ELEMENT 2.19.

1 CARTRIGE TYPE RESPIRATOR MONTHLY INSPECTIONS

SECTION ________________________________ YEAR ______________________

ID NO TYPE JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC LEGEND

NOTE

Do Not "tick". Write OK or use the number

of the specific item given in the legend.

1. Filter expiry date exceeded.

2. Mask dirty.
There is no hazardous activity in the project that requires 3. Cracks in visor.

the RESPIRATORY PROTECTION EQUIPMENT (RPE). If 4. Straps cracked or perished.

there is an activity involving the use of RPE, the same 5. Filter housing (stripped).

6. Exhalation valve.
format will be use and RA will be conducted. 7. Inhalation valve.

8. Speech diaphragm.

9. Carry strap (damaged).

10. Wrong type of filter for the hazard.

DATE INSPECTED

RESPIRATOR MAY BE USED

(Yes/No)

INSPECTOR'S INITIALS

SPOT CHECK / AUDIT