the confined space is not adequately ventilated No entry into known or suspected IDLH atmospheres shall be permitted. Known or suspected IDLH atmospheres shall be tested to determine the contaminants present and the concentration of these contaminants. If entry into the IDLH atmosphere is desired, engineering controls shall be implemented to reduce or eliminate these contaminants. Only after tests show the concentration of air contaminants are not immediately dangerous to life or health shall personnel be allowed to enter the affected area. Continuous monitoring will be performed while personnel are in a confined space Emergency Use Respirators 6.3 Additional Considerations The respiratory protection program will not issue respirators for emergency use. If a need arises for such use, a local emergency response team shall be summoned Once the appropriate respirator has been selected, the respiratory program administrator shall log the following information on the Respirator Selection Checklist (Appendix B): 5

40 6.3.2 Type of respirator (full face, half face, air purifying, or atmosphere supplying) Cartridge or filter type Protection factor Any special requirements (i.e., PPE) Signature Date The respiratory program administrator shall sign and date the respirator selection checklist (Appendix B) and retain a copy. 7.0 RECORDS REVIEW AND DISPOSITION 7.1 All records shall receive a documented review by the respiratory program administrator. 7.2 All respirator selection checklists shall be retained for a period of 30 years. 8.0 REFERENCES 8.1 ANSI Z , Practices for Respiratory Protection CFR , Respiratory Protection 8.3 NIOSH, Guide to Industrial Respiratory Protection 8.4 AIHA, Odor Thresholds - for Chemicals with Established Occupational Health Standards (1989) CFR 11, Respiratory Protective Devices; Tests for Permissibility; Fees 8.6 NIOSH Certified Equipment List as of December 31, (ACGIH) American Conference of Governmental Industrial Hygienists Threshold Limit Values for Chemical Substance and Physical Agents and Biological Exposure Indices. 6

41 9.0 FORMS AND APPENDICES Appendix A Evaluation of Respiratory Hazards in the Work Environment Appendix B Respirator Selection Checklist Appendix C Assigned Protection Factors 10.0 KEYWORDS AIR PURIFYING RESPIRATORS A device designed to protect the wearer from inhalation of harmful particles, vapors, gases, or a combination of these contaminants through the use of cartridges, filters, and/or canisters. Air purifying respirators do not protect against oxygen deficient atmospheres, skin irritation, or absorption of contaminants through the skin. The maximum contaminant concentration against which an air purifying respirator will protect is determined by the design efficiency and capacity of the cartridge, canister, or filter and the face to face piece seal on the wearer. For gases and vapors, the maximum concentration for which the air purifying element is designed may be specified by the manufacturer or regulatory agency. ATMOSPHERE SUPPLYING RESPIRATORS Airline Respirator - Respirable air (at least grade D quality as defined in 29 CFR ) is supplied through a hose from a compressor or compressed air cylinders. The hose is attached to the wearer by a belt of other suitable means and can be detached rapidly in an emergency. A flow control valve or orifice is provided to govern the rate of air flow to the wearer. Exhaled air passes through a valve(s) or opening(s) in the enclosure (face piece, helmet, hood, or suit). Up to 300 feet of hose is permissible depending upon manufacturer specifications. Since the air supply can be interrupted, their use is limited to situations from which the wearer can escape unharmed without the aid of the respirator. The wearer is restricted in movement by the hose and must return to a respirable atmosphere by retracing their route of entry. The hose is subject to being severed, pinched off, or disconnected. Airline respirators shall not be used in oxygen deficient or IDLH environments unless worn in conjunction with a separate, self contained air supply (escape bottle or SCBA). Self Contained Breathing Apparatus (SCBA) - A respirator with a supply of air carried by the wearer, this device is open circuit, such that exhaled air passes to the ambient atmosphere through the face piece exhalation valve. This respirator operates in the same manner as the airline respirator except that the wearer carries their own air supply. The 7

42 breathing air quality must be at least grade D quality as defined in 29 CFR The period during which the device will provide protection is limited by the amount of air or oxygen in the apparatus. Some SCBA devices have a short service life (less than 15 minutes) and shall be used only for escape from a hazardous atmosphere. Other important considerations are weight (up to 30 pounds) and bulk. 8

43 Appendix A Evaluation of Respiratory Hazards in the Work Environment

44 Appendix B Respirator Selection Checklist

45 University of Georgia Environmental Safety Division RESPIRATOR SELECTION CHECKLIST 1. Contaminant Name: 2. Contaminant s concentration: 3. Contaminant s: PEL TLV REL TWA STEL 4. Contaminant s physical state: (i.e. particle size, molecular weight, vapor pressure) 5. Probability of an Immediately Dangerous to Life or Health IDLH atmosphere. (Yes or No) 6. Hazard ratio: (divide the measured or estimated concentration of each contaminant by the exposure limit to obtain the hazard ratio) 7. Contaminant s warning properties: (i.e. odor, taste, or irritation threshold) Page 1 of 3

46 8. The nature of the hazardous operation or process including the operation or process characteristics, work area characteristics, materials used or produced during the work process, worker s duties, actions, and possible abnormal situations. 9. The activity of the workers in the hazardous area, whether the worker is in the hazardous area continuously or intermittently during the work shift and whether the work load is light, medium, or heavy. Page 2 of 3

47 This Section to Be Completed by The Respiratory Program Administrator Recommended type of respirator (full face, half face, air purifying, or atmosphere suppling) Recommended cartridge or filter type: Protection factor: Recommended special requirements (i.e., PPE): Respiratory Program Administrator s Signature: Date: Page 3 of 3

48 Appendix C Assigned Protection Factors

49 University of Georgia Environmental Safety Division ASSIGNED PROTECTION FACTORS ASSIGNED PROTECTION FACTORS(a) TYPE OF RESPIRATOR 10 Air purifying half mask. 25 Powered air purifying with a loose fitting hood or helmet or supplied air with a hood or helmet operated in the continuous flow mode. 50 Air purifying full face piece or powered air purifying with a tight fitting face piece Supplied air with a full face piece operated in the pressure demand mode. 10,000 SCBA operated in the pressure demand mode or supplied air with a full face piece operated in the pressure demand mode and having an auxiliary SCBA (escape) operated in the pressure demand mode. (a) The assigned protection factor may be further reduced according to the maximum use concentration of the purifying element being used. Page 1 of 1

50 UNIVERSITY OF GEORGIA ENVIRONMENTAL SAFETY DIVISION RESPIRATOR USE

51

52 TABLE OF CONTENTS PAGE SECTION NUMBER 1.0 PURPOSE DISCUSSION OF SIGNIFICANCE AND USE RESPONSIBILITY HAZARD ANALYSIS AND CONTROLS PRE-JOB PLANNING 5.1 Prerequisites Requirements INSTRUCTIONS 6.1 Full Face Respirators Half Face Respirators RECORDS REVIEW AND DISPOSITION REFERENCES...5

53 1.0 PURPOSE 1.1 The purpose of this procedure is to establish the method which the UGA Respiratory Protection Program shall employ to control routine and non-routine respirator usage. 2.0 DISCUSSION OF SIGNIFICANCE AND USE 2.1 To insure safe and proper respirator use and to maximize respiratory protection, a procedure is needed to promulgate the methods which trained respirator wearers shall employ while using a respirator. 3.0 RESPONSIBILITY 3.1 The environmental safety coordinator and the Environmental Safety Division (ESD) will administrate the respiratory protection program. 3.2 The respiratory protection program administrator is responsible for the implementation and revision of this procedure. 3.3 All UGA personnel qualified to wear a respirator are responsible for the day-today usage and care. 4.0 HAZARD ANALYSIS AND CONTROLS 4.1 The use of this procedure alone does not constitute any hazard or require any controls as its function is to promulgate respirator use guidelines. Respirator use may cause adverse affects on the user if he/she is not medically fit. Therefore, approval for use must be obtained by a qualified physician prior to use. 5.0 PRE-JOB PLANNING 5.1 Prerequisites Any personnel assigned to wear a respirator shall have written verification of completion of respirator training, and shall have successfully completed a fit test for the required respirator within the last 12 months or within 6 months if the respirator is to be used for protection against asbestos, acrylonitrile, lead, benzene, or formaldehyde. 1

54 5.1.2 A valid Respirator Selection Checklist (Respirator Selection, Appendix B) with the approval signature of the respirator protection program administrator shall be available for promulgation and justification of the respirator to be used. 5.2 Requirements All personnel assigned to wear a respirator shall: Guard the respirator against damage at all times If a respirator malfunction occurs, leave the area, remove the respirator, and notify ESD at Inform the respiratory protection program administrator of any change in medical or physical status that may impede the ability to safely wear a respirator: facial scars, teeth removed, weight loss, glasses, etc. 6.0 INSTRUCTIONS 6.1 Full Face Respirators Donning the Respirator Remove the respirator from the plastic bag (save the bag) Inspect the respirator throughly Install the appropriate cartridges/filters Grasp the front of the mask Insert chin Push mask against forehead, squared on the face Use opposite hand and pull strap assembly over the head Tighten the lower straps evenly Tighten the side straps evenly. 2

55 Re-tighten the lower straps Re-tighten the side straps Tighten the top strap or straps (full face only) Perform a satisfactory negative pressure fit check Perform a satisfactory positive pressure fit check. NOTE: Remember, the key to maximum respiratory protection with a respirator is to obtain a comfortable, pressure tight fit Perform the job with caution to insure that the face piece to face seal is not broken. If any problems occur (i.e., respirator malfunction, fatigue, anxiety, contaminant breakthrough, increased effort needed to breathe, etc.), exit the area, remove the respirator, and notify ESD at Doffing the respirator Exit the area and decontaminate all PPE and respiratory equipment as required Loosen all straps Grasp the front of the mask and pull up and away while ducking the head Insure that all the straps are loosened to their tabs, then pull the strap harness assembly over to in front of the face piece Disassemble and inspect all parts of the respirator, clean with warm water, mild soap and soft bristle brush. Air dry respirator and than sanitize Remove cartridges from the respirator and place cartridges into a sealable plastic bag, than place the respirator in another sealable plastic bag. Remember always separate cartridges from respirator to ensure the respirator doesn t become contaminated Store the respirator in an area where the risk of exposure and physical damage is minimal. 3

56 6.2 Half Face Respirators Donning the Respirator Remove the respirator from the plastic bag (save the Bag) or manufacturer s box Inspect the respirator Install the appropriate cartridges/filters If equipped with a harness; Step 1 Step 2 Step 3 Step 4 Insert chin. Pull the harness over the crown of the head. Clasp the lower straps together behind the neck. Adjust the strap tightness If equipped with just two straps; Step 1 Step 2 Step 3 Step 4 Step 5 Step 6 Step 7 Insert chin. Push mask up over the nose, squared on the face. Clasp the lower straps together behind the neck. Clasp the upper straps together and position over the crown of the head. Adjust lower strap tightness. Adjust upper strap tightness. Readjust lower strap tightness Perform a satisfactory negative pressure fit check Perform a satisfactory positive pressure fit check. NOTE: Remember the key to maximum respiratory protection with a respirator is to obtain a comfortable, pressure tight fit Perform the job with caution to insure that the face piece to face seal is not broken. If any problems occur (i.e., respirator malfunction, fatigue, anxiety, contaminant breakthrough, increased effort needed to breathe, etc.). Exit the area, remove the respirator, and notify ESD at Doffing the respirator Exit the area and decontaminate all PPE and respiratory equipment as required Loosen all straps. 4

57 Unclasp the straps and remove Disassemble and inspect all parts of the respirator, clean with warm water, mild soap and soft bristle brush.. Air dry respirator and than sanitize Remove cartridges from the respirator and place cartridges into a sealable plastic bag, than place the respirator in another sealable plastic bag. Remember always separate cartridges from respirator to ensure the respirator doesn t become contaminated Store the respirator in an area where the risk of exposure and physical damage is minimal. 7.0 RECORDS REVIEW AND DISPOSITION 7.1 There are no records generated by this procedure. 8.0 REFERENCES 8.1 ANSI Z , Practices for Respiratory Protection CFR , Respiratory Protection 8.3 NIOSH Publication No , Guide to Industrial Respiratory Protection 5

58 UNIVERSITY OF GEORGIA ENVIRONMENTAL SAFETY DIVISION RESPIRATOR CLEANING AND SANITIZATION

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60 TABLE OF CONTENTS SECTION PAGE NUMBER 1.0 PURPOSE DISCUSSION OF SIGNIFICANCE AND USE RESPONSIBILITY HAZARD ANALYSIS AND CONTROLS PRE-JOB PLANNING 5.1 Requirements INSTRUCTIONS 6.1 Respirator Disassembly Respirator Cleaning Reassembly Sanitizing Storage RECORDS REVIEW AND DISPOSITION REFERENCES...4

61 1.0 PURPOSE 1.1 This procedure establishes the methods which qualified UGA respirator users shall use to clean and sanitize respirators under the UGA Respiratory Protection Program. 2.0 DISCUSSION OF SIGNIFICANCE AND USE 2.1 To ensure maximum respiratory protection, routine cleaning and sanitization of respirators is required. The following procedures provide instruction for the care and maintenance for each type respirator. 3.0 RESPONSIBILITY 3.1 The environmental safety coordinator and the Environmental Safety Division (ESD) will administrate the respiratory protection program. 3.2 The respiratory protection program administrator is responsible for the implementation and revision of this procedure. 3.3 All UGA personnel certified to use respiratory protection shall be required to comply with this procedure. 4.0 HAZARD ANALYSIS AND CONTROLS 4.1 There are no associated hazards with this procedure. 5.0 PRE-JOB PLANNING 5.1 Requirements Only UGA certified respirator users, under the respiratory protection program, shall clean and sanitize respirators in accordance with this procedure Respirators shall be cleaned and sanitized after each use Each respirator shall be cleaned and sanitized at least annually even if it has not been used throughout the course of the year. 1

62 6.0 INSTRUCTIONS 6.1 Respirator Disassembly Remove filters and/or cartridges from face piece Inspect head straps and clips for abuse. Check all elastomer and rubber parts for pliability and signs of deterioration Unscrew and remove exhalation valve guard, valve and seat Remove the threaded plastic flange which held the exhalation valve seat from the inside of the oral/nasal cup Remove oral/nasal cup assembly by pulling it from the mask Unscrew the nut retaining the speaker diaphragm and remove the diaphragm and O-ring. Inspect the O-ring for damage, replace if necessary Remove the speaker adapter and gasket from the face piece by unscrewing the nut on the outside. Inspect the gasket for damage and replace if necessary Remove the cartridge connectors and their grommets from the face piece. Inspect grommet for damage and replace if necessary. 6.2 Respirator Cleaning Wash the face piece and accessories in warm soapy water. Gently scrub with a soft bristle brush. NOTE: Warm water shall be (110 S125 F) Rinse parts thoroughly in clean water Air dry in a clean place or wipe dry with a lintless cloth. 6.3 Reassembly Visually inspect the exhalation valve for damage. If physical abuse is evident, replace. 2

63 6.3.2 Check oral/nasal cup and its inhalation valves for distortion and completeness Reassemble the face piece by reversing the disassembly steps. Make sure all O-rings and gaskets are in place. 6.4 Sanitizing Immerse the respirator body for two minutes in a 50 ppm chlorine solution (about 2 ml bleach to 1 liter of water) Rinse thoroughly in clean water and dry. NOTE: Caution must be taken to thoroughly rinse the respirator after cleaning and sanitizing to prevent dermatitis. 6.5 Storage After inspection, cleaning and necessary repair, respirators shall be stored in an area to protect against dust, sunlight, heat, extreme cold, excessive moisture or damaging chemicals Storage measures which can be used to protect the respirators include: Plastic bags capable of being sealed Plastic containers with tight-fitting lids, such as freezer containers Cans with tight-fitting lids. Respirators should be packed or stored so that the face piece and exhalation valve will rest in a normal face down position. This will eliminate the possibility of distorting the mask and elastomers thus impairing the mask function. 7.0 RECORDS REVIEW AND DISPOSITION 7.1 There are no records generated by this procedure. 8.0 REFERENCES 3

64 8.1 ANSI Z , Practices for Respiratory Protection CFR , Respiratory Protection 8.3 North Safety Products, 7700 Series, Operating and Maintenance Instruction Manual. 4

65 UNIVERSITY OF GEORGIA ENVIRONMENTAL SAFETY DIVISION DETAILED INSPECTION, MAINTENANCE, AND STORAGE OF RESPIRATORY PROTECTION EQUIPMENT

66 TABLE OF CONTENTS SECTION PAGE NUMBER 1.0 PURPOSE DISCUSSION OF SIGNIFICANCE AND USE RESPONSIBILITY HAZARD ANALYSIS AND CONTROLS PRE-JOB PLANNING 5.1 Requirements INSTRUCTIONS 6.1 Inspection of Full-Face Air Purifying Respirators Inspection of Half-Face Air Purifying Respirators Storage of Respiratory Protection Equipment REFERENCES FORMS AND APPENDICES...5

67 1.0 PURPOSE 1.1 This document establishes the procedures which shall be used by personnel operating under the UGA Respiratory Protection Program to ensure detailed and proper inspection, maintenance, and storage of respiratory protection equipment. 2.0 DISCUSSION OF SIGNIFICANCE AND USE 2.1 This procedure provides instructions on the detailed inspection and maintenance of respiratory protection equipment. Any maintenance not specified in this procedure shall be performed by an authorized manufacturer s service center. 3.0 RESPONSIBILITY 3.1 The environmental safety coordinator and the Environmental Safety Division (ESD) will administrate the respiratory protection program. 3.2 The respiratory protection program administrator is responsible for the implementation and revision of this procedure. 3.3 All UGA personnel qualified to perform detailed inspection and maintenance of respiratory protection equipment shall comply with this procedure. 4.0 HAZARD ANALYSIS AND CONTROLS 4.1 The installation of other than specific manufacturer s replacement parts will compromise the integrity and void the National Institute of Occupational Safety and Health (NIOSH) approval of the respirator. 5.0 PRE-JOB PLANNING 5.1 Requirements Only UGA personnel who have been trained and qualified shall perform detailed inspections of air purifying respirators in accordance with this procedure When inspection indicates that parts replacement is necessary, the only 1

