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  • Mask Exemption Form

Get Mask Exemption Form

N95/Respirator Mask Fit testing Exemption Form TRAINEE NAME: Last Name First Name PROGRAM: Training Level (PGY2, Fellow, etc) I am aware that I am not mask fit tested and will not be permitted to.

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How to fill out the Mask Exemption Form online

Completing the Mask Exemption Form online is an essential process for individuals not fit-tested for N95/Respirator masks. This guide provides clear and supportive instructions to ensure you fill out the form accurately and efficiently.

Follow the steps to complete the Mask Exemption Form online

  1. Click ‘Get Form’ button to obtain the Mask Exemption Form and open it in the online editor.
  2. Enter the trainee's last name and first name in the designated fields to accurately identify yourself.
  3. Fill in the program name and training level (like PGY2, Fellow, etc.) in the respective section.
  4. Indicate the reason for your mask exemption by checking the appropriate box: Religious/Cultural, Medical Condition, or Other. If selecting 'Other,' specify your reason in the space provided.
  5. Acknowledge that you understand the implications of not being mask fit tested and consent to seek medical attention if exposed to airborne infectious agents.
  6. Sign the form in the designated area and include the current date.
  7. Ensure the Occupational Health Office signs and dates the form to acknowledge your exemption.
  8. Obtain the Program Director's signature and date on the form as a final confirmation.
  9. Once all signatures are obtained, save your changes, then download, print, or share the completed form as required. You may need to submit it by fax or email to the provided contact.

Take a moment to complete your Mask Exemption Form online today!

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Both your mouth and nose should be protected. Do not wear respirator/facemask under your chin or store in scrubs pocket between patients.* Respirator: Respirator straps should be placed on crown of head (top strap) and base of neck (bottom strap). Perform a user seal check each time you put on the respirator. Facemask: Mask ties should be secured on crown of head (top tie) and base of neck (bottom tie). If mask has loops, hook them appropriately around your ears.

Cloth masks should NOT be worn by children less than 2 years old or anyone who has trouble breathing or is unconscious, incapacitated, or otherwise unable to remove the mask without assistance. Learn more about how to wear, take off, and wash your cloth masks.

By touching the front of your mask, you might infect yourself. Don't touch the front of your mask while you're wearing it. After taking your mask off, it's still not safe to touch the front of it. Once you've washed the mask in a normal washing machine, the mask is safe to wear again.

Facemasks should be carefully folded so that the outer surface is held inward and against itself to reduce contact with the outer surface during storage. The folded mask can be stored between uses in a clean sealable paper bag or breathable container.

The Washington State Department of Health has issued a statewide order requiring individuals to wear a face covering in indoor public spaces such as stores, offices and restaurants. The order also requires face coverings outdoors when you can't stay 6 feet apart from others.

Clean your hands with soap and water or hand sanitizer before touching the mask. Remove a mask from the box and make sure there are no obvious tears or holes in either side of the mask. The side of the mask that has a stiff bendable edge is the top and is meant to mold to the shape of your nose.

Two 10 x6 rectangles of cotton fabric Two 6 pieces of elastic (or rubber bands, string, cloth strips, or hair ties) Needle and thread (or bobby pin) Scissors Sewing machine

CDC recommends all people 2 years of age and older wear a mask in public settings and when around people who don't live in their household.

See full answerWearing cloth masks can help prevent people infected with the virus that causes COVID-19 from spreading the virus. Make sure your cloth mask: fits snugly but comfortably against the side of the face, completely covers the nose and mouth, is secured with ties or ear loops, includes multiple layers of fabric, allows for breathing without restriction, and can be laundered and machine dried without damage or change to shape. Cloth masks should NOT be worn by children less than 2 years old or anyone who has trouble breathing or is unconscious, incapacitated, or otherwise unable to remove the mask without assistance.

See full answer- Use cloth face coverings or masks as appropriate. Cloth face coverings or masks are intended to protect other people not the wearer. They are not considered to be personal protective equipment. Emphasize that care must be taken when putting on and taking off cloth face coverings or masks to ensure that the worker or the cloth face covering or mask does not become contaminated. Cloth face coverings or masks should be routinely laundered. Do not wear cloth face coverings or masks if their use creates a new risk (i.e., interferes with driving or vision, or contributes to heat-related illness) that exceeds their COVID-19 related benefits of slowing the spread of the virus. Cloth face coverings or masks should also not be worn by anyone who has trouble breathing or is unable to remove it without assistance.

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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
Help Portal
Legal Resources
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