Document G516EeQ6ok0qoKeNGZaynpve7

NIOSH Appr val Lab I For R9722 ESCAPE ARTI TTM Mouthpiec Respirator Using R722 Ch mical Cartridg Permissible ESCAPE TYPE CHEMICAL CARTRIDGE RESPIRATOR FOR CHLORINE, HYDROGEN CHLORIDE, SULFUR DIOXIDE, CHLORINE DIOXIDE, HYDROGEN SULFIDE, DUSTS AND MISTS MINE SAFETY AND HEALTH ADMINISTRATION NATIONAL INSTITUTE OF OCCUPATIONAL SAFETY AND HEALTH ___ MSHA APPROVAL NO. TC-23C-111 UTOwa r mma [*< Cum 1* t>-- curl NIOSH Mi** |Im? HI MUK ISSUED TO to OoMftsto totoyMMU* CABOT SAFETY CORPORATION SOUTHBRIDGE, MASSACHUSETTS, U.S.A. LIMITATIONS Approved for respiratory protection during escape only, from atmospheres containing (1) chlorine, hydrogen chloride, sulfur dioxide, (2) dusts and mists havng a time weighted average not less than 0.05 milligrams per cubic meter or 2 million particles per cubic foot (mppcf), (3) chlorine dioxide, (4) hydrogen sulfide. Do not exceed maximum use concen trations established by regulatory standards. Not for use in atmospheres containing less than 19.5 percent oxygen or in atmospheres containing toxic gases or vapors. Not for use in atmospheres immediately dangerous to life or health. _. 2K CAUTION ' ~ In making renewals or repairs, parts identical with those furnished by the manufacturer under the pertinent approval shall be maintained. Follow the manufacturer's instructions for changing cartridges. This respirator shall be selected, fitted, used and maintained in accordance with the Mine Safety and Health Administration, Occupational Safety and Health Administration, and other applicable regulations. MSHA--NIOSH APPROVAL NO. TC-23C-111 ISSUED TO CABOT SAFETY CORPORATION SOUTHBRIDGE, MASSACHUSETTS, U.S.A. APPROVED: May 3,1990 The approved assembly consists of the following Cabot Safety parts: 50822 respirator assembly and R722 (TC-23C-111) Cartridge. 13 c Oo 1 Escape Only Mouthbit Respirator Alr-Purlfylng Simple Cleaning and Maintenance Using a Personal Safety Equipment Cleaning Pad clean these items and Insure they arp present. May sure the Items are not distorted, damaged, d teriorated, or missing. Personal Safety Equipment Cleaning Pad A. Exhalation Valve Cover B. Exhalation Valve Rap C. Rubber Gasket 0. Mouthpiece E. Note Clamp A Cord P. Inhalation Valve Seat Q. Inhalation Valve Flape H. R722 Cartridge 1. Respirator Body J. Nylon Neckband Not Present In The MSA *478338 If respirator Is too dirty to clean or a part Is missing - THROW THE RESPIRATOR AWAY NOTE: If respirator Is not removed from the manufacturer's protective bag, th respirator does not require Inspection, cleaning, individual's name, or cartrldg Solvents / EDC 1 Industrial Hygiene Communication # 95.01 Issue Date: January 10,1995 Return Date: Author: Michael S. Brown Subject: 1995 Escape Respirator Training Please review the attached training material as quickly as possible and pass on to the next person on the list. Remember, your signature and the date are required (in ink) to document that you have read and understood this material. Please return this entire package to the Industrial Hygiene Coordinator. Personnel whose names are shaded are not required to review this material. Bay..PeiH>nnei Staff. Master #Signature ,.Date Gunn, T.M. 433073 Carrier, B.P. Baldwin, P.B. 085908 434498 lb"?- GcyUUfiA /A //7 Conley, III, L.N. 434090 t Gaspard, L.H. Rolke, R.W. 088600 fL EUk . 097946 Tl Stallcup, J.S. 240558 1 White, W.S. 434499 l /?f/ts _uja_/as -JJjUlf Jj2i2sr -JJ3JS^ JJJ3J2& / i/?l*S" 1/10/95 Industrial Hygiene Training Document o.`o ^n 5 Solvents / EDC 1 Industrial Hygiene Communication # 95.01 Issue Date: January 10,1995 Return Date: _________ Author: Michael S. Brown Subject: 1995 Eseane Respirator Training Please review the attached training material as quickly as possible and pass on to the next person on the list. Remember, your signature and the date are required (in ink) to document that you have read and understood this material. Please return this entire package to the Industrial Hygiene Coordinator. Personnel whose names are shaded are not required to review this material. k Dav Personnel Supervisors Hotard, Sr., R.J. James, C.E. Miller, W.A. Master # 431516 432928 t-oja431555 Signature --)et---- Date / //?/ 9s- / //?/5S- SOS Brown, M.S. Butler, R.W. Stain, D.G. Mathis, Jr., J.H. Sims, J.A. OS Landry, C.P. Master # I Signature Date 433928 __L7_L57_52 433623 433609 J-JUAi> j 432997 431959 1 -fan, A- LJLfJ 7-5- `J Master # Signature Date 434292 ___________ E__m/*____________________ JJ3JZ" 1/10/95 Industrial Hygiene Training Document On C-OMpr A O T0,NTt 4t. Solvents / EDC 1 Industrial Hygiene Communication # 95.01 Issue Date: January 10,1995 Return Date: Author: Michael S. Brown Subject: 1995 Escanc Respirator Training Please review the attached training material as quickly as possible and pass on to the next person on the list. Remember, your signature and the date are required (in ink) to document that you have read and understood this material. Please return this entire package to the Industrial Hygiene Coordinator. Personnel whose names are shaded are not required to review this materials A/B Shift Personnel Supervisor Vaughn, R.P. Master# 432882 Signature' Date / 17/IPj SOS Master# Signature_______________________________________________ Arnold, B.E. 434037 Carville, G.M. 432419 Chustz, G.P. 433899 Godeaux, J. 431709 Lafleur, D.J. May, G.R. Templet, T.V. 434384 ( tT^rt 433625 433366 A. V- JcZtJ Date > /70/9J* ^ LlulJs" i mm / / <To / *77 jja52. ! / '7/9r~ OSMaster #SignatureDate Bergeron, B.F. 098995 Davis, H.S. 432619 Hebert, D.M. 434243 Jones, J.T. 099295 Mayfield, J.H. Washington, H.J. 432761 433555 Jl f r^o Young, Jr., R.R. 431633 J*JlZ / It7i<rr / Uol'rS' -JJ-LU3S J*iJ5s jXji 1/10/95 Industrial Hygiene Training Document D0 rOA/^ Solvents / EDC 1 Industrial Hygiene Communication # 95.01 Issue Date: January 10,1995 Return Date: Author: Michael S. Brown Subject: 1995 Escape Respirator Training Please review the attached training material as quickly as possible and pass on to the next person on the list. Remember, your signature and the date are required (in ink) to document that you have read and understood this material. Please return this entire package to the Industrial Hygiene Coordinator. Personnel whose names are shaded are not required to review this material, C/D Shift Personnel Supervisor Rachal, G.W. Master # 432421 Signature Date Lj1j2 SOSMaster #SignatureDate Bourgeois, Jr., E.O. 431530 C - /V '}s\ / / ii r? Daigle, J.L. 432627 / asm Duck, W.C. 433122 JjMUiy Hearns, S.A. 432873 JULSJlS. McQuarter, J.L. Theriot, J.J. 433944 J431763 l jjjsjas T \ R^D-------------------- irt=/-- Thibodeaux, J.G. 432959 J$j-22 OSMaster #-SignatureDate Cooper, J.L. 434258 /2fj\ Jackson, A.L. 433106 Jackson,J. Landry, M,D. 433511 241688 Ivl Landry, R.W. 434061 Lee, Jr., E. Prestonback, S.K. 432722 Igrruzizi 433945 mas ' JjMl5L5 JJ/SJfS JjlSjtS -LJMJ3S. 1/10/95 Industrial Hygiene Training Document c o S-101, Standard Safety Equipment Scope Statement of Standard Exception to Standard Responsibilities To specify minimum standard safety equipment for personal protection of Dow employees, contractor and construction personnel, and visitors while on the Louisiana Division plant site. Equipment approved by the Personal Protective Equipment Committee and appropriate for the job, must be worn by all persons as required on the plant site and in outlying operating areas (docks, meter stations, etc.) Exceptions to this standard are permitted in the following cases: 1. While going to and from plant gates to the place of work at the beginning and end of each day or shift period 2. In buildings designated by block supervision 3. While traveling in closed vehicles 4. In Maintenance shops at the discretion of the shop supervision (If so, shop boundary must be defined by supervision) Safety Department & Safety Superintendents: 1. Coordinate testing of any new safety equipment 2. Approve new safety equipment prior to general purpose distribution and use Personal Protective Equipment Committee fPPEC): 1. Evaluate new personal protective and safety equipment for possible use in the division 2. Recommend the approval/rejection of equipment after evaluation to the above group 3. Maintain list of approved equipment Industrial Hygiene: 1. Provide technical data and information on chemical resistance, hearing protectors, respirators, etc. Safety Supply Center: 1. Inventory and distribute only approved safety equipment Purchasing; 1. Purchase only equipment which has been approved for use in the division 2. Notify the requisitioner to contact the PPEC, Industrial Hygiene, or Safety for any requests for non-approved personal protective equipment _____________________________________ Safety & Loss Prevention Standard S-101, Standard Safety Equipment Responsibilities, continued References Plant/Department; 1. Establish specific department rules on the use and type of personal protective equipment allowed in the block including any additional requirements or exceptions 2. Post department minimum PPE requirements at block limits and communicate to all personnel within the block 3. Post any area specific equipment requirements at area boundaries within the block (special hearing protection, monogoggle areas, respirators needed, etc.)______ _ OSHA 29 CFR 1910.132 - .140 ' ANSI Z87.1.Z89.1, and Z41.1 Program Requirements for Personal Protective Equipment, The Dow Chemical Company, March 1992 GENERAL EQUIPMENT REQUIREMENTS Note that individual areas may have more stringent requirements than those listed below. Minimum Requirements Hearing Protection Mouthbit Respirators The following are required as a minimum: Approved hard hats Safety Spectacles Chemical Monogoggles Mouthbit respirators Appropriate hearing protection ________________ Hearing protection must be chosen to ensure that no exposure occurs to excessive noise levels which could lead to irreversible hearing loss. For additional information see S-103, Hearing Conservation. Mouthbit respirators are to be used for escape purposes only. Their use does not require'medical approval or fit testing but does require initial and annual training in their proper use. Individuals assigned mouthbit respirators must mark their name and date the cartridge was put into service on the respirator and are responsible for maintaining the respirator in good working condition. Cartridge replacement and storage is in accordance with the specific plant/department written respiratory protection program. Safety & Loss Prevention Standard S-101, Standard Safety Equipment ^rr Page l ' Other Respiratory Exception for wearing mouthbit respirators shall be governed by Considerations plant/department rules for that area only. Also special respirators may be required in some areas. (See S-102, Respiratory Protection) Facial Hair: Employees must be clean shaven in the area between the mask sealing surface and the facial skin if required by their job assignment to potentially wear any of the following: Half-mask respirator Full-face gas masks Air-line masks Self Contained Breathing Apparatus (SCBA) - positive pressure or demand mode Other similar protective equipment Employees with skin conditions which interfere with clean shaving, must be evaluated and documented by Dow Medical Department. Plant Supervision must insure that these employees are adequately protected from hazardous exposure. Eye Protection Monogoeeles: It is not recommended to wear chemical monogoggles over glasses. There may be cases, however, where this is necessary. Monogoggles must be fitted to form an effective seal around the eye. When not in use, monogoggles can be carried around the neck, in the hat, or in a caddy or hat clip. Do not stretch the adjusting band around the hat. Monogoggles must be worn independent from the hard hat to insure eye protection is maintained in case the hat is knocked off. Safety Spectacles & Contact Lenses: Prescription safety spectacles will be supplied to Dow employees upon submission of proper lens prescription and an approved Dow order form. Contact lenses may be worn. Wearers must follow same eye protection policy for the block or area in which they are working. It is the responsibility of the employee to report the use of contact lenses to supervision. Safety & Loss Prevention Standard S-101, Standard Safety Equipment c,. o A <Oi ------ ' A/ Page 3 Seat Belts Seat belts must be worn by all occupants of passenger vehicles and truck cabs within the division limits and when on company business outside the division. All occupants of Dow furnished vehicles must wear seat belts any time the vehicle is in operation. An allowable exception to this is equipment which is received from the manufacturer without seat belts and which are not required by law to have them. PROPER ATTIRE Minimum Requirements Fire Retardant Clothing/Flash Protection Jewelry Gloves or Chemical Protective Clothing Footwear Proper attire must be worn while performing work in labs, shops, and operating areas of the Louisiana division. This includes: Shirt with at least short sleeves Long Pants * Leather, vinyl, or rubber footwear Fire Retardant Protective Clothing is required in instances where there is a potential for flash fires in order to minimize bum injuries. (See also Reference B-l, Fire Retardant Protective Clothing) Dangling jewelry must not be worn if it presents a hazard (possibly getting caught in a piece of equipment) or if it interferes with personal protective equipment (for example, earrings which hang down below hearing protection). Finger Rings must not be worn wherever personal protective equipment is required. Block supervision must designate the specific glove and other Chemical Protective Clothing to be used in an area for chemical handling. The material being handled will determine the material of construction to be used. Safety shoes are recommended for all labs, shops, and operating areas. All safety shoes available from the Safety Supply Center are acceptable for general use in the division except where department rules are more stringent. Canvas or open-toed shoes are not allowed outside office areas. Shoes with "factory designed" vents are acceptable unless spe^cally restricted by plant/department policy. n o > Cu Safety & Loss Prevention Standard S~ 101, Standard Safety Equipment Page 4 JOB SPECIFIC REQUIREMENTS Miscellaneous Exposed Moving Parts Welding & Cutting Handling Hazardous Chemicals Exposure to Flying Particles See S-217, Tools, for personal protective equipment requirements when working with specific tools.