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Respiratory Protection Program Form
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Respiratory Protection Program Form
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Employee Name
*
App State Email
*
Banner ID
*
Reason for wearing respirator:
*
What hazardous materials do you work with that require respiratory protection?
Respirator Type/Cartridge Type
*
N95 or other filtering facepiece (N, R, or P; 95 or 99)
Half Face
Full Face
PAPR with tight-fitting mask
PAPR with loose-fitting hood
Cartridge Type(s):
Respirator Type/Cartridge Type Cartridge Type(s):
Have you been medically cleared and/or fit-tested to wear a respirator at Appalachian State University before?
- Select -
Yes
No
I'm not sure.
Other...
App Respiratory Protection Program History Other...
When do you need to be able to start wearing a respirator?
Month
Jan
Feb
Mar
Apr
May
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Aug
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Dec
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Day
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Day
Year
2022
2023
2024
2025
2026
Year
Desired start date:
*
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Submit
