| A. Employee First Name | Raul |
|---|---|
| A. Employee Last Name | Rascon |
| Date | 04/19/2025 |
| B. Employer: | Ram enterprise |
| Select Half or Full-face | PAPR |
| D. Conditions which could affect your respirator fit: |
|
| E. Fit Check Test (select one of each): | E. Fit Check Test (select one of each): |
| Positive Pressure |
|
| Negative Pressure |
|
| F: Fit Testing |
|
| Fit Factor | 3150 |
| Passed/Failed | Pass |
| OHD Unit | OHD 3 - 6700 |
| Upload OHD Unit File |  |
| Retest Date | 04/22/2026 |
| G. Comments | N/A |
| H. CONCERNS or issues represented by worker: | none |
| Employee Name | Raul Rascon |
| Employee Signature | |
| Date: | Date: December 7, 2025 |
| Test Conducted By: | Dahiana Pimentel |
| Signature: | |
| Retest Date | 04/21/2025 |
| Disclaimer: | The above respirator fit test was performed on and by the persons listed. The results indicate the performance of the listed respiratory protective device, as fitted on the employee named on this record under controlled conditions. Fit testing as performed measures the ability of the respiratory protective device to provide protection to the individual tested. The Test Conductor express or imply no guarantee that this or an identical respiratory protective device will provide adequate protection under conditions other than those present when this test was performed. Improper use, maintenance, or application of this or any other respiratory protective device will reduce or eliminate protection. |
