N95 Fit Testing Request
Please complete this form to request fit testing services from York County HAZMAT Team.
YC EMA
PAgency Name *
Physical Address *
Point of Contact *
Telephone *
Email Address *
How many employees require fit testing? *
Do you have a Respiratory Protection Plan in place?
Clear selection
Have your employees being fit tested, been medically cleared for respiratory use? *
Do you have N95 masks? Enough for all your employees who require fit testing?
Clear selection
Is anyone in your facility (Resident or Staff) COVID-19 positive?
Clear selection
Comments
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy