In-person Respirator Training and Fit test
Need directions to EHS? https://www.case.edu/ehs/about.html
What is your first name
Your answer
What is your last name?
Your answer
What is your email address?
CWRU email preferred
Your answer
Who is the Principal Investigator (PI) that you will be working under?
Use N/A if this is for a Medical Student Away Rotation.
Your answer
What department do you require this training for?
Your answer
Have you completed the OSHA Respirator Medical Evaluation Questionnaire
If "No" then you will need to complete the form before you receive a fit test. Here is the link: https://www.case.edu/ehs/ChemSafety/respques.pdf
Have you submitted the OSHA Respirator Medical Evaluation Questionnaire to University Health Service?
If "No" then you will need to submit the form before you receive a fit test.
Do you need more information about University Health Service?
Has your OSHA Respirator Medical Evaluation Questionnaire been approved by University Health Services?
If "No" then you will need to have confirmation of approval before you receive a fit test.
When would you like to attend?
A date will CLOSE once 15 slots are registered.
Do you plan to complete your fit test on the day of your training?
If so you must come clean shaven for you respirator to test accurately.
Submit
Never submit passwords through Google Forms.
This form was created inside of Case Western Reserve University. Report Abuse - Terms of Service - Additional Terms