OHS​​​​​​​ ► N95 Respirator Fit Test Record Sheet

This form can be used by N95 Champions on ZSFG campus to record N95 fit test results for your department staff.

Click, print and complete this form ahead of N95 fit test to save your time

► N95 Respirator Fit Test Record Sheet

Update: Duckbill Masks Not Recommended (April, 2023)

Please note that due to an FDA Safety Communication, the use of O&M (Halyard) Small Duckbill (H7089562) or Regular Duckbill (H7035496) N95 respirators are not recommended for use at this time. 

Related

OHS ► N95/Respiratory Protection Program

Learn about N95/Respiratory fit test and what you might want to know before your next fit test.

OHS ► Respirator Medical Online Questionnaire

Submit this online questionnaire ONLY IF this is your FIRST TIME getting fitted for a N95/PAPR respirator. This questionnaire is to be used by Department of Public Health (DPH) employees only. If you are from a different department, give us a call (628-206-6581).

OHS ► Respirator Medical Paper Questionnaire

Submit this paper questionnaire only if this is your FIRST TIME getting fitted for a respirator. This questionnaire can be used by all employees of City & County of San Francisco departments.

Last updated June 12, 2023

Department

Occupational Health Service (OHS) at Zuckerberg San Francisco General Hospital (ZSFG)