68 parts allowed for replacement shall be from the manufacturer of that specific respirator. 6.0 INSTRUCTIONS 6.1 Inspection of Full-Face Air Purifying Respirators Inspect the face piece and harness assemble for: Cracks, tears, holes, and rips Defective buckles Evidence of distortion and deterioration Inspect the seal area of the face piece for evidence of distortion and deterioration Inspect the lens for cracks or excessive scratches Inspect the lens ring for defects and verify the ring holding the lens is securely in place Remove the exhalation valve cover and inspect the exhalation valve body for cracks, nicks, and proper fit Verify the exhalation valve (flapper valve) is in good condition and seats properly Push the exhalation valve cover into place until it snaps, locking the cover Inspect the cartridge receptacle for cracks, nicks, and damaged threads Verify that the cartridge receptacle gasket is free of cracks and nicks Install the gasket with the flat side facing up Visually inspect the inhalation valves and assure they are attached to the post on the inhalation valve seat. NOTE: A nose cup shall be installed whenever the device is used in temperatures at or below 32/ F. 2

69 NOTE: Any respirator not passing inspection shall be tagged out of service and repaired by UGA trained qualified respiratory personnel, using specific manufacturer parts. If the respirator is not repairable, discard it and replace with a new one of the same manufacturer and size If the respirator is considered ready for personnel use, print the following on the Full-Face Air Purifying Respirator Inspection Certification (Appendix A of this document) Identification Number Manufacturer Type (AP = Air Purifying) Date due for inspection (one year from inspection date) Technician s name performing inspection Date of inspection Place the certification with the respirator in a zip-lock bag and seal Place the respirator in its appropriate storage location, stored face-down to prevent damage. 6.2 Inspection of Half-Face Air Purifying Respirators Inspect the face piece assembly for cracks, tears, holes and rips Inspect the harness assembly for defective buckles and evidence of strap distortion and deterioration Inspect the seal area of the face piece for distortion and deterioration Remove the exhalation valve cover and inspect exhalation valve body for cracks, nicks, and proper fit Push the exhalation valve cover into place until it snaps, locking the cover Inspect the cartridge receptacle for cracks, nicks, and damaged threads Verify that the cartridge receptacle gasket is free of nicks and cracks. 3

70 6.2.8 Install the cartridge receptacle gasket flat side up Visually inspect the inhalation valves and ensure that they are attached to the post on the inhalation valve seat. NOTE: Any respirator not passing inspection shall be tagged out of service and repaired by UGA trained qualified respiratory personnel, using specific manufacturer parts. If the respirator is not repairable, discard it and replace with a new one of the same manufacturer and size If the respirator is considered ready for use, record the following information on the Half-Face Air Purifying Respirator Inspection Certification (Appendix B of this document) Respirator Identification Number Manufacturer Type (AP = Air Purifying) Date due for inspection (one year from inspection date) Technician s name performing inspection Date of inspection Place the certification with the respirator in a zip-lock bag and seal Place the respirator in its appropriate storage location, stored face-down to prevent damage. 6.3 Storage of Respiratory Protection Equipment NOTE: Respirators shall be stored in a manner which will protect them from dust, sunlight, heat, extreme cold, excessive moisture, and damaging chemicals. While in storage, the respirator shall be physically oriented to prevent distortion of the rubber and other elastomeric parts Preferred Respirator Storage Method Half-face respirators should be stored inside a heat sealed or zip-lock plastic bag with the appropriate respirator inspection certification (Appendix B) and placed face down inside a storage slot. 4

71 Full-face respirators should be stored inside a heat sealed or ziplock plastic bag with the appropriate respirator inspection certification (Appendix A) and placed face down inside a storage slot Alternate Respirator Storage Method NOTE: The alternate storage method should only be used if respirators are being stored at remote job sites or where limited storage space is available Half-face respirators should be stored inside a heat sealed or zip-lock plastic bag with the appropriate respirator inspection certification and placed face down in a cardboard box Full-face respirators should be stored inside a heat sealed or ziplock plastic bag with the appropriate respirator inspection certification and placed face down in a cardboard box. 7.0 REFERENCES 7.1 ANSI Z , Practices for Respiratory Protection CFR , Respiratory Protection 7.3 NIOSH Publication No , Guide to Industrial Respiratory Protection 7.4 North Safety Products, Maintenance Manual for Air Purifying Respirators 8.0 FORMS AND APPENDICES Appendix A Full-Face Air Purifying Respirator Inspection Certification Appendix B Half-Face Air Purifying Respirator Inspection Certification 5

72 Appendix A Full-Face Air Purifying Respirator Inspection Certification

73 University of Georgia Environmental Safety Division FULL-FACE AIR PURIFYING RESPIRATOR INSPECTION CERTIFICATION 1. Inspect the face piece and harness assembly for: Q Cracks, tears, holes, and rips. Q Defective buckles. Q Evidence of distortion and deterioration. 2. Inspect the seal area of the face piece for: Q Evidence of distortion and deterioration. 3. Inspect the lens for: Q Cracks, and excessive scratches. 4. Inspect the lens ring for: Q Defects Q Verify the ring is holding the lens securely in place. 5. Remove the exhalation valve cover and inspect the exhalation valve body for: Q Cracks, nicks, and proper fit. 6. Verify the exhalation valve (flapper valve) is: Q In good condition and seats properly. 7. Inspect the cartridge receptacle for: Q Cracks, nicks, and damaged threads. 8. Verify that the cartridge receptacle gasket is: Q Free of cracks and nicks. 9. Visually inspect the inhalation valves for: Q Nicks, holes, and tears. Q Assure the inhalation valves are attached to the post on the inhalation valve seat. Respirator Manufacturer Type Size Date due for inspection (one year from inspection date) Technician s name performing inspection Date of inspection