____________ Long hair, loose clothing, dangling sleeves or jewelry, neckties, etc., must not be worn unprotected when working on this type equipment. Long Hair and loose clothing must not be worn unprotected. Hard hats must be worn except as noted in "Exception to Standard" section. As a minimum, welders will wear safety spectacles under their welding hood, or the eye protection required for the area in which they are working. _________ . _____ ________________ ________ Minimum eye protection when working with hazardous chemicals is approved chemical monogoggles. This is true for all line and equipment openings, sampling, loading or unloading, handling of carboys, working on equipment under pressure or any equipment which contains hazardous or corrosive materials. Face shields with either safety spectacles or monogoggles are required while performing any jobs which create exposure to flying particles. VISITOR POLICY Individual Visitors Tours Persons being visited must insure that individual visitors, suppliers, and carriers entering operating areas are supplied with required personal safety equipment. Tour groups being conducted through the plant must use personal safety equipment whenever in an operating area. Guide personnel are responsible for insuring this precaution is met. CONTRACTOR REQUIREMENTS Hard Hats Must meet ANSI Z89.2-1981 No rolled up lip on edge Metal hats and Bump Caps are prohibited Color blue is primarily for Dow and Contractor Supervision Safety & Loss Prevention Standard S-101, Standard Safety Equipment rO^ > NrT,,, Safety Spectacles Prescription glasses must meet ANSI Z87.1-1989. Others must meet ANSI Z87.1-1989 and be Safety Equipment Institute (SEI) certified. Photo-ray not allowed for tinted lens Tinted lenses are not permitted during evening hours or in dark locations such as in vessels Monogoggles Must meet ANSI Z87.1-1989 and be Safety Equipment Institute (SEI) certified Suggest All Safe Monogoggles # G-211-10-R Open vents on monogoggles are not allowed Respirators Contractors must wear an approved Mouthbit respirator on their person at all times. The only approved mouth piece respirators are: American Optical 5438 mouth piece with cartridge AOR-722 for Chlorine MSA 476338 mouth piece with cartridge 4770777 GMB for acid gas and chlorine Hearing Protection All devices used for single hearing protection while performing work must have a noise reduction rating (NRR) of 23 or greater. Suggested Muffs Hard Hat Mounted: Bilsom Viking Muff (NRR 25) Howard Leight Quiet 27H muff (NRR 27) Vallen ProMax II (NRR 25) Not Mounted: Tasco Slimline T-2 (NRR 19) (Restricted for use as secondary protection under welding and sandblasting hoods with ear plugs.) Suggested Ear Plugs Disposable: EAR Classic foam earplug (NRR 29) Howard Leight Max foam earplug (NRR 33) Vallen DB Down Expand-o-Fit II (NRR 29) Reusable: North Comfit triple flanged earplug (NRR 26) (available in small, medium, or large) Safety & Loss Prevention Standard S-101, Standard Safety Equipment co? Page 6 DOW LOUISIANA DIVISION MOUTHBIT RESPIRATOR TRAINING MODULE Mouthbit Respirators: MSA #476338 American Optical #9722 Purposes To enhance your knowledge and understanding of the use of respiratory protection in order to prevent inhalation exposures. The mouthbit respirator is to be use for Escapeonly. Upon completion, you will be able to demonstrate the correct use of respirator equipment and explain the correct procedure for donning, cleaning, maintaining, and storing. Resources: 1.) Manufacturer's written instruction manual 2. ) Louisiana Division S&LP S-101 - Standard Safety Equipment 3. ) 2 attached training slides 4. ) General supplementary information is found in the OTIST Respiratory Training Package (but considered not essential for effective mouthbit usage) Required Level of Performance: 100% Correct Objectives: 1.) Written Requirements - Identify the location of the LAD S&LP-101 Standard Safety Equipment and understand the contents. 2.) Respiratory Hazards - Understand the limitations of the mouthbit respirator and the conditions in which it can be used. 3.) Respirator Handling - Demonstrate and explain the procedures for proper use of the respirator including donning and storage. Additionally, if the mouthbit is individually assigned, demonstrate cartridge replacement, cleaning and maintenance procedures. 4.) Employee Responsibilities - Summarize the employee's responsibilities as a respirator user, including the limitations of the respiratory protection used. Revised: Angut IS, 1993 BY: Darlene S. Creel 1 DOW CONFIDENTIAL Solvents / EDC 1 Annual Inspection Record Air Purifying Mouthbit Respirators Name : _____________________ Date : /(_ Master # : _____________________ Employer : Dow Chemical Respirator Mfg. & Model #: AO R722 Cartridge Type: Acid Gas Disassemble the respirator (if possible) and inspect the following; (Circle One) Is the body/cartridge holder free of any dents, distortion, and wear ? Is the cartridge face unobstructed, with no cracks or holes ? Is the cartridge and respirator manufactured by the same company (compatible) ? Is the cartridge gasket (if applicable) cut, cracked, or missing ? Are the Inhalation/Exhalation diaphragm valve flaps stiff, decomposed, or cut ? Are the Inhalation/Exhalation diaphragm valve seats distorted, scratched* cracked, or obstructed ? Is the Exhalation valve cover distorted, scratched, cracked, or missing ? Is the Mouthbit distorted, stiff, decomposed, cut, or obstructed ? Is the Mouthbit cover stiff, distorted, missing, or has it lost tension ? Is the nose clamp stiff, distorted, missing, or has it lost tension ? Is the cartridge dated ? Is the cartridge date more than 1 year old ? Is the owners name on the respirator ? Is the respirator clean ? ' Y/N Y /N Y /N Y /N Y /N Y /N Y /N Y /N Y /N Y /N Y /N Y /N Y /N Y /N Note: Make sure the cartridge is clean. Never try to clean it by washing it or blowing with air. Inspect the cartridge for dents or other damage. Breathe at least once through the respirator to insure that it is functioning properly. If any odor or taste is detected, replace the air-purifying element or dispose of the respirator (if it is a disposable model). Note any actions taken to correct any deficiency found during this inspection. DO 1 r.OMp- TOf^ttai Mouthbit Respirator Training Test I. Complete the following statements: 1. A mouthbit respirator is used for. 2. If a mouthbit respirator is individually assigned and removed from the manufacturer's protective bag, then it becomes your property and needs to have your _and the it was opened marked on the respirator. 3. In the Solvents / EDC 1 Plant, the mouthbit respirator cartridge must be replaced______________ or when it is. 4. The replacement cartridges for mouthbit respirators are located in Bldg.(the ).'___________________________________ II. Circle "T" if True or "F* if False for the following statements: 6. T F You need medical approval to use a mouthbit respirator. 7. T F You need to be fit-tested to use a mouthbit respirator. 8. T F Respirator equipment is approved as a unit and pans are not interchangeable with other models. 9, T F A mouthbit respirator can be used to catch process samples. 10. T F The mouthbit respirator that you use in the plant is individually assigned to you. III. Complete the following exercises, mark with an "V" when done: 11. ______ Demonstrate the correct procedure to clean, maintain, and store your mouthbit respirator. 12. ______ Demonstrate how to correctly change the cartridge of your mouthbit respirator. 13. ______ Review how to correctly don your mouthbit respirator. 2 fro fro/vr Solvents / EDC 1 Annual Inspection Record Air Purifying Mouthbit Respirators Name : ___________________ Date : ______ l(_ Master # : ___________________ Employer : Dow Chemical Respirator Mfg. & Model #: AO R722 Cartridge Type: Acid Gas~ Disassemble the respirator (if possible) and inspect the following; (Circle One) Is the body/cartridge holder free of any dents, distortion, and wear ? Is the cartridge face unobstructed, with no cracks or holes ? Is the cartridge and respirator manufactured by the same company (compatible) ? Is the cartridge gasket (if applicable) cut, cracked, or missing ? Are the Inhalation/Exhalation diaphragm valve flaps stiff, decomposed, or cut ? Are the Inhalation/Exhaladon diaphragm valve seats distorted, scratched, cracked, or obstructed ? Is the Exhalation valve cover distorted, scratched, cracked, or missing ? Is the Mouthbit distorted, stiff, decomposed, cut, or obstructed ? Is the Mouthbit cover stiff, distorted, missing, or has it lost tension ? Is the nose clamp stiff, distorted, missing, or has it lost tension ? Is the cartridge dated ? Is the cartridge date more than 1 year old ? Is the owners name on the respirator ? Is the respirator clean ? Y/N Y/N Y/N Y/N Y/N Y/N Y/N Y/N Y/N Y/N Y/N Y/N Y/N Y/N Note: Make sure the cartridge is clean. Never try to clean it by washing it or blowing with air. Inspect the cartridge for dents or other damage. Breathe at least once through the respirator to insure that it is functioning properly. If any odor or taste is detected, replace the air-purifying element or dispose of the respirator (if it is a disposable model). Note any actions taken to correct any deficiency found during this inspection. A 0401 7ft 1 CONFTDFm-J-t AI Mouthbit Respirator Training Test I. Complete the following statements: 1. A mouthbit respirator is used for__ 2. If a mouthbit respirator is individually assigned and removed from the manufacturer's protective bag, then it becomes your property and needs to have yourand the it was opened marked on the respirator. 3. In the Solvents / EDC 1 Plant, the mouthbit respirator cartridge must be replaced_____________ or when it is. 4. The replacement cartridges for mouthbit respirators are located in Bldg.(the . ___________ j. II.' Circle "T" if True or "F' if False for the following statements: 6. T F You need medical approval to use a mouthbit respirator. 7. T F You need to be fit-tested to use a mouthbit respirator. 8. T F Respirator equipment is approved as a unit and parts are not interchangeable with other models. 9. T F A mouthbit respirator can be used to catch process samples. 10. T F The mouthbit respirator that you use in the plant is individually assigned to you. III. Complete the following exercises, mark with an "V" when done: 11. _______ Demonstrate the correct procedure to clean, maintain, and store your mouthbit respirator. 12. ______ Demonstrate how to correctly change the cartridge of your mouthbit respirator. 13. ______ Review how to correctly don your mouthbit respirator. 2 no A 040177 CONFTDFNTTAL DOW LOUISIANA DIVISION MOUTHBIT RESPIRATOR TRAINING MODULE Answers: 1. Escape Only Escape Purposes Escape Use 2. Name Date 3. Specific to block/department's policy or after each use 4. Specific to block/department's policy 5. F 6. T 7. F 8. F Correct procedures for the demonstration section can be found in the manufacturer's instructions. Revised: Aagnst IS, 1993 BY: Darlene S. Creel 3 ,,00 DOW CONFIDENTIAL r '^ T*i Solvents / EDC 1 Annual Inspection Record Air Purifying Mouthbit Respirators Name : Date : / //?/?<" Master # : V 7 3 7 Employer : Dow Chemical Respirator Mfg. & Model #: AO R722 Cartridge Type: Acid Gas' Disassemble the respirator (if possible) and inspect the following; (Circle One) Is the body/cartridge holder free of any dents, distortion, and wear ? Is the cartridge face unobstructed, with no cracks or holes ? Is thecartridge and respirator manufactured by the same company (compatible) ? Is the cartridge gasket (if applicable) cut, cracked, or missing ? Are the Inhalation/Exhalation diaphragm valve flaps stiff, decomposed, or cut ? Are the Inhalation/Exhalation diaphragm valve seats distorted, scratched, cracked, or obstructed ? Is the Exhalation valve cover distorted, scratched, cracked, or missing ? Is the Mouthbit distorted, stiff, decomposed, cut, or obstructed ? Is the Mouthbit cover stiff, distorted, missing, or has it lost tension ? Is the nose clamp stiff, distorted, missing, or has it lost tension ? Is the cartridge dated ? Is the cartridge date more than 1 year old ? Is the owners name on the respirator ? Is the respirator clean ? Y<P Y^P Y^SP Y/tfP YtfSP Yyt^ ^y/N Note: Make sure the cartridge is clean. Never try to clean it by washing it or blowing with air. Inspect the cartridge for dents or other damage. Breathe at least once through the respirator to insure that it is functioning properly. If any odor or taste is detected, replace the air-purifying element or dispose of the respirator (if it is a disposable model). Note any actions taken to correct any deficiency found during this inspection. 1 DO A 040179 CONFTOFNTT Al Mouthbit Respirator Training Test I. Complete the following statements: 1. A mouthbit respirator is used for fSra,?*-_________^ ^/c-, 2. If a mouthbit respirator is individually assigned and removed from the manufacturer's protective bag, then it becomes your property and needs to have your a/e and the -e it was opened marked on the respirator. 3. In the Solvents / EDC 1 Plant, the mouthbit respirator cartridge must be replaced or when it is ^ //^ 4. The replacement cartridges for mouthbit respirators are located in Bldg. /? j (the ). II. -Sv.` Circle "T" if True or "F' if False for the following statements: 6. You need medical approval to use a mouthbit respirator. (v, /7. T You need to be fit-tested to use a mouthbit respirator. 8. & F Respirator equipment is approved as a unit and parts are not interchangeable with other models. 9. T Cp;) 10. & F A mouthbit respirator can be used to catch process samples. The mouthbit respirator that you use in the plant is individually assigned to you. III. Complete the following exercises, mark with an "V" when done: 11. L/' \/ 12. Demonstrate respirator. Demonstrate 13. Review how 2 r>o l\ip r^N0M1 f/tQ r\ Name Solvents / EDO 1 Annual Inspection Record A1A*Air Purifying Mouthbit Respirators Date Master # : M. Employer Dow Chemical Respirator Mfg. & Model #: AO R722 Cartridge Type: Acid Gas Disassemble the respirator (if possible) and inspect the following; (Circle One) Is the body/cartridge holder free of any dents, distortion, and wear ? Is the cartridge face unobstructed, with no cracks or holes ? Is the cartridge and respirator manufactured by the same company (compatible) ? Is the cartridge gasket (if applicable) cut, cracked, or missing ? Are the Inhalation/Exhalation diaphragm valve flaps stiff, decomposed, or cut ? Are the Inhalation/Exhalation diaphragm valve seats distorted, scratched, cracked, or obstructed ? Is the Exhalation valve cover distorted, scratched, cracked, or missing ? Is the Mouthbit distorted, stiff, decomposed, cut, or obstructed ? Is the Mouthbit cover stiff, distorted, missing, or has it lost tension ? Is the nose clamp stiff, distorted, missing, or has it lost tension ? Is the cartridge dated ? Is the cartridge date more than 1 year old ? Is the owners name on the respirator ? Is the respirator clean ? Note: Make sure the cartridge is clean. Never try to clean it by washing it or blowing with air. Inspect the cartridge for dents or other damage. Breathe at least once through the respirator to insure that it is functioning properly. If any odor or taste is detected, replace the air-purifying element or dispose of the respirator (if it is a disposable model). Note any actions taken to correct any deficiency found during this inspection. Mouthbit Respirator Training Test I. Complete the following statements: 1. A mouthbit respirator is used for 2. If a mouthbit respirator is individually assigned and removed from the manufacturer's protective bag, then it becomes your property and needs to have your ^ _____ and the it was opened marked on the respirator. 3. In the Solvents / EDC 1 Plant, the mouthbit respirator cartridge must be replaced or when it isc *T- M/ 4. The replacement cartridges for mouthbit respirators are located in Bldg. I j l) J' (the ). II. Circle "T" if True or "F' if False for the following statements: You need medical approval to use a mouthbit respirator. You need to be fit-tested to use a mouthbit respirator. Respirator equipment is approved as a unit and pans are not interchangeable with other models. A mouthbit respirator can be used to catch process samples. The mouthbit respirator that you use in the plant is individually assigned to you. III. Complete the following exercises, mark with an "V" when done: 11. Demonstrate the correct procedure to clean, maintain, and store your mouthbit respirator. 12. 13. r" Demonstrate how to correctly change the cartridge of your mouthbit respirator. Review how to correctly don your mouthbit respirator. 2 DO A 0401 ft? CONFTDFNTT Al Name Solvents / EDC 1 Annual Inspection Record Air Purifying Mouthbit Respirators Date : O / / / ^-5 Master # Employer : Dow Chemical Respirator Mfg. & Model #: AO R722 Cartridge Type: Acid Gas Disassemble the respirator (if possible) and inspect the following; (Circle One) Is the body/cartridge holder free of any dents, distortion, and wear ? Is the-cartridge face unobstructed, with no cracks or holes ? Is the cartridge and respirator manufactured by the same company (compatible) ? Is the cartridge gasket (if applicable) cut, cracked, or missing ? Are the Inhalation/Exhalation diaphragm valve flaps stiff, decomposed, or cut ? Are the Inhalation/Exhalation diaphragm valve seats distorted, scratched, cracked, or obstructed ? Is the Exhalation valve cover distorted, scratched, cracked, or missing ? Is the Mouthbit distorted, stiff, decomposed, cut, or obstructed ? Is the Mouthbit cover stiff, distorted, missing, or has it lost tension ? Is the nose clamp stiff, distorted, missing, or has it lost tension ? Is the cartridge dated ? Is the cartridge date more than 1 year old ? Is the owners name on the respirator ? Is the respirator clean ? Note: Make sure the cartridge is clean. Never try to clean it by washing it or blowing with air. Inspect the cartridge for dents or other damage. Breathe at least once through the respirator to insure that it is functioning properly. If any odor or taste is detected, replace the air-purifying element or dispose of the respirator (if it is a disposable model). Note any actions taken to correct any deficiency found during this inspection. 00 A 04 O} r-ONFTn^r1^ 1 Mouthbit Respirator Training Test Complete the following statements: 1. A mouthbit respirator is used for. 2. If a mouthbit respirator is individually assigned and removed from the manufacturer's protective bag, then it becomes your property and needs to have yourand the it was opened marked on the respirator. 3. In the Solvents / EDC 1 Plant, the mouthbit respirator cartridge must be replaced_____________ or when it is. 4. The replacement cartridges for mouthbit respirators are located in Bldg.(the ).'___________________________________ Circle "T" if True or "F' if False for the following statements: 6. T F You need medical approval to use a mouthbit respirator. 7. T F You need to be fit-tested to use a mouthbit respirator. 8. T F Respirator equipment is approved as a unit and pans are not interchangeable with other models. 9. T F A mouthbit respirator can be used to catch process samples. 10. T F The mouthbit respirator that you use in the plant is individually assigned to you. Complete the following exercises, mark with an "V" when done: 11. ______ Demonstrate the correct procedure to clean, maintain, and store your mouthbit respirator. 12. ______ Demonstrate how to correctly change the cartridge of your mouthbit respirator. 13. ______ Review how to correctly don your mouthbit respirator. On 2 cnhjp- ^ op40i&4 r*t Solvents / EDC 1 Annual Inspection Record Air Purifying Mouthbit Respirators Name : ^/-^V Vyt */Vy fit/?: V Master # : C/ T 3 <-> Date : / / / ? / ^ ) Employer : Dow Chemical Respirator Mfg. & Model #: AO R722 Cartridge Type: Acid Gas Disassemble the respirator (if possible) and inspect the following; (Circle One) Is the body/cartridge holder free of any dents, distortion, and wear ? Is the cartridge face unobstructed, with no cracks or holes ? Is the'tartridge and respirator manufactured by the same company (compatible) ? Is the cartridge gasket (if applicable) cut, cracked, or missing ? Are the Inhalation/Exhalation diaphragm valve flaps stiff, decomposed, or cut ? Are the Inhalation/Exhalation diaphragm valve seats distorted, scratched, cracked, or obstructed ? Is the Exhalation valve cover distorted, scratched, cracked, or missing ? Is the Mouthbit distorted, stiff, decomposed, cut, or obstructed ? Is the Mouthbit cover stiff, distorted, missing, or has it lost tension ? Is the nose clamp stiff, distorted, missing, or has it lost tension ? Is the cartridge dated ? Is the cartridge date more than 1 year old ? Is the owners name on the respirator ? Is the respirator clean ? Note: Make sure the cartridge is clean. Never try to clean it by washing it or blowing with air. Inspect the cartridge for dents or other damage. Breathe at least once through the respirator to insure that it is functioning properly. If any odor or taste is detected, replace the air-purifying element or dispose of the respirator (if it is a disposable model). Note any actions taken to correct any deficiency found during this inspection. DO DONF A 040 185 tofnt ta I 1 Mouthbit Respirator Training Test Complete the following statements: 1. A mouthbit respirator is used for 2. If a mouthbit respirator is individually assigned and removed from the manufacturer's protective^ bag, then it becomes your property and needs to have your NflA/tf-. and the /W 7?>1 it was opened marked on the respirator. 3. In the Solvents / EDC 1 Plant, the mouthbit respirator cartridge must be replaced or when it is 4. The replacement cartridces for mouthbit respirators are located in Bide. /c4> St) Circle "T" if True or "F' if False for the following statements: (the You need medical approval to use a mouthbit respirator. You need to be Fit-tested to use a mouthbit respirator. Respirator equipment is approved as a unit and parts are not interchangeable with other models. A mouthbit respirator can be used to catch process samples. The mouthbit respirator that you use in the plant is individually assigned to you. Complete the following exercises, mark with an "V" when done: 11. Demonstrate the correct procedure to clean, maintain, and store your mouthbit respirator. i/12. Demonstrate how to correctly change the cartridge of your mouthbit respirator, y13. Review how to correctly don your mouthbit respirator. 2o Name Solvents / EDC 1 Annual Inspection Record Air Purifying Mouthbit Respirators Date : M / \ I i Master # Employer : Dow Chemical Respirator Mfg. & Model #: AO R722 Cartridge Type: Acid Gas Disassemble the respirator (if possible) and inspect the following; (Circle One) Is the body/cartridge holder free of any dents, distortion, and wear ? Is the cartridge face unobstructed, with no cracks or holes ? Is the cartridge and respirator manufactured by the same company (compatible) ? Is the cartridge gasket (if applicable) cut, cracked, or missing ? Are the Inhalation/Exhalation diaphragm valve flaps stiff, decomposed, or cut ? Are the Inhalation/Exhalation diaphragm valve seats distorted, scratched, cracked, or obstructed ? Is the Exhalation valve cover distorted, scratched, cracked, or missing ? Is the Mouthbit distorted, stiff, decomposed, cut, or obstructed ? Is the Mouthbit cover stiff, distorted, missing, or has it lost tension ? Is the nose clamp stiff, distorted, missing, or has it lost tension ? Is the cartridge dated ? Is the cartridge date more than 1 year old ? Is the owners name on the respirator ? Is the respirator clean ? Note: Make sure the cartridge is clean. Never try to clean it by washing it or blowing with air. Inspect the cartridge for dents or other damage. Breathe at least once through the respirator to insure that it is functioning properly. If any odor or taste is detected, replace the air-purifying element or dispose of the respirator (if it is a disposable model). Note any actions taken to correct any deficiency found during this inspection. rn^LA 040187 roonf tdfnt ai Mouthbit Respirator Training Test Complete the following statements: 1. A mouthbit respirator is used for r> 2. If a mouthbit respirator is individually assigned and removed from the manufacturer's protective bag, then it becomes your property and needs to have your f W- .. and the parts' it was opened marked on the respirator. 3. In the Solvents / EDC I Plant, the mouthbit respirator cartridge must be replaced or when it is & LTUfu.ret>. r 4. The replacement cartridges for mouthbit respirators are located in Bldg. 170*2. (the Circle "T" if True or "F' if False for the following statements: 6. T 7. T CD 8. F 9. T 10. F You need medical approval to use a mouthbit respirator. You need to be Fit-tested to use a mouthbit respirator. Respirator equipment is approved as a unit and pans are not interchangeable with other models. A mouthbit respirator can be used to catch process samples. The mouthbit respirator that you use in the plant is individually assigned to you. Complete the following exercises, mark with an "V" when done: 11. Demonstrate respirator. 12. Demonstrate 13. Review how 2 On CnNF^?; Solvents / EDC 1 Annual Inspection Record Air Purifying Mouthbit Respirators Name Date : / / / ^ LZA Master # : ^ Employer : Dow Chemical Respirator Mfg. & Model #: AO R722 Cartridge Type: Acid Gas" Disassemble the respirator (if possible) and inspect the following; (Circle One) Is the body/cartridge holder free of any dents, distortion, and wear ? Is the Cartridge face unobstructed, with no cracks or holes ? Is the cartridge and respirator manufactured by the same company (compatible) ? Is the cartridge gasket (if applicable) cut, cracked, or missing ? Are the Inhalation/Exhalation diaphragm valve flaps stiff, decomposed, or cut ? Are the Inhalation/Exhalation diaphragm valve seats distorted, scratched, cracked, or obstructed ? Is the Exhalation valve cover distorted, scratched, cracked, or missing ? Is the Mouthbit distorted, stiff, decomposed, cut, or obstnicted ? Is the Mouthbit cover stiff, distorted, missing, or has it lost tension ? Is the nose clamp stiff, distorted, missing, or has it lost tension ? Is the cartridge dated ? Is the cartridge date more than 1 year old ? Is the owners name on the respirator ? Is the respirator clean ? $7N c&n Y/<& Y/ Y/ _ Y Note: Make sure the cartridge is clean. Never try to clean it by washing it or blowing with air. Inspect the cartridge for dents or other damage. Breathe at least once through the respirator to insure that it is functioning properly. If any odor or taste is detected, replace the air-purifying element or dispose of the respirator (if it is a disposable model). Note any actions taken to correct any deficiency found during this inspection. Mouthbit Respirator Training Test Complete the following statements: 1. A mouthbit respirator is used for /) P - 2. If a mouthbit respirator is individually assigned and removed from the manufacturer's protective bag, then it becomes your property and needs to have your a ^' and the "ft* t it was opened marked on the respirator. 3. In the Sodlvveents / EDC 1 Planj^the mouthbit respirator cartridge must be replaced or when it is * tfJfvsijr 7 / 7 4. The repliacenment cartridges for mouthbit respirators are located in Bldg. d (the Circle "T" if True or "F' if False for the following statements: 6. T > You need medical approval to use a mouthbit respirator. 7. T F 8. T F 9. T 10. /T^ F F You need to be fit-tested to use a mouthbit respirator. Respirator equipment is approved as a unit and parts are not interchangeable with other models. A mouthbit respirator can be used to catch process samples. The mouthbit respirator that you use in the plant is individually assigned to you. Complete the following exercises, mark with an "V" when done: 11. Demonstrate the correct procedure to clean, maintain, and store your mouthbit respirator. 12. Demonstrate how to correctly change the cartridge of your mouthbit respirator. 13. ^ Review how to correctly don your mouthbit respirator. Name : Master # : 0*5 Solvents / EDC 1 Annual Inspection Record Air Purifying Mouthbit Respirators * Ca^Xle/^ Date : _ \ / 0*5 Employer : Dow Chemical Respirator Mfg. & Model #: AO R722 Cartridge Type: Acid Ga~ Disassemble the respirator (if possible) and inspect the following; (Circle One) Is the body/cartridge holder free of any dents, distortion, and wear ? Is the cartridge face unobstructed, with no cracks or holes ? Is the cartridge and respirator manufactured by the same company (compatible) ? Is the cartridge gasket (if applicable) cut, cracked, or missing ? Are the Inhalation/Exhalation diaphragm valve flaps stiff, decomposed, or cut ? Are the Inhalation/Exhalation diaphragm valve seats distorted, scratched, cracked, or obstructed ? Is the Exhalation valve cover distorted, scratched, cracked, or missing ? Is the Mouthbit distorted, stiff, decomposed, cut, or obstructed ? Is the Mouthbit cover stiff, distorted, missing, or has it lost tension ? Is the nose clamp stiff, distorted, missing, or has it lost tension ? Is the cartridge dated ? Is the cartridge date more than 1 year old ? Is the owners name on the respirator ? Is the respirator clean ? Note: Make sure the cartridge is clean. Never try to clean it by washing it or blowing with air. Inspect the cartridge for dents or other damage. Breathe at least once through the respirator to insure that it is functioning properly. If any odor or taste is detected, replace the air-purifying element or dispose of the respirator (if it is a disposable model). Note any actions taken to correct any deficiency found during this inspection. 1 00 A 040191 C'ONF tdfnt tai Mouthbit Respirator Training Test I. Complete the following statements: 1. A mouthbit respirator is used for. ___ 2. If a mouthbit respirator is individually assigned and removed from the manufacturer's protgctivj bag, then it becomes your property and needs to have your and the _ it was opened marked on the respirator. 3. In the Solvents /EDCJLPlant, the mouthbit respirator cartridge must be replaced.-&1\ or when it is /vS1La/\jL . 4. The replacemient cartridges for mouthbit respirators are located in Bldg. I~I O&L (the ` ____ ) II. Circle "T" if True or "F1 if False for the following statements: 6. T (?) You need medical approval to use a mouthbit respirator. 7. T (f) 8. ( F 9. T 10. F You need to be fit-tested to use a mouthbit respirator. Respirator equipment is approved as a unit and parts are not interchangeable with other models. A mouthbit respirator can be used to catch process samples. The mouthbit respirator that you use in the plant is individually assigned to you. III. Complete the following exercises, mark with an y11. Demonstrate respirator. 