Respirator Mask Inspection Checklist
Use this checklist to record respirator mask inspection details, condition checks, defects, and follow-up actions.
Inspection Details
Inspector Name
*
First Name
Last Name
Inspection Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Inspection Time
Hour Minutes
AM
PM
AM/PM Option
Workplace / Location
*
Respirator / Mask Identifier
*
Mask Type / Model
*
Please Select
Disposable particulate respirator
Reusable half-face respirator
Full-face respirator
Powered air-purifying respirator (PAPR)
Surgical mask
Other
Department / Work Area
*
Respirator Condition Checklist
Overall physical condition
*
Good
Needs Attention
Fail
Not Applicable
Facepiece condition
*
Good
Needs Attention
Fail
Not Applicable
Straps and headbands condition
*
Good
Needs Attention
Fail
Not Applicable
Nose piece and seal condition
*
Good
Needs Attention
Fail
Not Applicable
Valve condition
*
Good
Needs Attention
Fail
Not Applicable
Filter or cartridge condition
Good
Needs Attention
Fail
Not Applicable
Cleanliness and sanitation
*
Clean
Needs Cleaning
Needs Attention
Fail
Visible damage or wear
Cracks
Tears
Deformation
Missing parts
Discoloration
Excessive wear
Other
Inspection Outcome and Follow-up
Final Inspection Result
*
Pass
Fail
Needs Repair
Replace
Defects Found or Issues Noted
Corrective Action Taken or Required
Reinspection Required?
*
Yes
No
Reinspection Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Inspector Remarks or Additional Notes
Submit Inspection
Should be Empty: