A M Water Services Forms

Fit Test Record

AMWS — Qualitative Fit Test Record (HS_FM_14)

RPE fit test record per HSE INDG479. Mirror of paper HS_FM_14 + 14.1.

This field is for validation purposes and should be left unchanged.

AMWS — Qualitative Fit Test Record (HS_FM_14)

RPE fit test record — for tight-fitting respiratory protective equipment per HSE INDG479. Combines legacy HS_FM_14 (test record) and HS_FM_14.1 (employee record) into one form.

Document ReferenceHS_FM_14 — Qualitative Fit Test — Employee Record
Issue Number2
Issue Date12 May 2026
Next Review12 May 2027
Controlled BySean Ashton (HSQE Consultant, Onyx Operations)
Approved ByAaron Mason, Managing Director
StatusPaper versions HS_FM_14 + HS_FM_14.1 consolidated and retired on digital go-live.

Employee details

Prescription glasses worn?(Required)
Presence of facial hair?(Required)
Will facial hair interfere with facepiece seal?

RPE detail

Test record

Test agent(Required)
Sensitivity test(Required)
Initial fit(Required)
Positive pressure check(Required)
Negative pressure check(Required)

Test regime — pass = 100% / fail = 0%

Normal breathing (1 min)(Required)
Deep breathing (1 min)(Required)
Turning head side to side (1 min)(Required)
Moving head up and down (1 min)(Required)
Speaking / chewing (1 min)(Required)
Bending over (1 min)(Required)
Normal breathing (1 min) — closing(Required)
Average fit factor — OVERALL(Required)

Signatures + tester detail

Clear Signature
Clear Signature
DD slash MM slash YYYY