EHS

Request for Respirator Fit-test and Training

For coordinators/schedulers of a SINGLE or GROUP fit-test, please:

• use your information to complete the form;
• UPLOAD a list that includes the name, UCI Net ID, contact information, School/Department, UCI affiliation, fit-test history (see subsequent fields below for guidance on the asked information);
• use the Comments field below, as needed, to elaborate.

Please provide all applicable documents. These may include a copy of of your Respiratory Hazard Evaluation (RHE), Medical Clearance To Wear a Respirator (signed and dated by a Physician or Licensed Health Care Professional (PHLCP)), or other documents relevant to the fit-test.

For coordinator/schedulers, please upload the list here.

Please suggest dates and times for an appointment. Your proposal will be crosschecked against staff availability to derive an appointment date. The appointment date can be one or more days from the time of the initial appointment request.

Important note regarding facial hair: please refer to the CDC/NIOSH guide for acceptable facial hairstyles.