74 Appendix B Half-Face Air Purifying Respirator Inspection Certification

75 University of Georgia Environmental Safety Division HALF-FACE AIR PURIFYING RESPIRATOR INSPECTION CERTIFICATION 1. Inspect the face piece assembly for: Q Cracks, tears, holes, and rips. 2. Inspect the harness assembly for: Q Defective buckles. Q Evidence of distortion and deterioration. 3. Inspect the seal area of the face piece for: Q Evidence of distortion and deterioration. 4. Remove the exhalation valve cover and inspect the exhalation valve body for: Q Cracks, nicks, and proper fit. 5. Inspect the cartridge receptacle for: Q Cracks, nicks, and damaged threads. 6. Verify that the cartridge receptacle gasket is: Q Free of cracks and nicks. 7. Visually inspect the inhalation valves for: Q Nicks, holes, and tears. Q Assure the inhalation valves are attached to the post on the inhalation valve seat. Respirator Manufacturer Type Size Date due for inspection (one year from inspection date) Technician s name performing inspection Date of inspection

76 UNIVERSITY OF GEORGIA ENVIRONMENTAL SAFETY DIVISION RESPIRATOR FIT TESTING

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78 TABLE OF CONTENTS SECTION PAGE NUMBER 1.0 PURPOSE DISCUSSION OF SIGNIFICANCE AND USE RESPONSIBILITY HAZARD ANALYSIS AND CONTROLS PRE-JOB PLANNING 5.1 Prerequisites Requirements FIT TESTING PROTOCOL 6.1 Bitrex TM Solution Aerosol Qualitative Fit Test Protocol Respirator Functional Fit Checks Bitrex Qualitative Fit Testing Cleaning Qualitative Fit Testing - Stannic Chloride (Irritant Smoke) Recording Information on Respirator Fit Test Record Odor Threshold Screening - Isoamyl Acetate (IAA, Banana Oil) Qualitative Fit Testing - Isoamyl Acetate (IAA, Banana Oil) Recording Information on Respirator Fit Test Record RECORDS REVIEW AND DISPOSITION REFERENCES FORMS AND APPENDICES...15

79 1.0 PURPOSE 1.1 This procedure establishes the method that personnel shall use to perform respirator fit testing under the UGA Respiratory Protection Program. 2.0 DISCUSSION OF SIGNIFICANCE AND USE 2.1 Since people are unique and physically different, all possible variables pertaining to respirator use cannot be predetermined. Therefore, fit tests for each person assigned to wear a respirator are required. 3.0 RESPONSIBILITY 3.1 The environmental safety coordinator and the Environmental Safety Division (ESD) will administrate the respiratory protection program. 3.2 The respiratory protection program administrator is responsible for the implementation and revision of this procedure. 3.3 All ESD personnel qualified to perform fit tests are required to comply with this procedure. 4.0 HAZARD ANALYSIS AND CONTROLS 4.1 Potential hazards involved with this procedure include the use of stannic chloride absorbed on pumice and isoamyl acetate (IAA) for performing qualitative fit testing. 4.2 Stannic chloride (SnC14) smoke tubes will produce tin oxides, smoke, and hydrochloric acid when exposed to air. This mixture is irritating to the eyes and mucous membranes. Controls shall consist of performing the fit test either in a well ventilated area, outside upwind, or while wearing a negative pressure respirator with HEPA cartridges. Avoid contact of the granules in the tube with the eyes or skin and avoid inhaling heavy concentrations of the smoke. If the contents of a tube are released, leave the area until smoke generation subsides, fill a bucket 3/4 full of water and add 1 ounce of sodium bicarbonate, don protective gloves and safety glasses, sweep up the tube and contents, place in the bucket, let sit overnight, then filter the solids from the water and dispose of both. 4.3 Since the use of isoamyl acetate is infrequent and involves minute amounts, the only concern here is the flammability rating of 3 (severe). Control shall consist of 1

80 usage in a well ventilated area at least 15 feet away from any ignition source. 5.0 PRE-JOB PLANNING 5.1 Prerequisites The following conditions shall be completed by each proposed respirator user prior to fit testing Successful completion of a respirator medical evaluation from a qualified Licensed Healthcare Practitioner (LHP) or physician dated within the past 12 months Successful completion of UGA respiratory protection training within the past 12 months Shall not have smoked within 15 minutes prior to the fit test Shall be clean shaven (defined as within the last 24 hours and preferably that morning) in the seal area of the respirator Any protective equipment that may be worn during a project which could interfere with the respirator fit shall be worn during the fit test (e.g., hard hat, safety glasses, etc.) The respirator used for the fit test shall be cleaned and sanitized. (For the half masks used in the qualitative fit test, a thorough wipe with an appropriate disinfectant shall suffice). 5.2 Requirements Only qualified ESD personnel shall perform respirator fit testing in accordance with this procedure Qualitative fit testing using Bitrex TM (denatonium benzoate) Solution Aerosol shall be the preferred method for respirator fit testing Qualitative fit testing with stannic chloride (irritant smoke) shall be used if Bitrex TM Solution is unavailable or a test subject is unable to detect Bitrex TM Solution Qualitative fit testing with isoamyl acetate (banana oil) shall be used if Bitrex TM or stannic chloride is unavailable or not detected by the test 2

81 subject. 6.0 FIT TESTING PROTOCOL 6.1 Bitrex TM (denatonium benzoate) Solution Aerosol Qualitative Fit Test Protocol The Bitrex TM (denatonium benzoate) solution aerosol QLFT protocol uses the published saccharin test protocol since it is the most widely accepted. Bitrex is routinely used as a taste aversion agent in household liquids which children should not be drinking and is endorsed by the American Medical Association, the National Safety Council, and the American Association of Poison Control Centers. The entire screening and testing procedure shall be explained to the test subject prior to the conduct of the screening test Preparation Connect the snaps at the top of the hood, so that the connections help to support the hood Pour a small amount, approximately 1 teaspoon full, of the screening solution into the nebulizer labeled No. 1 - Threshold Screening Test Solution Pour the same amount of fit test solution into the second nebulizer labeled No. 2 - Fit Test Solution Sensitivity Test This is conducted to assure that the person being fit tested can detect the taste of the Bitrex solution at very low levels. The sensitivity test solution is a 200 to1 dilution of the fit test solution. NOTE: The test subject should not eat, drink, smoke or chew gum for at least 15 minutes before the test Explain the fit test procedures to the subject Have the subject don the hood without a respirator Position the hood forward so there is about six inches between the subject s face and the window. This is especially important for the fit test which will help to ensure even dispersion of the aerosol and allows free movement of the subject s head while wearing a respirator Instruct the subject to breathe through his/her mouth. 3

82 Using the threshold screening test solution nebulizer No.1, aspirate the aerosol into the hood through the hole in the window. Aspirate ten squeezes of the bulb, fully collapsing and allowing the bulb to expand fully between each squeeze Ask the subject if he/she can detect the bitter taste of the solution. If tasted, note the number of squeezes at detection and proceed to the fit test If the subject does not taste the screening solution, aspirate an additional 10 full squeezes of the aerosol into the hood. Repeat with 10 more squeezes of the aerosol into the hood if still not tasted If 30 squeezes were inadequate to produce a response from the subject, the test should be ended and another type of fit test protocol must be used. NOTE: If the test subject was unable to detect the bitter taste of Bitrex at this point, a qualitative fit test using stannic chloride (irritant smoke) shall be used; proceed to 6.2 and Remove the hood and give the subject a few minutes to clear the taste from his/her mouth. 6.2 Respirator Functional Fit Checks Lay out one of each size of each manufacturer s respirator for the test subject to choose from equipped with a particulate filter Verify the following information on each test subject prior to performing a fit test: Respirator training date is within the past 12 months Respirator medical date is within the past 12 months Test subject is clean shaven (defined as within the last 24 hours and preferably that morning) in the seal area of the respirator. NOTE: The following shall be noted for full face piece respirators: If the test subject must wear corrective lenses, perform the fit 4

83 test with a spectacle kit installed in the respirator. Note on the Fit Test Record (Appendix A) that a spectacle kit is required. Give the person a spectacle kit for the chosen respirator and instruct him/her to submit a purchase request for prescription lenses (an eye exam within the past 12 months will be required) Explain to the test subject that he/she is being asked to choose the respirator that will provide the most comfortable fit. This promotes proper wearing of the respirator and thus provides designed protection during use Review the following information with each test subject: How to inspect the respirator prior to donning How to don the respirator How to position the respirator How to set strap tension. NOTE: A mirror shall be available to assist the test subject in evaluating the fit and positioning of the respirator Have the test subject perform the following: Hold each face piece up to his/her face and eliminate the ones that do not seal properly Don the chosen respirator Perform a negative pressure fit check Perform a positive pressure fit check. NOTE: If leakage is detected, reposition the respirator and perform the negative and positive pressure fit checks again. If a satisfactory fit is NOT obtained after the second attempt, try another respirator. 5

84 6.2.6 Have the subject wear the respirator for 10 minutes while considering the following points to assist in comfort assessment: Chin properly placed Positioning of respirator Strap tension Tendency to slip Self observation in a mirror If the test subject considers the respirator comfortable after 10 minutes, have them perform the following: Move the head from side to side Move the head up and down Perform a negative pressure fit check Perform a positive pressure fit check Don any probable interfering PPE. (i.e. hard hat) Review the test exercises to be performed (Section thru ) 6.3 Bitrex Qualitative Fit Test Have the test subject don and fit check the respirator per the instructions provided with the respirator. NOTE: The fit test is to be performed with the test subject using a particulate filter or respirator Have the test subject don and position the hood as before, and to breathe through his/her mouth Using the fit test nebulizer #2, inject the fit test aerosol through the hole in the hood using the same number of full bulb squeezes as required in the sensitivity test; i.e., 10, 20, or 30 squeezes. 6

85 6.3.4 To maintain an adequate concentration of aerosol during this test, inject one-half of the number of squeezes used in step about every 30 seconds Instruct the subject to indicate if they detect the bitter taste of Bitrex at any time during the test After the initial aerosol is injected, instruct the test subject to perform the following exercises for 60 seconds each Normal breathing Deep breathing breaths should be deep and regular Turning head from side to side movement should be complete with one turn every second Nodding head up and down movement should be complete and made about once per second Talking: have the test subject recite the Rainbow Passage located in Appendix B Have the test subject resume normal breathing If the entire test is completed without the subject detecting the bitter taste of the Bitrex aerosol, the test is successful and the respirator fit is deemed adequate. This test verifies an assigned protection factor of If the test subject does detect the bitter taste of the Bitrex aerosol, terminate the test (this indicates an inadequate fit). Wait 15 minutes and perform the tests over, starting with the sensitivity test and proceeding to thru NOTE: Certain OSHA standards require specific exercises in addition to the ones listed above. Examples of these are: Substance Regulation Exercise Asbestos CFR Jog in place Benzene CFR Grimace, bend over, or jog in place Formaldehyde CFR Grimace, bend over, or jog in place Have the test subject remove the respirator. 7

86 Record the following information on the Respirator Fit Test Record. (Appendix A) 6.4 Cleaning Test subject s name, date, employee number (SS#), phone number, job title/description, department, building, and room number Respirator selected, manufacturer, NIOSH approval number, and model Conditions which could affect respirator fit: beard growth, facial scars, dentures absent, glasses, etc Results of fit checks; negative and positive pressure Fit test type (quantitative or qualitative) and results (overall fit factor for quantitative fit test or pass/fail for qualitative fit test) Have test subject and the person conducting the test sign and date the Respirator Fit Test Record Immediately after completing the test, pour the unused solutions back into the respective bottles. Rinse the nebulizers with warm water to prevent clogging. Wipe out the inside of the hood with a damp cloth or paper towel to remove any deposited test solution. 6.5 Qualitative Fit Testing - Stannic Chloride (Irritant Smoke) NOTE: Qualitative fit testing using irritant smoke shall only be performed if qualitative Bitrex fit testing equipment is unavailable or if test subject does not detect Bitrex This qualitative fit test uses a person s response to the irritating chemicals released in the smoke produced by a stannic chloride ventilation smoke tube to detect leakage into the respirator General Requirements and Precautions The respirator to be tested shall be equipped with high efficiency particulate air (HEPA) or P100 series filter(s) Only stannic chloride smoke tubes shall be used for this 8

