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Home My WebLink AboutFit Test ReportM CO .nnv ronmental, Thc. ASBESTOS & LEAD ABATEMENT •- MOLD REMEDIATION RADON MEASUREMENT. & MITIGATION • SITE REMEDIATION WATERPROOFING & PAINTING • FUEL. TANK REMOVAL. & REPLACEMENT GENERAL CONSTRUCTION • DEMOLITION • LANDSCAPING FIT TEST REPORT These fittests will determine whether your . respirator is fitting well or not. Follow the guidelines below for both the Irritant Smoke Fit Test and the Banana Oil Fit Test. After you are through, use the evaluation form (Fit Test Report Form) and keep it for your records: Irritant Smoke: 1. The wearer must don a respirator equipped :with HPA (high efficiency) filters.. 2. The .wearer'must 'Close his/her eye tightly, . 3. The tester must break the ends of the smoke tube and insert one end of the tube into. the • squeeze bulb. 4.. Squeeze the bulb to create a cloud of sme near the- wearer's face. The wearer sh. \l• run through the exercises listed below • . 15 •'seconds apiece. If • he/she • coughs, sneezes, :.Complains; -of :,itri•.• ion, . try repositioning -the headband d " . ' epiece -' ' to 'eliminate the leak. • 5. If, in two attempts, the wea has not stopped the leak,, he/she has fa - d the fit • test and must'try other size. 1. The weare with G100 Banana Qil: must 'do a ,rAespirator equipped' ridge 2. The tester mt crush thutnb' and. fore nger, 3. fro inpoulebetween Hold you a roximately 1: tb 2' inehes.' aroun vale, the earer . face. Pass . ampoule e face seal area and exhalation wearer' should run 'through the ercises listed below for 15 seconds apiece. e. age will be noted by a ."bariaraa-like" 1. or • the facepiece.. • '5. If, in two attempts, the wearer` ,has not - stopped ,the leak, he/she has failed the fit- test, and must try, another size. FIT =TST REPORT, Company MCO En ronmental, Inc.. Vitt Test Method Used: Irritant Smoke: Respirator Size: • . North S M Move Head Side. to Side: X Bend At Waist; X Talk: Fit Test Results: • Comments: X• Pass: = X Employee'.s Signature: TEST ADMINISTERED BY: X Banana Oil:. Move Head•Up. & Down: X Run in Place: X Breath Deeply: X Fail: Date: 72.75,N.W. 64 Street *'Miami','FL 33166 • 21:(305) 468-1650 • Fax:(305)'468-1649 • MiamzMCO@aol,com ' wwu:.incoenvironmentalcom MCO Envirogmental, Iycc. ASBESTOS. & LEAD ABATEMENT MOLD REMEDIATION RADON MEASUREMENT. & MITIGATION • SITE REMFDIATION WATERPROOFING & PAINTING • FUEL TANK REMOVAL & REPLACEMENT GENERAL CONSTRUCTION • DEMOLITION • LANDSCAPING FIT TEST REPORT These fit tests will determine whether your . respirator is fitting well or not. Follow the guidelines below for both the Irritant Smoke Fit Test and the Banana Oil Fit Test. After you are through, use the evaluation form (Fit Test Report Form) and keep it for your records. • Irritant Smoke: • ' , Banana Oil: 1_. The. wearer must don a respirator equipped • With HEPA (hi h efficient filters.. 1. The wearer must .don 'a respirator equipped ' � with G100 cartrid es: . 2. The .wearer'must'Close his/her eye tightly, sh the ampoule, between 3, -The tester must ,break the. ends of the smoke tube and insert one end of the tube into. the squeeze bulb.. .. 3`. Held a' poule : a roxiinately 1; t'o 2' inches.' from . t . wea r's. ace. Pass , ampoule around th face 1 ea and., 'exhalation .v ve. he eager ould•. run 'through the ••... e • rcise list below for 15. seconds apiece. '4.. Squeeze the bulb to create a cloud of smoke - near the wearer's face• The wearer shpuld run through. the exercises listed bel for 15, 'seconds apiece. If he/she,. c s, sneezes, :.complains" -of - i ••tion, . repositianhig the headband, •cepie ' ' to eliminate the leak. • 4. Le.' �: _e will b noted by a "briana-like" odor 1 the facepiece. - , • • . . . _ ' - , . ' . 5, If, in 'two attemp , e ,weare , it . • stopped the le he/she has fail • the fit . test and rnust't another5-1 . •'5, If, in two attempts; the wearer. has not ' stopped the , leak, '• he/she has failed, the fit. ' test, and must try.another size. Employee: Company : MCO Envi Fit Test Method Used: Respirator Size: Move Head Side to Side: Bend At Waist: Talk: FITTEST REPORT nmental, Inc._ Irritant Smoke: X Survivar S M;. E X X X• • Banana Oil: , Move Bead Up & Down: X Run in Place: 'Breath Deeply: X X Fit Test Results: Pass: X . Fail: Comments: Employee's Signature: Dater TEST ADMINISTERED BY: 72.75 N:W. 64 Street * Miama', FL.33166 • Tel: (305) 4684650 • Fax: (305).468-1649 • -mail: MiamiMCD@aol,com • wwz:a.mcoeipironmcntal.,com •ASBESTOS & LEAD ABATEMENT MOLD IiEMED!ATION RADON` MEASUREMENT. & MITIGATION • SITE REMEDIATION WATERPROOFING & PAINTING • FUEL TANK REMOVAL & REPLACEMENT GENERAL CONSTRUCTION • DEMOLITION • LANDSCAPING FIT TEST REPORT These fit tests will determine whether your respirator is fitting well or not. Follow the guidelines below for both the Irritant Smoke Fit Test and the Banana Oil Fit Test. After you are through, use the evaluation form (Fit Test Report Form) and keep it for your records. Irritant Smoke; , Banana Oil: 1. The wearer must don a respirator equipped ' : with REM (high efficiency) filters. . . 