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DCH-3877 (Rev. 9-16) Previous edition obsolete. 1. PREADMISSION SCREENING (PAS)/ANNUAL RESIDENT REVIEW (ARR). (Mental Illness / Intellectual .

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How to fill out the Face Fit Test Record Sheet online

Filling out the Face Fit Test Record Sheet online is an important step for ensuring compliance with health and safety regulations. This guide provides a clear, step-by-step approach to help users accurately complete the form, providing essential information for maintaining safety standards.

Follow the steps to fill out the Face Fit Test Record Sheet comprehensively.

  1. Press the ‘Get Form’ button to access the Face Fit Test Record Sheet and open it in your digital editor.
  2. Complete the 'Patient Information' section by entering the patient’s name, date of birth, gender, address including city, state, and ZIP code. Ensure that all required fields are filled out accurately.
  3. Provide the necessary identification numbers, including the Social Security number, Medicaid Beneficiary ID number, and Medicare ID number. Double-check for accuracy to prevent processing delays.
  4. Indicate whether the patient has a court-appointed guardian or legal representative. If yes, fill in their name, the county where appointed, and contact information.
  5. Fill in the referring agency’s name and contact number, along with the nursing facility's name and address, as well as the proposed or actual admission date.
  6. Sections II and III must be completed by a qualified clinician such as a nurse or therapist. Review the screening criteria carefully, marking responses as 'Yes' or 'No' as applicable.
  7. In the 'Clinician’s Statement,' ensure the clinician signs and dates the form, providing their name, degree or license, address, and telephone number. This certifies that the information is accurate to the best of their knowledge.
  8. After reviewing all entries, save your changes. You can also download or print the completed form for your records or share it as necessary.

Begin filling out the Face Fit Test Record Sheet online today to ensure timely compliance and safety standards.

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Keep a written record of fit-tests carried out for each worker, including the: type of test performed • make, model, style and size of respirator tested • date and result of the test. Issue workers with a fit-test record card after fit-testing.

You need to make sure any long hair is tied back and that your face is clean-shaven to provide the most effective seal. Respirator wearers also need to be aware that facial scars as well as facial and dental surgery can impact the size and protection level offered by their respirator.

How long does a face fit test certificate last? BSIF recommend a re-test at least every 2 years. However, if the mask is being used as the primary means of protection then annual testing should be conducted.

Face Fit testing is a method of ensuring that a facepiece or mask is tight-fitting and seals adequately to the wearer's face. The performance of tight-fitting facepieces depends on achieving continuous contact between the wearer's skin and the seal of the mask.

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Fill Face Fit Test Record Sheet

Fit testing conducted in compliance with OSHA Standard 1910.134(F). If other local, state or federal regulations apply (such as MSHA), you may list them here:. Individual selected the respirator with the most acceptable fit. 5. Individual conducted a seal check. 6. Respirator Fit Tested. (Make, Model, Style, Size). (Ex. Following are the forms that should be used when performing a qualitative fit test. A. Qualitative Fit Test Record. 1. Full Name of Handler: Respirator Tested. Is this employee clean shaven (i.e.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232