87 protocol. 9

88 No form of test enclosure or hood for the test subject shall be used The smoke can be irritating to the eyes, lungs, and nasal passages. The test conductor shall take precautions to minimize the test subject s exposure to irritant smoke. Sensitivity varies, and certain individuals may have a greater degree of response to irritant smoke. Care shall be taken when performing the sensitivity screening checks to use only the minimum amount of smoke necessary to elicit a response from the test subject The fit test shall be performed in an area with adequate ventilation to prevent exposure of the person conducting the fit test or the build-up of irritant smoke in the general atmosphere Sensitivity Screening Check The person to be tested must demonstrate his or her ability to detect a weak concentration of the irritant smoke. NOTE: If the test subject does not react to the smoke, than a qualitative fit test using isoamyl acetate (banana oil) shall be conducted The test operator shall break both ends of a ventilation smoke tube containing stannic chloride, and attach one end of the smoke tube to a low flow air pump set to deliver 200 milliliters per minute, or to an aspirator squeeze bulb. The test operator shall cover the other end of the smoke tube with a short piece of tubing to prevent potential injury from the jagged end of the smoke tube The test operator shall advise the test subject that the smoke can be irritating to the eyes, lungs, and nasal passages and instruct the subject to keep his/her eyes closed while the test is performed The test subject shall be allowed to smell a weak concentration of the irritant smoke before the respirator is donned to become familiar with its irritating properties and to determine if he/she can detect the irritating properties of the smoke. The test operator shall carefully direct a small amount of the irritant smoke in the test subject s direction to make this determination. 10

89 6.5.4 Proceed to section 6.2 (Respirator Functional Fit Checks) of this procedure prior to performing the irritant smoke fit test Irritant Smoke Fit Test Procedure The person being fit tested shall don the respirator without assistance, and perform the required user seal checks in section The test subject shall be instructed to keep his/her eyes closed The test operator shall direct the stream of irritant smoke from the smoke tube toward the face-seal area of the test subject, using the low flow pump or the squeeze bulb. The test operator shall begin at least 12 inches from the face piece and move the smoke stream around the whole perimeter of the mask. The operator shall gradually make two more passes around the perimeter of the mask, moving to within six inches of the respirator If the person being tested has not had an involuntary response and/or detected the irritant smoke, proceed with the test exercises Each of the exercises identified in Appendix B of this procedure shall be performed for at least one minute by the test subject while the respirator seal is being continually challenged by the smoke, directed around the perimeter of the respirator at a distance of six inches If the person being fit tested reports detecting the irritant smoke at any time, the test is failed. The person being retested must repeat the entire sensitivity check and fit test procedure Each test subject passing the irritant smoke test without evidence of a response (involuntary cough, irritation) shall be given a second sensitivity screening check, with the smoke from the same smoke tube used during the fit test, once the respirator has been removed, to determine whether he/she still reacts to the smoke. Failure to evoke a response shall void the fit test If a response is produced during this second sensitivity check, then the fit test is passed. 11

90 6.6 Record the following information on the Respirator Fit Test Record. (Appendix A) Test subject s name, date, employee number (SS#), phone number, job title/description, department, building, and room number Respirator selected, manufacturer, NIOSH approval number, and model Conditions which could affect respirator fit: beard growth, facial scars, dentures absent, glasses, etc Results of fit checks; negative and positive pressure Fit test type (quantitative or qualitative) and results (overall fit factor for quantitative fit test or pass/fail for qualitative fit test) Have test subject and the person conducting the test sign and date the Respirator Fit Test Record. NOTE: Clean and Sanitize respirator, refer to section 6.0 of Cleaning and Sanitization instruction. 6.7 Odor Threshold Screening - Isoamyl Acetate (Banana Oil) Three, one-liter glass jars with metal lids are required Use odor free water at approximately (78/ F) for the solutions Prepare the isoamyl acetate stock solution by adding 1 ml of pure isoamyl acetate 800 ml of odor free water in a one-liter glass jar and shaking for 30 seconds. New solution must be prepared at least weekly Conduct the screening test in a room separate from the room used for the actual testing. The two rooms should be well ventilated, but may not be connected to the same recirculating ventilation system Prepare the odor test solution in a second jar by placing 0.5 ml of the stock solution into 625 ml of odor free water using the enclosed pipette. Shake for 30 seconds and allow to stand for two to three minutes so that the isoamyl acetate concentration above the liquid may reach equilibrium. This solution may be used for one day only Prepare a test blank in a third jar by adding 625 ml of odor free water. 12

91 6.7.7 Label the odor test and test blank jars 1 and 2 for jar identification. If the labels are put on the lids, they can be periodically switched to avoid test subjects recognition of the IAA jar Type the following instruction and place on a table in front of the two test jars: The purpose of this test is to determine whether you can smell banana oil at a low concentration. The two jars in front of you contain water. One of these jars also contains a small amount of banana oil. Be sure the covers are secured tightly, then shake each jar for two seconds. Unscrew the lid of each jar (one at a time) and smell contents. Indicate to the test conductor which jar contains banana oil Prepare the mixtures used in the IAA odor detection test in an area separate from the testing area to prevent olfactory fatigue in the test subject If the test subject is unable to correctly identify the jar containing the odor test solution, the IAA qualitative fit test may not be used If the test subject correctly identifies the jar containing the odor test solution, he may proceed to section 6.2 (Respirator Functional Fit Checks) of this procedure. 6.8 Qualitative Fit Testing-Isoamyl Acetate (Banana Oil) Take a 24" round piece of cardboard and cut a 2" slit in the center. Slide the hook of a wire coat hanger through the slit. Invert the plastic bag over the cardboard. Puncture the center of what would normally be the bottom of the plastic bag with the hook portion of the wire coat hanger. The hook of the wire coat hanger should now support the inverted plastic bag and form a test chamber Suspend the test chamber from the ceiling of the fit test area with a length of heavy string so that the chamber can be adjusted to the height of the employee being tested. The top of the test chamber should be about six inches above the test subject s head Each respirator used for the fitting and fit testing should be equipped with organic vapor cartridges, or offer protection against organic vapors. The cartridge or masks should be changed at least weekly. 13

