VALENCIACOLLEG Schools of Allied Health and Nursing NN 95 RESPIRATOR FIT TESTING iow: Phone: Email: You cannot be fit teste if you havea fever nasal congestion, or any other cli rfl like symptoms. Please be fittested after your symptoms have gane away. ‘+ D0 NOT eat, drink, smoke or chew gum for at least 15 minutes before your fit testing. + tf you wear gasses, please remember to bring them with you to the i test ‘+ Any change in your weight greater than 10 pounds or change in your facial shape (such as dental procedures or facial surgery) or scarring wll require youto be ft ested to insure you stil wear the same respirator. + fa strop breaks or te respirator is knocked off eave the room and replace or refit the respirator. ‘Student Signature: Date: ‘To Be Completed by the Fit Tester Sensitivity Test Saccharin squeezes 5 10 __20 pass fail N/A sicrex squeezes > a ae pass rail A Fit check Positive Pressure Fit Check Test (normal breathing causes ample movement) _pass __fail FitTest Satisfactory fittest performed (indicate respirator manufacturer and size below) Could not ft student to any avallable respirators (Contact hscompliance@valenciacollege.edu) Respirator (please check the respirator manufacturer and size) Kimberly Clark (KC) Technol Small Regular aM N9S ‘Small Regular Certified Fit Tester Date Revised January 2020,