12. Demonstrate y13. Review how when done: r>o a C0NF^rNTJT^ / Name : Solvents / EDC 1 Annual Inspection Record Air Purifying Mouthbit Respirators Date / i/7if Master # : Employer Dow Chemical Respirator Mfg. & Model #: AO R722 Cartridge Type: Acid Gas Disassemble the respirator (if possible) and inspect the following; Is the body/cartridge holder free of any dents, distortion, and wear ? Is the cartridge face unobstructed, with no cracks or holes ? Is the cartridge and respirator manufactured by the same company (compatible) ? Is the cartridge gasket (if applicable) cut, cracked, or missing ? Are the Inhalation/Exhalation diaphragm valve flaps stiff, decomposed, orcut ? Are the Inhalation/Exhalation diaphragm valve seats distorted, scratched, cracked, or obstructed ? Is the Exhalation valve cover distorted, scratched, cracked, or missing ? Is the Mouthbit distorted, stiff, decomposed, cut, or obstructed ? Is the Mouthbit cover stiff, distorted, missing, or has it lost tension ? Is the nose clamp stiff, distorted, missing, or has it lost tension ? Is the cartridge dated ? Is the cartridge date more than 1 year old ? Is the owners name on the respirator ? Is the respirator clean ? (Circle One) Note: Make sure the cartridge is clean. Never try to clean it by washing it or blowing with air. Inspect the cartridge for dents or other damage. Breathe at least once through the respirator to insure that it is functioning properly. If any odor or taste is detected, replace the air-purifying element or dispose of the respirator (if it is a disposable model). Note any actions taken to correct any deficiency found during this inspection. 1 rio *" Ol\lpr * l9 Tr)FNTTAl & Mouthbit Respirator Training Test I. Complete the following statements: 1. A mouthbit respirator is used for 2. If a mouthbit respirator is individually assigned and removed from the manufacturer's protective bag, then it becomes your property and needs to have your ______ aannddththee Xr it was opened marked on the respirator. 3. In the Solvents / EDC 1 Plant, the mouthbit respirator cartridge must be replaced or when it is ^ 4. The replacement cartridges for mouthbit respirators are located in Bldg. (the II. Circle "T" if True or "F' if False for the following statements: t d) You need medical approval to use a mouthbit respirator. 7. You need to be fit-tested to use a mouthbit respirator. 8. Respirator equipment is approved as a unit and parts are not interchangeable with other models. 9. T A mouthbit respirator can be used to catch process samples. 610. The mouthbit respirator that you use in the plant is individually assigned to you. III. Complete the following exercises, mark with an "V" when done: 11. Demonstrate the correct procedure to clean, maintain, and store your mouthbit respirator. 12. Demonstrate how to correctly change the cartridge of your mouthbit respirator. 13. Review how to correctly don your mouthbit respirator. F~ (3> 2 rn? A 040194 CONFTOFNTTAl Name : Solvents / EDC 1 Annual Inspection Record Aii^ Purifying Mouthbit Respirators Date : X / Master # : 3 Employer : Dow Chemical Respirator Mfg. & Model #: AO R722 Cartridge Type: Acid Gas~ Disassemble the respirator (if possible) and inspect the following; (Circle One) Is the body/cartridge holder free of any dents, distortion, and wear ? Is the cartridge face unobstructed, with no~cracks or holes ? Is the cartridge and respirator manufactured by the same company (compatible) ? Is the cartridge gasket (if applicable) cut, cracked, or missing ? Are the Inhalation/Exhalation diaphragm valve flaps stiff, decomposed, or cut ? Are the Inhalation/Exhalation diaphragm valve seats distorted, scratched, cracked, or obstructed ? Is the Exhalation valve cover distorted, scratched, cracked, or missing ? Is the Mouthbit distorted, stiff, decomposed, cut, or obstructed ? Is the Mouthbit cover stiff, distorted, missing, or has it lost tension ? Is the nose clamp stiff, distorted, missing, or has it lost tension ? Is the cartridge dated ? Is the cartridge date more than 1 year old ? Is the owners name on the respirator ? Is the respirator clean ? Note: Make sure the cartridge is clean. Never try to clean it by washing it or blowing with air. Inspect the cartridge for dents or other damage. Breathe at least once through the respirator to insure that it is functioning properly. If any odor or taste is detected, replace the air-purifying element or dispose of the respirator (if it is a disposable model). Note any actions taken to correct any deficiency found during this inspection. rio V 040 7 9.S r0F/VTrA; Mouthbit Respirator Training Test I. Complete the following statements: 1. A mouthbit respirator is used for j@A/*yu ___ 2. If a mouthbit respirator is individually assigned and removed fronuhe manufacturer's protective bag, then it becomes your property and needs to have your and the it was opened marked on the respirator. 3. In the Solvents / EDC lPIant, the mouthbit respirator cartridge must be replaced or when it is j&AJbtK 4. The repilacemmient cartridges for mouthbit respirators are located in Bldg. _____). (the IL Circle "T" if True or "F* if False for the following statements: 6. T (?) You need medical approval to use a mouthbit respirator. 7. T (?) 68. F You needso be fit-tested to use a mouthbit respirator. Respirator equipmtTTHS approved as a unit and pans are not interchangeable with other models. 9. A mouthbit respirator can be used to catch process samples. 10. The mouthbit respirator that you use in the plant is individually assigned to you. III. Complete the following exercises, mark with an "V" when done: 11. Demonstrate respirator. 12. Demonstrate 13. Review how 2 rio Np- 0A4IT0wj 9^ Name Solvents / EDC 1 Annual Inspection Record Air Purifying Mouthbit Respirators fi**- /gy Date : // /ft Master # Employer : Dow Chemical Respirator Mfg. & Model #: AO R722 Cartridge Type: Acid Gas Disassemble the respirator (if possible) and inspect the following; (Circle One) Is the body/cartridge holder free of any dents, distortion, and wear ? Is the cartridge face unobstructed, with no cracks or holes ? Is the cartridge and respirator manufactured by the same company (compatible) ? Is the cartridge gasket (if applicable) cut, cracked, or missing ? Are the Inhalation/Exhalation diaphragm valve flaps stiff, decomposed, or cut ? Are the Inhalation/Exhalation diaphragm valve seats distorted, scratched, cracked, or obstructed ? Is the Exhalation valve cover distorted, scratched, cracked, or missing ? Is the Mouthbit distorted, stiff, decomposed, cut, or obstructed ? Is the Mouthbit cover stiff, distorted, missing, or has it lost tension ? Is the nose clamp stiff, distorted, missing, or has it lost tension ? Is the cartridge dated ? Is the cartridge date more than 1 year old ? Is the owners name on the respirator ? Is the respirator clean ? Note: Make sure the cartridge is clean. Never try to clean it by washing it or blowing with air. Inspect the cartridge for dents or other damage. Breathe at least once through the respirator to insure that it is functioning properly. If any odor or taste is detected, replace the air-purifying element or dispose of the respirator (if it is a disposable model). Note any actions taken to correct any deficiency found during this inspection. on A 040197 CONF T DFNT T Al Mouthbit Respirator Training Test I. Complete the following statements: 1. A mouthbit respirator is used for 2 2. If a mouthbit respirator is individually assigned and removedtrom the manufacturer's prptecjive bag, then it becomes your property and needs to have your f) and the. it was opened marked on the respirator. 3. In tthhee SSoollvveennttss // EEDDCC,.^l PPllaanntt,, tthhee nmiqopptthbit respirator cartridge must be replaced #WOru/fj when it is i* .. 4. The replacement cartridges for mouthbit respirators are located in Bldg. /7 :) II. Circle "T" if True or "F' if False for the following statements: (the You need medical approval to use a mouthbit respirator. You need to be fit-tested to use a mouthbit respirator. Respirator equipment is approved as a unit and parts are not interchangeable with other models. A mouthbit respirator can be used to catch process samples. The mouthbit respirator that you use in the plant is individually assigned to you. in. Complete the following exercises, mark with an "V" when done: 11. LS' Demonstrate respirator. 12. S' Demonstrate 13. Review how 2 cn/vp Namee : Solvents / EDC 1 Annual Inspection Record 0 Air Purifying Mouthbit Respirators - DDaattee : J__J3lS3 Master Employer Dow Chemical Respirator Mfg. & Model #: AO R722 Cartridge Type: Acid Gas Disassemble the respirator (if possible) and inspect the following; (Circle One) Is the body/cartridge holder free of any dents, distortion, and wear ? Is tl$ cartridge face unobstructed, with nrxcracks or holes ? Is the cartridge and respirator manufactured by the same company (compatible) ? Is the cartridge gasket (if applicable) cut, cracked, or missing ? Are the Inhalation/Exhalation diaphragm valve flaps stiff, decomposed, or cut ? Are the Inhalation/Exhalation diaphragm valve seats distorted, scratched, cracked, or obstructed ? Is the Exhalation valve cover distorted, scratched, cracked, or missing ? Is the Mouthbit distorted, stiff, decomposed, cut, or obstructed ? Is the Mouthbit cover stiff, distorted, missing, or has it lost tension ? Is the nose clamp stiff, distorted, missing, or has it lost tension ? Is the cartridge dated ? Is the cartridge date more than 1 year old ? Is the owners name on the respirator ? Is the respirator clean ? Note: Make sure the cartridge is clean. Never try to clean it by washing it or blowing with air. Inspect the cartridge for dents or other damage. Breathe at least once through the respirator to insure that it is functioning properly. If any odor or taste is detected, replace the air-purifying element or dispose of the respirator (if it is a disposable model). Note any actions taken to correct any deficiency four\d during this inspection. ____________________________________________________________________________________________________________ c-,oV,0,n /5 9* 1 Mouthbit Respirator Training Test Complete the following statements: 1. A mouthbit respirator is used for 2. If a mouthbit respirator is individually assigned and removed fipm the manufacturer's protective bag, then it becomes your property and needs to have your AiO.aA^ and the (fo i~~e it was opened marked on the respirator. 3. In the Solvents/EDC 1 Plant, the mouthbit respirator cartridge must be replaced h or when it is qh rH~ 1/ < jJ 4. The replacement cartridges for mouthbit respirators are located in Bldg. / *70 H- (the ____________). Circle "T" if True or "F' if False for the following statements: 6. T SL You need medical approval to use a mouthbit respirator. 7. T w You need to be fit-tested to use a mouthbit respirator. 8. F Respirator equipment is approved as a unit and parts are not interchangeable whh other models. 9. T A mouthbit respirator can be used to catch process samples. 10. F The mouthbit respirator that you use in the plant is individually assigned to you. Complete the following exercises, mark with an "V" when done: 11. Demonstrate the correct procedure to clean, maintain, and store your mouthbit respirator. 12. Demonstrate how to correctly change the cartridge of your mouthbit respirator, 13. Review how to correctly don your mouthbit respirator. Dn 2 Tn^0?0 Solvents / EDC 1 Annual Inspection Record Air Purifying Mouthbit Respirators Name : L riA Date : / / Master # : Employer : Dow Chemical Respirator Mfg. & Model #: AO R722 Cartridge Type: Acid Gas Disassemble the respirator (if possible) and inspect the following; (Circle One) Is the body/cartridge holder free of any dents, distortion, and wear ? Is the cartridge face unobstructed, with no cracks or holes ? Is the cartridge and respirator manufactured by the same company (compatible) ? Is the cartridge gasket (if applicable) cut, cracked, or missing ? Are the Inhalation/Exhalation diaphragm valve flaps stiff, decomposed, or cut ? Are the Inhalation/Exhalation diaphragm valve seats distorted, scratched, cracked, or obstructed ? Is the Exhalation valve cover distorted, scratched, cracked, or missing ? Is the Mouthbit distorted, stiff, decomposed, cut, or obstructed ? Is the Mouthbit cover stiff, distorted, missing, or has it lost tension ? Is the nose clamp stiff, distorted, missing, or has it lost tension ? Is the cartridge dated ? Is the cartridge date more than 1 year old ? Is the owners name on the respirator ? Is the respirator clean ? )/ N Note: Make sure the cartridge is clean. Never try to clean it by washing it or blowing with air. Inspect the cartridge for dents or other damage. Breathe at least once through the respirator to insure that it is functioning properly. If any odor or taste is detected, replace the air-purifying element or dispose of the respirator (if it is a disposable model). Note any actions taken to correct any deficiency found during this inspection. Oq a r-ONr 040^ Mouthbit Respirator Training Test I. Complete the following statements: 1. A mouthbit respirator is used for 'CscAf .2 If a mouthbit respirator is individually assigned and removed from, the manufacturer's protective bag, then it becomes your property and needs to have your pJ and the it was opened marked on the respirator. 3. In the Solvents / EDC 1 Plant, the mouthbit respirator cartridge must be replaced & /?) AfTft or when it is 54-4^/^ . 4. Thereplacement cartridges for mouthbit respirators are located in Bldg. ^ (the W II. w Circle "T" if True or "F' if False for the following statements: 6. T You need medical approval to use a mouthbit respirator. 7. T & You need to be fit-tested to use a mouthbit respirator. 8. (52 F Respirator equipment is approved as a unit and parts are not interchangeable with other models. 9. T (j2 A mouthbit respirator can be used to catch process samples. 10. & F The mouthbit respirator that you use in the plant is individually assigned to you. III. Complete the following exercises, mark with an "V" when done: Demonstrate the correct procedure to clean, maintain, and store your mouthbit respirator. Demonstrate how to correctly change the cartridge of your mouthbit respirator. Review how to correctly don your mouthbit respirator. 