92 6.8.4 After selecting, donning, and properly adjusting a respirator himself/herself, the test subject should wear the respirator to the fit test room. This room must be separate from the room used for odor threshold screening and respirator selection and should be ventilated by an exhaust fan or lab hood to prevent general room contamination Tape a copy of the Rainbow Passage to the inside of the test chamber. This can be located in Appendix B Each test subject should wear their respirator for at least ten minutes before starting the test Upon entering the test chamber, the test subject should be given a 6" x 5" piece of paper towel (or other porous absorbent single ply material) folded in half and wetted with 0.75 ml of pure IAA. The test subject should hang the wet towel over the hanger inside the top of the chamber Allow two minutes for the IAA test concentration to stabilize before starting the fit test exercises. This would be an appropriate time to explain the fit test to the test subject and to discuss the importance of his/her cooperation, the purpose for the head exercises, or to demonstrate some of the exercises Each exercise described in Appendix B must be performed for at least one minute If at any time during the test the test subject detects the banana-like odor of IAA, he/she shall quickly exit the test chamber and leave the test area to avoid olfactory fatigue. NOTE: At low concentrations, there is no respiratory danger involved with using IAA. A quick exit is recommended to prevent the test subject s sense of smell from being overcome with banana oil and preventing a good retest Upon returning to the selection room, the test subject should remove the respirator, repeat the odor sensitivity test, select and don another respirator, return to the test chamber, and repeat the test. The process must continue until a respirator that fits correctly has been found. Should the odor sensitivity test be failed, the subject should wait about 5 minutes before retesting. Odor sensitivity will usually have returned by this time When a respirator is found that passes the test, the efficiency can be demonstrated for the subject by having him break the face seal and take a 14

93 breath before exiting the chamber When the test subject leaves the test chamber, he should remove the saturated towel, returning it to the test conductor. To keep the area from becoming contaminated, the used towels should be kept in a self-sealing bag. There is no significant IAA concentration buildup in the test chamber from repetitive testing A test subject who has successfully passed this fit test may be assigned the use of the tested respirator in atmospheres with up to ten times the PEL of a known contaminant. In other words, this IAA protocol may be used to assign a protection factor not higher than Record the following information on the Respirator Fit Test Record. (Appendix A) Test subject s name, date, employee number (SS#), phone number, job title description, department, building, and room number Respirator selected, manufacturer, NIOSH approval number, and model Conditions which could affect respirator fit: beard growth, facial scars, dentures absent, glasses, etc Results of fit checks; negative and positive pressure Fit test type (quantitative or qualitative) and results (overall fit factor for quantitative fit test or pass/fail for qualitative fit test) Have test subject and the person conducting the test sign and date the Respirator Fit Test Record. NOTE: Clean and Sanitize respirator, refer to section 6.0 of Cleaning and Sanitization instruction. 7.0 RECORDS REVIEW AND DISPOSITION 7.1 All records shall receive a documented review by the respiratory program administrator. 7.2 ESD shall retain all respirator fit test records in subject s respirator file indefinitely. 15

94 8.0 REFERENCES 8.1 ANSI Z , Practices for Respiratory Protection CFR , Respiratory Protection CFR Appendix E, Qualitative and Quantitative Fit Testing Procedures 9.0 FORMS AND APPENDICES Appendix A Respirator Fit Test Record Appendix B Fit Test Exercises 16

95 Appendix A Respirator Fit Test Record

96 University of Georgia Environmental Safety Division RESPIRATOR FIT TEST RECORD A. Employee: Date: Employee No/SSN: Phone: Employee Job Title/Description: Department: Building/Room number: B. Respirator selected: Manufacturer: NIOSH approval number: Model: C. Conditions which could affect respirator fit: G Clean shaven G Facial scar G 1S2 day beard growth G Dentures absent G 2+ days beard growth G Glasses G Moustache G None Comments: D. Fit checks: Negative pressure G Pass G Fail G Not done Positive pressure G Pass G Fail G Not done E. Fit testing: Quantitative Fit factor Qualitative Bitrex Irritant smoke Isoamyl acetate G Pass G Fail G Pass G Fail G Pass G Fail Comments: F. Employee Acknowledgment of test results: Employee Signature: Date: Test Conducted by: Date: Reviewed by: Date: Respiratory Program Administrator The above respirator fit test was performed on and by the persons listed. The results indicate the performance of the listed respiratory protective device, as fitted on the employee named on this record under controlled conditions. Fit testing, as performed, measures the ability of the respiratory protective device to provide protection to the individual tested. The Environmental Safety Division or the test conductor cannot guarantee that this or an identical respiratory protective device will provide adequate protection under conditions other than those present when this test was performed. Improper use, maintenance, or application of this or any other respiratory protective device will reduce or eliminate protection.

97 University of Georgia Environmental Safety Division RESPIRATOR FIT TEST EXERCISES NOTE: EACH EXERCISE SHALL BE PERFORMED FOR ONE MINUTE 1. Normal breathing 2. Deep breathing (deep and regular) 3. Turning head from side to side make sure movement is complete, shoulder to shoulder ensuring that the respirator is not bumped on the shoulders, and inhaling is performed when the head is at either side. 4. Nodding head up and down make sure movement is complete and made about every second, ensuring not to bump respirator on the chest, and inhaling when the head is in the up position. 5. Talking slowly and audibly, read the Rainbow Passage. When the sunlight strikes raindrops in the air, they act like a prism and form a rainbow. The rainbow is a division of white light into many beautiful colors. These take the shape of a long round arch, with its path high above, and its two ends apparently beyond the horizon. There is, according to legend, a boiling pot of gold at one end. People look but no one ever finds it. When a man looks for something beyond reach, his friends say he is looking for the pot of gold at the end of the rainbow. 6. Resume normal breathing