1. The wearer must • don --a respirator equipped with G100 cartridg-.: : . ' 2. The,wearer must `elose his/her eye tightly, • 2. The .t ter must :\ s h'e ampoule, between , thuinba d forefin_: . • 13. •The tester Must break the. ends of the smoke tube and insert one end of the tube into the , squeeze bulb. • 3. Ho p ule • appro�' ately 1:- tb 2 'inches' f •m th earer's face. Pass ampoule a , ' d t E e ce eal area and exhalation vale we ref should run' through the xercis:•.• listed below for 15 seconds apiece. 4. Squeeze the bulb to create a cloud o.' ke near the wearer's face. The wearer ou run through the exercises li ed belo of 15 'seconds apiece. If hi e coug, , sneezes, . complains' - of - ita ' •n,. t repositioning the headband a d" fa' .iece ' ' to eliminate the leak. , , 4. akage. ' .ill be noted by a "banana -likes' od in the facepiece.. , , • • . • . + , ' ' ' 5. If, in y two atte ts, 'the .we.: 'has not . stopped ;the 1 k, he/she has fai `: d the fit - test and must Ty anoth'e ze. : ' 5. If, in two attempts, the wearer has .not- stopped the leak,` he/she has failed the fit test, and Must try another size. FITTEST REPORT• Employee: Carripany MCO Environmental, Jnc,, Fit Test Method Used: Irritant Smoke: X Banana Oil: Respirator Size: PAPR . One Size Fit all.,,;. Move Head Up & Down: X Move.Hed Side to Side: X Run in Place: X Bend At Waist : X Breath Deeply: X Talk: X • ' Fit 'Test Results: , : Pass: ' X . Fail: Comments: Employee's Signature: Date: TEST ADMINISTERED BY: 7275 N.W 64 Street 'Miami, FL 33166 • .Thl.•(305) 468-1650 • Fax: (305J'468-1649 • t-mail: Miami.IVICO@aolsom • www.mcoenvaronmental.,com CERTIFICATE OF WORKER'S ACKNOWLEDGEMENT SCHOOL/ FACILITY: CONTRACTOR; MCO Environmental, Inc EMPLOYEE: DATE JOF # SOCIAL SECURITY NO. WORKING WITH ASBESTOS CAN BE DANGEROUS. INHALING BESTOS F`S HAS BEEN LINKED WITH VARIOUS TYPES OF CANCER. IF YOU SMOKE AND 1NHAL ASBESTOS IB "'S THE CHANCE THAT YOU WILL DEVELOP LUNG CANCER 1S GREATER THAN THA OFTHE NO OKING PERSON. Your employer's contract with the Owner for the above pr proper respirator and be trained in its use. You will be tra • equipment found on the job: ' You will receive a medical exam at no cost to you. RESPIRATORY PROTECTION: 1 have been respirator to be used on the above reference manual Issued by my employer. I havbeen eq project. I have been Fit Tested with + .e past TRAINING COURSE: I hay complete trained .in the dangers i trent in han procedures and person-1 ,and area prot following: - Physical chacteristics o Health haza ds asso ed with R.espiratory +rot-- ion Use of personal protective e. ,ipment Pressure Differential Syste ' s Work practices including ands -on or on-the-job training Personal decontamin- 'on procedures Air monitoring, personal and area Physical effects of smoking cigarettes and breathing asbestos fibers MEDICAL EXAMINATION: I have had a medical examination within the as 12 months which was paid for _ by my employer. This examination included: health history, pulmonary function tests and may have included an evaluation of a chest x-ray. My employer has provided me an opportunity to attend a stop smoking clinic at no cost. By signing this document you, are -acknowledging only that the Owner of the building you are about to work in has advised you of your rights to training and protection relative to your employer, the Contractor. ed in th •Ject. I Y+p= • a ires th t: Y u will be supplied with the afe'work ctices and in the use of' the Lion. These things are to have been done roper use of respirators, and informed of the type e a copy of the written respiratory protection no cost with the respirator to be used on the above onths. . stos trining course of not less than three days. I have been as. -stos and breathing asbestos dust and in proper work ive measures. The topics covered in the course included the Printed Name: tos sbestos Employee Signature: DATE Contractor Signature (Witness): DATE June 05: 2006 MCO Environmental, Inc. ASBESTOS & LEAD -ABATEMENT • MOLL] REMEDIATION RADON MEASUREMENT & MITIGATION • SITE REMEDIATION WATERPROOFING & PAINTING • FUEL TANK REMOVAL & REPLACEMENT GENERAL CONSTRUCTION • DEMOLITION • LANDSCAPING Medical Surveillance Program This is to . certify that all asbestos abatement personnel participate in a medical surveillance program. 7275 N. W 64 Street • Miami, FL. 33166. • Tel: (305) 468-1650 ' Fax: (305) 468-1649 • e-mail: MialniMCO@aol.com • www.mcoenvironmental,com