2 . (-0/\/p Tr, Name : Solvents / EDC 1 Annual Inspection Record Air Purifying Mouthbit Respirators /l &***_______ Date : // Master # : 4 3101$_________ Respirator Mfg. & Model #: AO R722 Cartridge Type: Acid Gas Employer : Dow Chemical Disassemble the respirator (if possible) and inspect the following; (Circle One) Is the body/cartridge holder free of any dents, distortion, and wear ? Is the cartridge face unobstructed, with no cracks or holes ? Is the cartridge and respirator manufactured by the same company (compatible) ? Is the cartridge gasket (if applicable) cut, cracked, or missing ? Are the Inhalation/Exhalatipn diaphragm valve flaps stiff, decomposed, or cut ? Are the Inhalation/Exhalation diaphragm valve seats distorted, scratched, cracked, or obstructed ? Is the Exhalation valve cover distorted, scratched, cracked, or missing ? Is the Mouthbit distorted, stiff, decomposed, cut, or obstructed ? Is the Mouthbit cover stiff, distorted, missing, or has it lost tension ? Is the nose clamp stiff, distorted, missing, or has it lost tension ? Is the cartridge dated ? Is the cartridge date more than 1 year old ? Is the owners name on the respirator ? Is the respirator clean ? /EV N a>/ N N Y /(w Y /<&) Y Y /$& Y /m) Y /S' YXN; oDl N (Y// N W/ N Note: Make sure the cartridge is clean. Never try to clean it by washing it or blowing with air. Inspect the cartridge for dents or other damage. Breathe at least once through the respirator to insure that it is functioning properly. If any odor or taste is detected, replace the air-purifying element or dispose of the respirator (if it is a disposable model). Note any actions taken to correct any deficiency found during this inspection. Mouthbit Respirator Training Test Complete the following statements: A mouthbit respirator is used for. . 6 f-j 2. If a mouthbit respirator is individually assigned and removed from the manufacturer's protective bag, then it becomes your property and needs to have your _____ and the As. it was opened marked on the respirator. 3. In the Solvents / EDCJ Plant, the mouthbit respirator cartridge must be replaced /\ or when it is I( ^ 4. The replacement cartridges for mouthbit respirators are located in Bldg. 1 ? ___ ). (the Circle "T" if True or "F' if False for the following statements: 6. T t> You need medical approval to use a mouthbit respirator. 7. T &> You need to be fit-tested to use a mouthbit respirator. 8. & F Respirator equipment is approved as a unit and parts are not interchangeable with other models. 9. T 0 10. & F A mouthbit respirator can be used to catch process samples. The mouthbit respirator that you use in the plant is individually assigned to you. Complete the following exercises, mark with an "V" when done: 11. 1/ 12. Demonstrate respirator. Demonstrate 13. Review how Solvents / EDC 1 Annual Inspection Record Air Purifying Mouthbit Respirators Name : ll'-d. bvt/c Date : / / Master # : H3 3 / 2JI______ Employer : Dow Chemical Respirator Mfg. & Model #: AO R722 Cartridge Type: Acid Gas Disassemble the respirator (if possible) and inspect the following; Is the body/cartridge holder free of any dents, distortion, and wear ? Is the cartridge face unobstructed, with no cracks or holes ? Is the cartridge and respirator manufactured by the same company (compatible) ? Is the cartridge gasket (if applicable) cut, cracked, or missing ? Are the Inhalation/Exhalation diaphragm valve flaps stiff, decomposed, or,cut ? Are the Inhalation/Exhalatiori diaphragm valve seats distorted, scratched, cracked, or obstructed ? Is the Exhalation valve cover distorted, scratched, cracked, or missing ? Is the Mouthbit distorted, stiff, decomposed, cut, or obstructed ? Is the Mouthbit cover stiff, distorted, missing, or has it lost tension ? Is the nose clamp stiff, distorted, missing, or has it lost tension ? Is the cartridge dated ? Is the cartridge date more than 1 year old ? Is the owners name on the respirator ? Is the respirator clean ? (Circle One) <3/ N <2>/N &)/N Y/B> Y/fi> Y/&P Y f& Y/IP Y/6P Y/6P /N Y/D <>/n $>/N Note: Make sure the cartridge is clean. Never try to clean it by washing it or blowing with air. Inspect the cartridge for dents or other damage. Breathe at least once through the respirator to insure that it is functioning properly. If any odor or taste is detected, replace the air-purifying element or dispose of the respirator (if it is a disposable model). Note any actions taken to correct any deficiency found during this inspection. Mouthbit Respirator Training Test Complete the following statements: 1. A mouthbit respirator is used for _______ 2. If a mouthbit respirator is individually assigned and removed from the manufacturer's protective bag, then it becomes your property and needs to have vour /V/?*?) and the b/T it was opened marked on the respirator. 3. In the Solvents / EDC 1 Plant, the mouthbit respirator cartridge must be replaced or when it is ($&_______. Pi*** 4. The replacement cartridges for mouthbit respirators are located in Bldg. / hi.-' s'W V (the Circle "T" if True or "F' if False for the following statements: 6. T You need medical approval to use a mouthbit respirator. 7. T 0 You need to be fit-tested to use a mouthbit respirator. 8. F Respirator equipment is approved as a unit and parts are not interchangeable with other models. 9. T <0 A mouthbit respirator can be used to catch process samples. 10. F The mouthbit respirator that you use in the plant is individually assigned to you. Complete the following exercises, mark with an "V" when done: 11. Demonstrate the correct procedure to clean, maintain, and store your mouthbit respirator. 12. Demonstrate how to correctly change the cartridge of your mouthbit respirator. 13. Review how to correctly don your mouthbit respirator. 2 no Name : Solvents / EDC 1 Annual Inspection Record Air Purifying Mouthbit Respirators LsiuKiC hctSpgc(( Date : // /^ / ^-5 Master # : Of ft o o Employer : Dow Chemical Respirator Mfg. & Model #: AO R722 Cartridge Type: Acid Gas Disassemble the respirator (if possible) and inspect the following; (Circle One) Is the body/cartridge holder free of any dents, distortion, and wear ? Is the cartridge face unobstructed, with no cracks or holes ? Is the cartridge and respirator manufactured by the same company (compatible) ? Is the cartridge gasket (if applicable) cut, cracked, or missing ? Are the Inhalation/Exhalation diaphragm valve flaps stiff, decomposed, or cut ? Are the Inhalation/Exhalation diaphragm valve seats distorted, scratched, cracked, or obstructed ? Is the Exhalation valve cover distorted, scratched, cracked, or missing ? Is the Mouthbit distorted, stiff, decomposed, cut, or obstructed ? Is the Mouthbit cover stiff, distorted, missing, or has it lost tension ? Is the nose clamp stiff, distorted, missing, or has it lost tension ? Is the cartridge dated ? Is the cartridge date more than 1 year old ? Is the owners name on the respirator ? Is the respirator clean ? Y/j Y/3& Y/fi^ Y !%? Y/^ Y/4 Y/i^/N ^JfN Note: Make sure the cartridge is clean. Never try to clean it by washing it or blowing with air. Inspect the cartridge for dents or other damage. Breathe at least once through the respirator to insure that it is functioning properly. If any odor or taste is detected, replace the air-purifying element or dispose of the respirator (if it is a disposable model). Note any actions taken to correct any deficiency found during this inspection. Mouthbit Respirator Training Test Complete the following statements: 1. A mouthbit respirator is used for / JC-" r 'K f""1- 2. If a mouthbit respirator is individually assigned and removed from the manufacturer's protective bag, then it becomes your property and needs to have your and the o it was opened marked on the respirator. 3. In the Solvents / EDC 1 Plant, the mouthbit respirator cartridge must be replaced ^ r <` 'j or when it is aTdn. 4. The reglacement cartridges for mouthbit respirators are located in Bldg. /76 (the Circle "T" if True or "F' if False for the following statements: You need medical approval to use a mouthbit respirator. You need to be fit-tested to use a mouthbit respirator. Respirator equipment is approved as a unit and parts are not interchangeable with other models. 9. T C&. 10. cxS F A mouthbit respirator can be used to catch process samples. The mouthbit respirator that you use in the plant is individually assigned to you. Complete the following exercises, mark with an "V" when done: 11. ^ Demonstrate the correct procedure to clean, maintain, and store your mouthbit respirator. 12. ^ Demonstrate how to correctly change the cartridge of your mouthbit respirator. 13. - Review how to correctly don your mouthbit respirator. Name : JMaster #^f Solvents / EDC 1 Annual Inspection Record Air Purifying Mouthbit Respirators Dale : __/ / /*71 Employer : Dow Chemical Respirator Mfg. & Model #: AO R722 Cartridge Type: Acid Gas Disassemble the respirator (if possible) and inspect the following; (Circle One) Is the body/cartridge holder free of any dents, distortion, and wear ? Is the cartridge face unobstructed, with no cracks or holes ? Is the cartridge and respirator manufactured by the same company (compatible) ? Is the cartridge gasket (if applicable) cut, cracked, or missing ? Are the Inhalation/Exhalation diaphragm valve flaps stiff, decomposed, or cut ? Are the Inhalation/Exhalation diaphragm valve seats distorted, scratched, cracked, or obstructed ? Is the Exhalation valve cover distorted, scratched, cracked, or missing ? Is the Mouthbit distorted, stiff, decomposed, cut, or obstructed ? Is the Mouthbit cover stiff, distorted, missing, or has it lost tension ? Is the nose clamp stiff, distorted, missing, or has it lost tension ? Is the cartridge dated ? Is the cartridge date more than 1 year old ? Is the owners name on the respirator ? Is the respirator clean ? Note: Make sure the cartridge is clean. Never try to clean it by washing it or blowing with air. Inspect the cartridge for dents or other damage. Breathe at least once through the respirator to insure that it is functioning properly. If any odor or taste is detected, replace the air-purifying element or dispose of the respirator (if it is a disposable model). Note any actions taken to correct any deficiency found during this inspection. 1 Oo 00NF rop*0^09 TFNTTai Mouthbit Respirator Training Test I. Complete the following statements: 1. A mouthbit respirator is used for 2. If a mouthbit respirator is individually assigned and removed from the manufacturer's protective bag, then it becomes your property and needs to have your /lamp_____ and the Oaf/ it was opened marked on the respirator. 3. In the Solvents / EDC/1 Plant, the mouthbit respirator cartridge must be replaced us or when it is rfS ______ . ~/ 4. The replacement cartridges for mouthbit respirators are located in Bldg. / 7C Jffgjo /js/c( Jv/ fjt. (the II. Circle "T" if True or "F* if False for the following statements: 6. T () You need medical approval to use a mouthbit respirator. 7. T ( You need to be fit-tested to use a mouthbit respirator. 8- (t) F Respirator equipment is approved as a unit and parts are not interchangeable with other models. 9. T (f) A mouthbit respirator can be used to catch process samples. 10. {T~j F The mouthbit respirator that you use in the plant is individually assigned to you. ill. Complete the following exercises, mark with an "V" when done: 11. Demonstrate respirator. 12. Demonstrate 13. Review how 2 ^OA/p- rOpo,^<04: Name : Solvents / EDC 1 Annual Inspection Record Air Purifying Mouthbit Respirators Date : _ / / 3 I / S Master # : ^f33c>T ^ Employer : Dow Chemical Respirator Mfg. & Model #: AO R722 Cartridge Type: Acid Gas~ Disassemble the respirator (if possible) and inspect the following; Is the body/cartridge holder free of any dents, distortion, and wear ? Is the cartridge face unobstructed, with no cracks or holes ? Is the cartridge and respirator manufactured by the same company (compatible) ? Is the cartridge gasket (if applicable) cut, cracked, or missing ? Are the Inhalation/Exhalation diaphragm valve flaps stiff, decomposed, of cut ? Are the Inhalation/Exhalation diaphragm valve seats distorted, scratched, cracked, or obstructed ? Is the Exhalation valve cover distorted, scratched, cracked, or missing ? Is the Mouthbit distorted, stiff, decomposed, cut, or obstructed ? Is the Mouthbit cover stiff, distorted, missing, or has it lost tension ? Is the nose clamp stiff, distorted, missing, or has it lost tension ? Is the cartridge dated ? Is the cartridge date more than 1 year old ? Is the owners name on the respirator ? Is the respirator clean ? (Circle One) <9/N jg/N Or / N Y/<&> rm Y/<S> Y/$> Y/<&> Y/fP Y/K> /N &/E> y)/n >/N Note: Make sure the cartridge is clean. Never try to clean it by washing it or blowing with air. Inspect the cartridge for dents or other damage. Breathe at least once through the respirator to insure that it is functioning properly. If any odor or taste is detected, replace the air-purifying element or dispose of the respirator (if it is a disposable model). Note any actions taken to correct any deficiency found during this inspection. Mouthbit Respirator Training Test Complete the following statements: 1. A mouthbit respirator is used for 2. If a mouthbit respirator is individually assigned and removed from the manufacturer's protective bag, then it becomes your property and needs to have your _______ and the it was opened marked on the respirator. 3. In the Solvents / EDC 1 Plant, the mouthbit respirator cartridge must be replaced or when it is ______ . 4. The replacement cartridges for mouthbit respirators are located in Bldg. / 7c>3 (the l^> l7oi COo(. Circle "T" if True or "F* if False for the following statements: 6. (3 F You need medical approval to use a mouthbit respirator. 7. T You need to be fit-tested to use a mouthbit respirator. 8. CP F Respirator equipment is approved as a unit and parts are not inteichangeable with other models. 9. T A mouthbit respirator can be used to catch process samples. 10. (> F The mouthbit respirator that you use in the plant is individually assigned to you. Complete the following exercises, mark with an "V" when done: 11. y Demonstrate the correct procedure to clean, maintain, and store your mouthbit respirator. 12. Demonstrate how to correctly change the cartridge of your mouthbit respirator. 13. Review how to correctly don your mouthbit respirator. 2 Oo r0pNtt Name : Master # : Solvents / EDC 1 Annual Inspection Record Air Purifying Mouthbit Respirators Date : / / A 9S Ul b?7 3 Employer : Dow Chemical Respirator Mfg. & Model #: AO R722 Cartridge Type: Acid Gas" Disassemble the respirator (if possible) and inspect the following; (Circle One) Is the body/cartridge holder free of any dents, distortion, and wear ? Is the cartridge face unobstructed, with no cracks or holes ? Is the cartridge and respirator manufactured by the same company (compatible) ? Is the cartridge gasket (if applicable) cut, cracked, or missing ? Are the Inhalation/Exhalation diaphragm valve flaps stiff, decomposed, or cut ? Are the Inhalation/Exhalation diaphragm valve seats distorted, scratched, cracked, or obstructed ? Is the Exhalation valve cover distorted, scratched, cracked, or missing ? Is the Mouthbit distorted, stiff, decomposed, cut, or obstructed ? Is the Mouthbit cover stiff, distorted, missing, or has it lost tension ? Is the nose clamp stiff, distorted, missing, or has it lost tension ? Is the cartridge dated ? Is the cartridge date more than 1 year old ? Is the owners name on the respirator ? Is the respirator clean ? Note: Make sure the cartridge is clean. Never try to clean it by washing it or blowing with air. Inspect the cartridge for dents or other damage. Breathe at least once through the respirator to insure that it is functioning properly. If any odor or taste is detected, replace the air-purifying element or dispose of the respirator (if it is a disposable model). Note any actions taken to correct any deficiency found during this inspection. On c.qnf Tn4^3 7r)FOTT^L Mouthbit Respirator Training Test I. Complete the following statements: 1. A mouthbit respirator is used for ^) C AP* r 2. If a mouthbit respirator is individually assigned and removed from the manufacturer's protective bag, then it becomes your property and needs to have your ,\!?