Fit Testing Registration Form
Register for your fit test appointment and provide required health and consent information.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Organization/Employer Name
Job Title/Role
Type of Respirator/Mask to be Tested
*
Please Select
N95
Half-face respirator
Full-face respirator
PAPR (Powered Air-Purifying Respirator)
Other
Preferred Fit Test Appointment
*
Have you experienced any of the following in the past 14 days? (Select all that apply)
*
Fever or chills
Cough or respiratory symptoms
Loss of taste or smell
None of the above
Do you currently have facial hair that may interfere with the fit of the respirator?
*
Yes
No
Have you read and understood the pre-test instructions (e.g., no eating, drinking, smoking, or chewing gum 30 minutes prior to the test)?
*
Yes, I have read and understood the instructions.
No, I need more information.
Signature (Please sign to confirm your consent and the accuracy of your information)
*
Submit Registration
Submit Registration
Should be Empty: