Fit Test Questionnaire "*" indicates required fields Do you have Photo ID? YES NO Are you clean shaven around the Face Seal? N/A YES NO If worn do you have your head mounted PPE with you? YES NO Have you Eaten, Drunk or Smoked in the last Hour? YES NO Have you had RPE Training or worn this mask before? YES NO Are there any reasons for not being able to do the test? YES NO Please inform the Tester if there are any Medical Conditions which may affect your ability to use the Step/Treadmill/Hood, whilst performing the exercises, or any issues for wearing a mask (allergies).Data Protection YES NO Will you permit us to keep your details for 5 years. They may be shared with other Training Providers or for Verification of Certification only. They will not be shared with any Third Party for Financial/Commercial gain and can be removed at any time, if the candidate so wishes.PRINT FIRST NAME* PRINT SURNAME* COMPANY NAME* E-SIGN* Date* DD slash MM slash YYYY FOR TESTERS USE ONLYFIRST MASK TESTED PASS FAIL REAL TIME SCAN CONDUCTED YES NO FIRST TEST NOTES SECOND MASK TESTED PASS FAIL SECOND REAL TIME SCAN CONDUCTED YES NO SECOND TEST NOTES ADDITIONAL NOTES