^ & and the V- it was opened marked on the respirator. 3. In the Solvents / EDC 1 Plant, the mouthbit respirator cartridge must be replaced. 'M or when it is u it J. 4. The replacement cartridges for mouthbit respirators are located in Bldg. Hoi , (the _____________ ). II. _t Circle "T" if Tree or "F' if False for the following statements: 6. F You need medical approval to use a mouthbit respirator. 7. T Qp You need to be fit-tested to use a mouthbit respirator. 8. T (f Respirator equipment is approved as a unit and parts are not interchangeable with other models. 9. T & A mouthbit respirator can be used to catch process samples. 10` G F The mouthbit respirator that you use in the plant is individually assigned to you. III. Complete the following exercises, mark with an "V" when done: 11. Demonstrate respirator. 12. Demonstrate 13. ___Lil Review how Oq * 2 Name : Master # : Solvents / EDO 1 Annual Inspection Record urifying Mouthbit Respirators Date / / 30! 9- </? Employer nmv Chemical Respirator Mfg. & Model #: AO R722 Cartridge Type: Acid Gas Disassemble the respirator (if possible) and inspect the following; (Circle One) Is the body/cartridge holder free of any dents, distortion, and wear ? Is the cartridge face unobstructed, with no cracks or holes ? Is the cartridge and respirator manufactured by the same company (compatible) ? Is the cartridge gasket (if applicable) cut, cracked, or missing ? Are the Inhalation/Exhalation diaphragm valve flaps stiff, decomposed, or cut ? Are the Inhalation/Exhalation diaphragm valve seats distorted, scratched, cracked, or obstructed ? Is the Exhalation valve cover distorted, scratched, cracked, or missing ? Is the Mouthbit distorted, stiff, decomposed, cut, or obstructed ? Is the Mouthbit cover stiff, distorted, missing, or has it lost tension ? Is the nose clamp stiff, distorted, missing, or has it lost tension ? Is the cartridge dated ? Is the cartridge date more than 1 year old ? Is the owners name on the respirator ? Is the respirator clean ? Y/dSC Y ISP YAP? YK& Note: Make sure the cartridge is clean. Never try to clean it by washing it or blowing with air. Inspect the cartridge for dents or other damage. Breathe at least once through the respirator to insure that it is functioning properly. If any odor or taste is detected, replace the air-purifying element or dispose of the respirator (if it is a disposable model). Note any actions taken to correct any deficiency found during this inspection. ^0 A 040?]c CGNFTOFNrT^ Mouthbit Respirator Training Test Complete the following statements: 1. A mouthbit respirator is used for & QAJ f y 2. If a mouthbit respirator is individually assigned and removed from the manufacturer's protective bag, then it becomes your property and needs to have vour *\ and the A it was opened marked on the respirator. In the Solvents / EDC 1 Plant, the mouthbit respirator cartridge must be replaced 0. 3. or when it is se c 4. The replacement cartridges for mouthbit respirators are located in Bldg. / 1 O ^ (the jSAof? ). Circle "T" if True or "F' if False for the following statements: 6. T |2 You need medical approval to use a mouthbit respirator. 7. T Q You need to be fit-tested to use a mouthbit respirator. 8. (j) F Respirator equipment is approved as a unit and pans are not interchangeable with other models. 9. T 10. (t) f A mouthbit respirator can be used to catch process samples. The mouthbit respirator that you use in the plant is individually assigned to you. Complete the following exercises, mark with an "V" when done: 11. Demonstrate respirator. 12. Demonstrate 13. y Review how 2 A 040?]^ OOMFTDFNTTAr Name : Y^AiC, Solvents / EDC 1 Annual Inspection Record Air Purifying Mouthbit Respirators Date ' , /? / Ss Master # : ^ 3'*>/(&_____ Employer Dow Chemical Respirator Mfg. & Model #; AO R722 Cartridge Type: Acid Gas Disassemble the respirator (if possible) and inspect the following; (Circle One) Is the body/cartridge holder free of any dents, distortion, and wear ? Is the cartridge face unobstructed, with no cracks or holes ? Is the cartridge and respirator manufactured by the same company (compatible) ? Is the cartridge gasket (if applicable) cut, cracked, or missing ? Are the Inhalation/Exhalation diaphragm valve flaps stiff, decomposed, or cut ? Are the Inhalation/Exhalation diaphragm valve seats distorted, scratched, cracked, or obstructed ? Is the Exhalation valve cover distorted, scratched, cracked, or missing ? Is the Mouthbit distorted, stiff, decomposed, cut, or obstructed ? Is the Mouthbit cover stiff, distorted, missing, or has it lost tension ? Is the nose clamp stiff, distorted, missing, or has it lost tension ? Is the cartridge dated ? Is the cartridge date more than 1 year old ? Is the owners name on the respirator ? Is the respirator clean ? Note: Make sure the cartridge is clean. Never try to clean it by washing it or blowing with air. Inspect the cartridge for dents or other damage. Breathe at least once through the respirator to insure that it is functioning properly. If any odor or taste is detected, replace the air-purifying element or dispose of the respirator (if it is a disposable model). Note any actions taken to correct any deficiency found during this inspection. Mouthbit Respirator Training Test I. Complete the following statements: 1. A mouthbit respirator is used for <= __________ n^ 2. If a mouthbit respirator is individually assigned and removed from the manufacturer's protective bag, then it becomes your property and needs to have your ______and the crtxte it was opened marked on the respirator. 3. In the Solvents / EDC1 Plant, the mouthbit respirator cartridge must be replaced, or when it is ; 4. The replacement cartridges for mouthbit respirators are located in Bldg. * HO ^ (the ao Vc-,' SAop II. - Circle "T" if True or "F' if False for the following statements: ^6. T CD You need medical approval to use a mouthbit respirator. 7. T You need to be fit-tested to use a mouthbit respirator. CD8. T Respirator equipment is approved as a unit and pans are not interchangeable with other models. 9. T A mouthbit respirator can be used to catch process samples. - 10. F The mouthbit respirator that you use in the plant is individually assigned to you. III. Complete the following exercises, mark with an "V" when done: 11. \/_ y12. Demonstrate the correct procedure to clean, maintain, and store your mouthbit respirator. Demonstrate how to correctly change the cartridge of your mouthbit respirator. y 13. Review how to correctly don your mouthbit respirator. 2 DO A 040018 CONFIDENTIAL Name Master # Solvents / EDC 1 Annual Inspection Record Air Purifying Mouthbit Respirators Date / / to Employer Dow Chemical Respirator Mfg. & Model #: AO R722 Cartridge Type: Acid Gas- Disassemble the respirator (if possible) and inspect the following; (Circle One) Is the body/cartridge holder free of any dents, distortion, and wear ? Is the cartridge face unobstructed, with no cracks or holes ? Is the cartridge and respirator manufactured by the same company (compatible) ? Is the cartridge gasket (if applicable) cut, cracked, or missing ? Are the Inhalation/Exhalation diaphragm valve flaps stiff, decomposed, or cut ? Are the Inhalation/E'xhalation diaphragm valve seats distorted, scratched, cracked, or obstructed ? Is the Exhalation valve cover distorted, scratched, cracked, or missing ? Is the Mouthbit distorted, stiff, decomposed, cut, or obstructed ? Is the Mouthbit cover stiff, distorted, missing, or has it lost tension ? Is the nose clamp stiff, distorted, missing, or has it lost tension ? Is the cartridge dated ? Is the cartridge date more than 1 year old ? Is the owners name on the respirator ? Is the respirator clean ? Y/fP YtfT <7N Note: Make sure the cartridge is clean. Never try to clean it by washing it or blowing with air. Inspect the cartridge for dents or other damage. Breathe at least once through the respirator to insure that it is functioning properly. If any odor or taste is detected, replace the air-purifying element or dispose of the respirator (if it is a disposable model). Note any actions taken to correct any deficiency found during this inspection. 1 00 CO/vfr A 040?79 Mouthbit Respirator Training Test Complete the following statements: 1. A mouthbit respirator is used for ______ , it a moutnoit respirator is individually assigned and removed rrom tne manutacturer s protective__ bag, then it becomes your property and needs to have your and the . it was opened marked on the respirator. 3. In the SolventsJ EDC 1 Plant, the mouthbit respirator cartridge must be replaced or when it is /ri Q- ^ 4. Th^eglacement cartridges for mouthbit respirators are located in Bldg. / '7#^/ (the Circle "T" if True or "F' if False for the following statements: 6. T You need medical approval to use a mouthbit respirator. 7. You need to be fit-tested to use a mouthbit respirator. 8. Respirator equipment is approved as a unit and parts are not interchangeable with other models. 9. T 10. A mouthbit respirator can be used to catch process samples. / The mouthbit respirator that you use in the plant is individually assigned to you. Complete the following exercises, mark with an "V" when done: 11. Demonstrate the correct procedure to clean, maintain, and store your mouthbit respirator. l/ 12. Demonstrate how to correctly change the cartridge of your mouthbit respirator. J13. Review how to correctly don your mouthbit respirator. Name >T --r Master # 33St Solvents / EDC 1 Annual Inspection Record dr Purifying Mouthbit Respirators \0tfesv-' Date : / ^S ______ Employer : Dow Chemical Respirator Mfg. & Model #: AO R722 Cartridge Type: Acid Gas Disassemble the respirator (if possible) and inspect the following; (Circle One) Is the body/cartridge holder free of any dents, distortion, and wear ? Is the cartridge face unobstructed, with no cracks or holes ? Is the cartridge and respirator manufactured by the same company (compatible) ? Is the cartridge gasket (if applicable) cut, cracked, or missing ? Are the Inhalation/Exhalation diaphragm valve flaps stiff, decomposed, or cut ? Are the Inhalation/Exhalation diaphragm valve seats distorted, scratched, cracked, or obstructed ? Is the Exhalation valve cover distorted, scratched, cracked, or missing ? Is the Mouthbit distorted, stiff, decomposed, cut, or obstructed ? Is the Mouthbit cover stiff, distorted, missing, or has it lost tension ? Is the nose clamp stiff, distorted, missing, or has it lost tension ? Is the cartridge dated ? Is the cartridge date more than 1 year old ? Is the owners name on the respirator ? Is the respirator clean ? N N Note: Make sure the cartridge is clean. Never try to clean it by washing it or blowing with air. Inspect the cartridge for dents or other damage. Breathe at least once through the respirator to insure that it is functioning properly. If any odor or taste is detected, replace the air-purifying element or dispose of the respirator (if it is a disposable model). Note any actions taken to correct any deficiency found during this inspection. f),J A 04 0,"-,7i 1 conf t dfnt t ai Mouthbit Respirator Training Test I. Complete the following statements: 1. A mouthbit respirator is used for Scfrp~ n 2. If a mouthbit respirator is individually assigned and removed from the manufacturer's protective bag, then it becomes, your property and needs to have vour _ and the do. -hc- it was opened marked on the respirator. 3. In the Solvents / ED 1 Plant, the mouthbit respirator cartridge must be replaced or when it is irl `b-j /> v 4. The replacement cartridges for mouthbit respirators are located in Bldg. !7 0 ^ (the __________ ). II. Circle "T" if True or "F' if False for the following statements: 6. T & You need medical approval to use a mouthbit respirator. 7. T S You need to be fit-tested to use a mouthbit respirator. 8. 67 F Respirator equipment is approved as a unit and parts are not interchangeable with other models. 9. T A mouthbit respirator can be used to catch process samples. 10. F The mouthbit respirator that you use in the plant is individually assigned to you. III. Complete the following exercises, mark with an "V" when done: 11. v/ Demonstrate the correct procedure to clean, maintain, and store your mouthbit respirator. 12. 13. 1/ Demonstrate how to correctly change the cartridge of your mouthbit respirator. Review how to correctly don your mouthbit respirator. no 2 Tr^NjTAt <3. Name : Master # : Solvents / EDC 1 Annual Inspection Record Air Purifying Mouthbit Respirators J tDate : & / / ^ ^ ^5" 2 p* Employer : Dow Chemical Respirator Mfg. & Model #: AO R722 Cartridge Type: Acid Gas Disassemble the respirator (if possible) and inspect the following; (Circle One) Is the body/cartridge holder free of any dents, distortion, and wear ? Is the cartridge face unobstructed, with no cracks or holes ? Is the cartridge and respirator manufactured by the same company (compatible) ? Is the cartridge gasket (if applicable) cut, cracked, or missing ? Are the Inhalation/Exhalation diaphragm valve flaps stiff, decomposed, or cut ? Are the Inhalation/Exhalation diaphragm valve seats distorted, scratched, cracked, or obstructed ? Is the Exhalation valve cover distorted, scratched, cracked, or missing ? Is the Mouthbit distorted, stiff, decomposed, cut, or obstructed ? Is the Mouthbit cover stiff, distorted, missing, or has it lost tension ? Is the nose clamp stiff, distorted, missing, or has it lost tension ? Is the cartridge dated ? Is the cartridge date more than 1 year old ? Is the owners name on the respirator ? Is the respirator clean ? ' vX/N N N YfTT) Y Y/^T) Y4^7 YA?T) Y CyYn (Yv N N Note: Make sure the cartridge is clean. Never try to clean it by washing it or blowing with air. Inspect the cartridge for dents or other damage. Breathe at least once through the respirator to insure that it is functioning properly. If any odor or taste is detected, replace the air-purifying element or dispose of the respirator (if it is a disposable model). Note any actions taken to correct any deficiency found during this inspection. Do A 040 no/vFrr>FNTr(J(3 Mouthbit Respirator Training Test I. Complete the following statements: 1. A mouthbit respirator is used for cAfiil. cw.<y 2. If a mouthbit respirator is individually assigned and removed front the manufacturer's protective bag, then it becomes your property and needs to have your. AJ 4v^ ^ and the lJ4Trit was opened marked on the respirator. 3. In the So>lvlveentnst,s/HDC 1 Plant, the mouthbit respirator cartridge must be replaced /QmuAm c/ or when it is 4. Tte replaconept^cartridges for mouthbit respirators are located in Bldg. / 70 2 (the ii. Circle "T" if True or "F' if False for the following statements: 6. T You need medical approval to use a mouthbit respirator. 7. T (?> You need to be fit-tested to use a mouthbit respirator. 8. F Respirator equipment is approved as a unit and parts are not interchangeable with other models. 9. T A mouthbit respirator can be used to catch process samples. 10. F The mouthbit respirator that you use in the plant is individually assigned to you. ill. Complete the following exercises, mark with an "V" when done: 11. Demonstrate respirator. 12. ^"" Demonstrate 13. ^-- Review how 2 no nON/fr A 40Pp4 TDfrNTTAl, Name : Solvents / EDC 1 Annual Inspection Record Air Purifying Mouthbit Respirators cm\ \\ Date : / / f 7 ( is Master # : *0______ Employer : Dow Chemical Respirator Mfg. & Model #: AO R722 Cartridge Type: Acid7jaT~ Disassemble the respirator (if possible) and inspect the following; (Circle One) Is the body/cartridge holder free of any dents, distortion, and wear ? Is thfrcartridge face unobstructed, with no~cracks or holes ? Is the cartridge and respirator manufactured by the same company (compatible) ? Is the cartridge gasket (if applicable) cut, cracked, or missing ? Are the Inhalation/Exhalation diaphragm valve flaps stiff, decomposed, or cut ? Are the Inhalation/Exhalation diaphragm valve seats distorted, scratched, cracked, or obstructed ? Is the Exhalation valve cover distorted, scratched, cracked, or missing ? Is the Mouthbit distorted, stiff, decomposed, cut, or obstructed ? Is the Mouthbit cover stiff, distorted, missing, or has it lost tension ? Is the nose clamp stiff, distorted, missing, or has it lost tension ? Is the cartridge dated ? Is the cartridge date more than 1 year old ? Is the owners name on the respirator ? Is the respirator clean ? Note: Make sure the cartridge is clean. Never try to clean it by washing it or blowing with air. Inspect the cartridge for dents or other damage. Breathe at least once through the respirator to insure that it is functioning properly. If any odor or taste is detected, replace the air-purifying element or dispose of the respirator (if it is a disposable model). Note any actions taken to correct any deficiency found during this inspection. 1 DO CONF A 040pps TfNTTA(. Mouthbit Respirator Training Test i. Complete the following statements: 1. A mouthbit respirator is used for c a. _ 2. If a mouthbit respirator is individually assigned and removed from the manufacturer's protective bag, then it becomes your property and needs to have your i/\o. v\A. and the it was opened marked on the respirator. In the Solvents / EDC L Plant, the mouthbit respirator cartridge must be replaced 3. or when it is (cj 4. The repilacement cartridges for mouthbit respirators are located in Bldg. / ZL (the ^ l/vfc p J. 11.-"" Circle "T" ifTrue or "F' if False for the following statements: 6. T 7. T <s> 8. F (P 9. T (ps. 10. (Jj F You need medical approval to use a mouthbit respirator. You need to be fit-tested to use a mouthbit respirator. Respirator equipment is approved as a unit and parts are not interchangeable with other models. A mouthbit respirator can be used to catch process samples. The mouthbit respirator that you use in the plant is individually assigned to you. in. Complete the following exercises, mark with an "V" when done: /11. A/ Demonstrate the correct procedure to clean, maintain, and store your mouthbit respirator. 12. Demonstrate how to correctly change the cartridge of your mouthbit respirator. 13. Review how to correctly don your mouthbit respirator. 2 DO A 040??6 CONFTOFNTIAL Solvents / EDC 1 Annual Inspection Record Air Purifying Mouthbit Respirators Name : Date : / / 3c / ?>' Master # : _______ Employer : Dow Chemical Respirator Mfg. & Model #: AO R722 Cartridge Type: Acid Gas Disassemble the respirator (if possible) and inspect the following; (Circle One) Is the body/cartridge holder free of any dents, distortion, and wear ? Is the cartridge face unobstructed, with no cracks or holes ? Is the cartridge and respirator manufactured by the same company (compatible) ? Is the cartridge gasket (if applicable) cut, cracked, or missing ? Are the Inhalation/Exhalation diaphragm valve flaps stiff, decomposed, or cut ? Are the Inhalation/Exhalarion diaphragm valve seats distorted, scratched, cracked, or obstructed ? Is the Exhalation valve cover distorted, scratched, cracked, or missing ? Is the Mouthbit distorted, stiff, decomposed, cut, or obstructed ? Is the Mouthbit cover stiff, distorted, missing, or has it lost tension ? Is the nose clamp stiff, distorted, missing, or has it lost tension ? Is the cartridge dated ? Is the cartridge date more than 1 year old ? Is the owners name on the respirator ? Is the respirator clean ? Note: Make sure the cartridge is clean. Never try to clean it by washing it or blowing with air. Inspect the cartridge for dents or other damage. Breathe at least once through the respirator to insure that it is functioning properly. If any odor or taste is detected, replace the air-purifying element or dispose of the respirator (if it is a disposable model). Note any actions taken to correct any deficiency found during this inspection. jvi-c '.Ai'c.\ ____________________________ 1 A 040?P7 nONFTOFNTTAI Mouthbit Respirator Training Test Complete the following statements: 1. A mouthbit respirator is used for F'SQ-pg_______ 2. If a mouthbit respirator is individually assigned and rermr oved from the manufacturer's protective bagj, then it becomes your property and needs to have your Moke:and the it was opened marked on the respirator. 3. In the Solvents / EDC 1 Plant, the mouthbit respirator cartridge must be replaced, or when it is useO______ . 4. The replacement cartridges for mouthbit respirators are located in Bldg. * ~io4 (the __________ ). Circle "T" if True or "F' if False for the following statements: 6- (7}T You need medical approval to use a mouthbit respirator. 7. T You need to be fit-tested to use a mouthbit respirator. 8. <x Respirator equipment is approved as a unit and parts are not interchangeable with other models. 9. T A mouthbit respirator can be used to catch process samples. 10. (j. F The mouthbit respirator that you use in the plant is individually assigned to you. Complete the following exercises, mark with an "V" when done: 11. x/ 12. y y 13. Demonstrate respirator. Demonstrate Review how 2 OO A p. . Solvents / EDC 1 Annual Inspection Record Air Purifying^U^iijibit Respirators Name : LA0Ay " Iflhkter # : 43 4^*^* ** Date : & / / / 7 / Employer : Dow Chemical R^^pirator Mfg. & Model #: AO R722 K Cartridge Type: Acid Gas Disassemble the i^spjrator (if possible) and inspect the following; <w<. Is the body/cartridge holder free of any dents, distortion, and wear ? Is th&xartridge face unobstructed, with no cracks or holes ? Is the cartridge and respirator manufactured by the same company (compatible) ? Is the cartridge gasket (if applicable) cut, cracked, or missing ? A Are the Inhalation/Exhalation diaphragm valve flaps stiff, decomposed, or cut ? Are the Inhalation/Exhalation diaphragm valve seats distorted, scratched, cracked, obstructed ? Is the Exhalation valve cover distorted, scratched, cracked, or missing ? Is the Mouthbit distorted, stiff, decomposed, cut, or obstructed ? Is the Mouthbit cover stiff, distorted, missing, or has it lost tension ? Is the nose clamp stiff, distorted, missing, or has it lost tension ? Is the cartridge dated ? Is the cartridge date more than 1 year old ? Is the owners name on the respirator ? Is the respirator clean ? (Circle One) Note: Make sure the cartridge is clean. Never try to clean it by washing it or blowing with air. Inspect the cartridge for dents or other damage. Breathe at least once through the respirator to insure that it is functioning properly. If any odor or taste is detected, replace the air-purifying element or dispose of the respirator (if it is a disposable modl). Note any actions taken to correct any deficiency found during this inspection. ^ no A 04OO?A OONFTDFNTIAl Mouthbit Respirator Training Test I. Complete the following statements: 1. A mouthbit respirator is used for EScAftZ' 2. If a mouthbit respirator is individually assigned and removed from the manufacturer's protective bag, then it becomes your property and needs to have vour yAlfc______ and the. t>*reit was opened marked on the respirator. 3. In the Solvents / EDC 1 Plant, the mouthbit respirator cartridge must be replaced or when it is OfrvjLA^p ty 4. The re^acei^nt cartridges for mouthbit respirators are located in Bldg. J7& _______ ). II. Circle "T" if True or "F' if False for the following statements: (the You need medical approval to use a mouthbit respirator. You need to be fit-tested to use a mouthbit respirator. 8. F- 9. T 10. (j) F Respirator equipment is approved as a unit and parts are not interchangeable with other models. A mouthbit respirator can be used to catch process samples. The mouthbit respirator that you use in the plant is individually assigned to you. III. Complete the following exercises, mark with an "V" when done: 12. i3. y Demonstrate the correct procedure to clean, maintain, and store your mouthbit respirator. Demonstrate how to correctly change the cartridge of your mouthbit respirator. Review how to correctly don your mouthbit respirator. 2 DO A 040730 OONFTDFNTTAl Solvents / EDC 1 Annual Inspection Record Air Purifying Mouthbit Respirators Name : ' )7[ Master # : 9-MI Srg^ Date : / / /5 / 9 ^ Employer : Dow Chemical Respirator Mfg. & Model #: AO R722 Cartridge Type: Acid Gas Disassemble the respirator (if possible) and inspect the following; (Circle One) Is the body/cartridge holder free of any dents, distortion, and wear ? Is the cartridge face unobstructed, with no_cracks or holes ? Is the cartridge and respirator manufactured by the same company (compatible) ? Is the cartridge gasket (if applicable) cut, cracked, or missing ? Are the Inhalation/Exhalation diaphragm valve flaps stiff, decomposed, or cut ? Are the Inhalation/Exhalation diaphragm valve seats distorted, scratched, cracked, or obstructed ? Is the Exhalation valve cover distorted, scratched, cracked, or missing ? Is the Mouthbit distorted, stiff, decomposed, cut, or obstructed ? Is the Mouthbit cover stiff, distorted, missing, or has it lost tension ? Is the nose clamp stiff, distorted, missing, or has it lost tension ? Is the cartridge dated ? Is the cartridge date more than 1 year old ? Is the owners name on the respirator ? Is the respirator clean ? CY7N gD N ^Y?/N i(L YrN Y Y /<fT Y (w. Y /(Fi XifJ' uY/n. 7 N N Note: Make sure the cartridge is clean. Never try to clean it by washing it or blowing with air. Inspect the cartridge for dents or other damage. Breathe at least once through the respirator to insure that it is functioning properly. If any odor or taste is detected, replace the air-purifying element or dispose of the respirator (if it is a disposable model). Note any actions taken to correct any deficiency found during this inspection. Of) A f)4 0?3i (,ONF T DFNTTAI Mouthbit Respirator Training Test Complete the following statements: 1. A mouthbit respirator is used for ________ flWy 2. If a mouthbit respirator is individually assigned and removed from the manufacturer's protective bag, then it becomes your property and needs to have your ______ and the Oq it was opened marked on the respirator. 3. In the Solvents / EDO 1 Plant, the mouthbit respirator cartridge must be replaced . Yea a// or when it is uGe . 4. The replacement cartridges for mouthbit respirators are located in Bldg. / 7 Si? s nop.-_______ ) Circle "T" if True or "F' if False for the following statements: 6. T 0 You need medical approval to use a mouthbit respirator. 7. T @j You need to be fit-tested to use a mouthbit respirator. (the 8. F 9' T (0 10. ( F Respirator equipment is approved as a unit and pans are not interchangeable with other models. A mouthbit respirator can be used to catch process samples. The mouthbit respirator that you use in the plant is individually assigned to you. Complete the following exercises, mark with an "V" when done: _ f12. _ 13. v/ _ Demonstrate the correct procedure to clean, maintain, and store your mouthbit respirator. Demonstrate how to correctly change the cartridge of your mouthbit respirator. Review how to correctly don your mouthbit respirator. 2 no A 040P3P CONFTDFNTTAl Solvents / EDC 1 Annual Inspection Record Air Purifying Mouthbit Respirators Name Master # : / Date Employer : Dow Chemical Respirator Mfg. & Model #: AO R722 Cartridge Type: Acid Gas Disassemble the respirator (if possible) and inspect the following; (Circle One) Is the body/cartridge holder free of any dents, distortion, and wear ? Is thexartridge face unobstructed, with no cracks or holes ? Is the cartridge and respirator manufactured by the same company (compatible) ? Is the cartridge gasket (if applicable) cut, cracked, or missing ? Are the Inhalation/Exhalation diaphragm valve flaps stiff, decomposed, or cut ? Are the Inhalation/Exhalation diaphragm valve seats distorted, scratched, cracked, or obstructed ? Is the Exhalation valve cover distorted, scratched, cracked, or missing ? Is the Mouthbit distorted, stiff, decomposed, cut, or obstnicted ? Is the Mouthbit cover stiff, distorted, missing, or has it lost tension ? Is the nose clamp stiff, distorted, missing, or has it lost tension ? Is the cartridge dated ? Is the cartridge date more than 1 year old ? Is the owners name on the respirator ? Is the respirator clean ? Note: Make sure the cartridge is clean. Never try to clean it by washing it or blowing with air. Inspect the cartridge for dents or other damage. Breathe at least once through the respirator to insure that it is functioning properly. If any odor or taste is detected, replace the air-purifying element or dispose of the respirator (if it is a disposable model). Note any actions taken to correct any deficiency found during this inspection. 1 DO A 040203 CONFTDFNTTAl Mouthbit Respirator Training Test I. Complete the following statements: 1. A mouthbit respirator is used for ^ fits d/^'y 2. If a mouthbit respirator is individually assigned and removed from the manufacturer's protective bag, then it becomes your property and needs to have your _______and the it was opened marked on the respirator. 3. In the Solvents / EDC 1 Plant, the mouthbit respirator cartridge must be replaced or when it is Z>a^ciP. / ' 4. The replacement cartridges for mouthbit respirators are located in Bldg. /*?2fL(the _ 5/ft?r). II. Circle "T" if True or "F' if False for the following statements: 6. T You need medical approval to use a mouthbit respirator. 7. T ($> 8. G> You need to be fit-tested to use a mouthbit respirator. Respirator equipment is approved as a unit and parts are not interchangeable with other models. 9. T A mouthbit respirator can be used to catch process samples. <9 T The mouthbit respirator that you use in the plant is individually assigned to you. III. Complete the following exercises, mark with an "V" when done: 11. Demonstrate respirator. 12. Demonstrate 13. Review how 2 00 A 040734 CONFTDFNT T Al Name Master # Solvents / EDC 1 Annual Inspection Record Air Purifying Mouthbit Respirators fy/Jeti lee Date / ,JJ , 9S V 3> 3, 7 9\ S, Employer : Dow Chemical Respirator Mfg. & Model #: AO R722 Cartridge Type: Acid Gas" Disassemble the respirator (if possible) and inspect the following; (Circle One) Is the body/cartridge holder free of any dents, distortion, and wear ? Is the cartridge face unobstructed, with no cracks or holes ? Is the cartridge and respirator manufactured by the same company (compatible) ? Is the cartridge gasket (if applicable) cut, cracked, or missing ? Are the Inhalation/Exhalation diaphragm valve flaps stiff, decomposed, or cut ? Are the Inhalation/Exhalation diaphragm valve seats distorted, scratched, cracked, or obstructed ? Is the Exhalation valve cover distorted, scratched, cracked, or missing ? Is the Mouthbit distorted, stiff, decomposed, cut, or obstructed ? Is the Mouthbit cover stiff, distorted, missing, or has it lost tension ? Is the nose clamp stiff, distorted, missing, or has it lost tension ? Is the cartridge dated ? Is the cartridge date more than 1 year old ? Is the owners name on the respirator ? Is the respirator clean ? Note: Make sure the cartridge is clean. Never try to clean it by washing it or blowing with air. Inspect the cartridge for dents or other damage. Breathe at least once through the respirator to insure that it is functioning properly. If any odor or taste is detected, replace the air-purifying element or dispose of the respirator (if it is a disposable model). Note any actions taken to correct any deficiency found during this inspection. 1 on A 040?3C: C.ONFTDFNTTAl Mouthbit Respirator Training Test Complete the following statements: jr_ 1. A mouthbit respirator is used for ^ S^Cfy p? 2. If a mouthbit respirator is individually assigned and removed from the manufacturer's protective bag, then it becomes your property and needs to have your P and the dWt&~ it was opened marked on the respirator. 3. In the Solvents / EDC 1 Plant, the mouthbit respirator cartridge must be replaced TvCtCt & or when it is___ MV efctf<Z (*SC- Qtf&v 4. The replacement cartridges for mouthbit respirators are located in Bldg. ______ ). (the Circle "T" if True or "F' if False for the following statements: 6. T & You need medical approval to use a mouthbit respirator. 7. T 8. (J> You need to be fit-tested to use a mouthbit respirator. Respirator equipment is approved as a unit and pans are not interchangeable with other models. 9. T 10. A mouthbit respirator can be used to catch process samples. The mouthbit respirator that you use in the plant is individually assigned to you. Complete the following exercises, mark with an "V" when done: 11. Demonstrate the correct procedure to clean, maintain, and store your mouthbit respirator. 12. Demonstrate how to correctly change the cartridge of your mouthbit respirator. 13. Review how to correctly don your mouthbit respirator. 2 DO A 040?3<S CONFTDFNTTAl Name : Solvents / EDC 1 Annual Inspection Record Air Purifying Mouthbit Respirators Date : / ,ll Master # : Employer : Dow Chemical Respirator Mfg. & Model #: AO R722 Cartridge Type: Acid Gas Disassemble the respirator (if possible) and inspect the following; (Circle One) Is the body/cartridge holder free of any dents, distortion, and wear ? Is the cartridge face unobstructed, with no cracks or holes ? Is thlTcartridge and respirator manufactured by the same company (compatible) ? Is the cartridge gasket (if applicable) cut, cracked, or missing ? Are the Inhalation/Exhalation diaphragm valve flaps stiff, decomposed, or cut ? Are the Inhalation/Exhalation diaphragm valve seats distorted, scratched, cracked, or obstructed ? Is the Exhalation valve cover distorted, scratched, cracked, or missing ? Is the Mouthbit distorted, stiff, decomposed, cut, or obstructed ? Is the Mouthbit cover stiff, distorted, missing, or has it lost tension ? Is the nose clamp stiff, distorted, missing, or has it lost tension ? Is the cartridge dated ? Is the cartridge date more than 1 year old ? Is the owners name on the respirator ? Is the respirator clean ? Note: Make sure the cartridge is clean. Never try to clean it by washing it or blowing with air. Inspect the cartridge for dents or other damage. Breathe at least once through the respirator to insure that it is functioning properly. If any odor or taste is detected, replace the air-purifying element or dispose of the respirator (if it is a disposable model). Note any actions taken to correct any deficiency found during this inspection. HO A 040037 OONFTDFNTTAl. Mouthbit Respirator Training Test I. Complete the following statements: 1. A mouthbit respirator is used for. 2. If a mouthbit respirator is individually assigned and removed from the manufacturer's protective bag, then it becomes your property and needs to have yourand the it was opened marked on the respirator. 3. In the Solvents / EDC 1 Plant, the mouthbit respirator cartridge must be replaced_____________ or when it is. 4. The replacement cartridges for mouthbit respirators are located in Bldg.(the ______________) II. \ * Circle "T" if True or "F' if False for the following statements: 6. T F You need medical approval to use a mouthbit respirator. 7. T F You need to be fit-tested to use a mouthbit respirator. 8. T F Respirator equipment is approved as a unit and parts are not interchangeable with other models. 9. T F A mouthbit respirator can be used to catch process samples. 10. T F The mouthbit respirator that you use in the plant is individually assigned to you. III. Complete the following exercises, mark with an "V" when done: 11. ______ Demonstrate the correct procedure to clean, maintain, and store your mouthbit respirator. 12. ______ Demonstrate how to correctly change the cartridge of your mouthbit respirator. 13. ______ Review how to correctly don your mouthbit respirator. 2 DO A 04O.?3FS CONFTDFNTT Al Solvents / EDC 1 Annual Inspection Record Air Purifying Mouthbit Respirators Name : fV)A~-n Date : / / 30/ 9 Master # Employer : Dow Chemical Respirator Mfg. & Model #: AO R722 Cartridge Type: Acid Gas~ Disassemble the respirator (if possible) and inspect the following; Is the body/cartridge holder free of any dents, distortion, and wear ? Is thexartridge face unobstructed, with no cracks or holes ? Is the cartridge and respirator manufactured by the same company (compatible) ? Is the cartridge gasket (if applicable) cut, cracked, or missing ? Are the Inhalation/Exhalation diaphragm valve flaps stiff, decomposed, or cut ? Are the Inhalation/Exhalation diaphragm valve seats distorted, scratched, cracked, or obstructed ? Is the Exhalation valve cover distorted, scratched, cracked, or missing ? Is the Mouthbit distorted, stiff, decomposed, cut, or obstructed ? Is the Mouthbit cover stiff, distorted, missing, or has it lost tension ? Is the nose clamp stiff, distorted, missing, or has it lost tension ? Is the cartridge dated ? Is the cartridge date more than 1 year old ? Is the owners name on the respirator ? Is the respirator clean ? Note: Make sure the cartridge is clean. Never try to clean it by washing it or blowing with air. Inspect the cartridge for dents or other damage. Breathe at least once through the respirator to insure that it is functioning properly. If any odor or taste is detected, replace the air-purifying element or dispose of the respirator (if it is a disposable model). Note any actions taken to correct any deficiency found during this inspection. DO A 040739 CONFTDFNTTAl Mouthbit Respirator Training Test I. Complete the following statements: 1. A mouthbit respirator is used for '-r s*rj 2. If a mouthbit respirator is individually assiiggned and remov<ed from the manufacturer's protective bag, then it becomes your property and needs to have your Aand the dtLXa it was opened marked on the respirator. 3. In the Solvents / EDC 1 Plant, the mouthbit respirator cartridge must be replaced or when it is asjf C? ( 4. The replacement cartridges for mouthbit respirators are located in Bldg. - ______________). (the II. Circle "T" if True or "F' if False for the following statements: 6. T (?p You need medical approval to use a mouthbit respirator. 7 T (f) You need to be fit-tested to use a mouthbit respirator. 8. (T) F Respirator equipment is approved as a unit and parts are not inteichangeable with other models. A mouthbit respirator can be used to catch process samples. The mouthbit respirator that you use in the plant is individually assigned to you. III. Complete the following exercises, mark with an "V" when done: 11. t/ Demonstrate the correct procedure to clean, maintain, and store your mouthbit respirator. 12. l/ 13. 1/ Demonstrate how to correctly change the cartridge of your mouthbit respirator, Review how to correctly don your mouthbit respirator. 2 no A 040," 40 OONFTDFNTTAi Name Master # : Solvents / EDC 1 Annual Inspection Record AAiirr,.Purifying Mouthbit Respirators 95* Date : / / 30 / b^ Employer : Dow Chemical Respirator Mfg. & Model #: AO R722 Cartridge Type: Acid Gas Disassemble the respirator (if possible) and inspect the following; (Circle One) Is the body/cartridge holder free of any dents, distortion, and wear ? Is the cartridge face unobstructed, with no tracks or holes ? Is the'cartridge and respirator manufactured by the same company (compatible) ? Is the cartridge gasket (if applicable) cut, cracked, or missing ? Are the Inhalation/Exhalation diaphragm valve flaps stiff, decomposed, or cut ? Are the Inhalation/Exhalatiori diaphragm valve seats distorted, scratched, cracked, or obstructed ? Is the Exhalation valve cover distorted, scratched, cracked, or missing ? Is the Mouthbit distorted, stiff, decomposed, cut, or obstructed ? Is the Mouthbit cover stiff, distorted, missing, or has it lost tension ? Is the nose clamp stiff, distorted, missing, or has it lost tension ? Is the cartridge dated ? Is the cartridge date more than 1 year old ? Is the owners name on the respirator ? Is the respirator clean ? Note: Make sure the cartridge is clean. Never try to clean it by washing it or blowing with air. Inspect the cartridge for dents or other damage. Breathe at least once through the respirator to insure that it is functioning properly. If any odor or taste is detected, replace the air-purifying element or dispose of the respirator (if it is a disposable model). Note any actions taken to correct any deficiency found during this inspection. DO A 040741 OONFTDFNTTAl Mouthbit Respirator Training Test I. Complete the following statements: 1. A mouthbit respirator is used for 2. If a mouthbit respirator is individually assigned and removed from the manufacturer's protective bag, then it becomes your property and needs to have your N$M fcL and the _ it was opened marked on the respirator. 3. In the Solvents/EDO 1 Plant, the mouthbit respirator cartridge must be replaced or when it is . 1/ L Al-c 4. The replacement cartridges for mouthbit respirators are located in Bldg. /*!& (the _____________ ). II. Circle "T" if True or "F' if False for the following statements: 6. T You need medical approval to use a mouthbit respirator. 7. T g) You need to be fit-tested to use a mouthbit respirator. 8. F Respirator equipment is approved as a unit and parts are not interchangeable with other models. 9. T (5) A mouthbit respirator can be used to catch process samples. (10. F The mouthbit respirator that you use in the plant is individually assigned to you. III. Complete the following exercises, mark with an "V" when done: 11. Demonstrate the correct procedure to clean, maintain, and store your mouthbit respirator. 12. Demonstrate how to correctly change the cartridge of your mouthbit respirator. 13. Review how to correctly don your mouthbit respirator. 2 DO r,o/\/p ^ 040.'>4? Tr^NTTOt. Name : Solvents / EDC 1 Annual Inspection Record Air Purifying Mouthbit Respirators Date : & f 1^1 Master # : _________ Respirator Mfg. & Model #: AO R722 Cartridge Type: ~ Acid das' Employer : Dow Chemical Disassemble the respirator (if possible) and inspect the following; (Circle One) Is the body/cartridge holder free of any dents, distortion, and wear ? Is thecartridge face unobstructed, with no c-racks or holes ? Is the cartridge and respirator manufactured by the same company (compatible) ? Is the cartridge gasket (if applicable) cut, cracked, or missing ? Are the Inhalation/Exhalation diaphragm valve flaps stiff, decomposed, or cut ? Are the Inhalation/Exhalation diaphragm valve seats distorted, scratched, cracked, or obstructed ? Is the Exhalation valve cover distorted, scratched, cracked, or missing ? Is the Mouthbit distorted, stiff, decomposed, cut, or obstructed ? Is the Mouthbit cover stiff, distorted, missing, or has it lost tension ? Is the nose clamp stiff, distorted, missing, or has it lost tension ? Is the cartridge dated ? Is the cartridge date more than 1 year old ? Is the owners name on the respirator ? Is the respirator clean ? >V/N <Y/N Wl N Y/& Y/<& Y/ Y/<$ ym Y7N Y /(ft <Y/N Y/(N Y/N (Y./N Note: Make sure the cartridge is clean. Never try to clean it by washing it or blowing with air. Inspect the cartridge for dents or other damage. Breathe at least once through the respirator to insure that it is functioning properly. If any odor or taste is detected, replace the air-purifying element or dispose of the respirator (if it is a disposable model). Note any actions taken to correct any deficiency found during this inspection. iVu-c- 1 00 A 040P4 ~i r.ONFTDFNTTA( Mouthbit Respirator Training Test I. Complete the following statements: 1 y A mouthbit respirator is used for &nhi 2X If a mouthbit respirator is individually assigned and removed from the manufacturer's protective bag, then it becomes your property and needs to have your Mand the -.Da- /-e. it was opened marked on the respirator. 3. <y In the Solvents / EDC 1 Plant, the mouthbit respirator cartridge must be replaced i7f?(Xalv 4. ^ or when it is -P or Sehi'-hP 7-------- The replacement cartridges for mouthbit respirators are located in Bldg. JokP________ ). / 7 c /- } (the II. Circle "T" if True or "F' if False for the following statements: $6. T You need medical approval to use a mouthbit respirator. 7. T You need to be fit-tested to use a mouthbit respirator. 8. nr Respirator equipment is approved as a unit and pans are not interchangeable with other models. 9. T A mouthbit respirator can be used to catch process samples. 10. ^T) F The mouthbit respirator that you use in the plant is individually assigned to you. III. Complete the following exercises, mark with an "V" when done: 11. Demonstrate the correct procedure to clean, maintain, and store your mouthbit respirator. 12. LX Demonstrate how to correctly change the cartridge of your mouthbit respirator. 13. Review how to correctly don your mouthbit respirator. 2 on OQ/\jp r Solvents / EDC 1 Annual Inspection Record Air Purifying Mouthbit Respirators Name : Date Master # : Employer : Dow Chemical Respirator Mfg. & Model #: AO R722 Cartridge Type: Acid Gas- Disassemble the respirator (if possible) and inspect the following; (Circle One) Is the body/cartridge holder free of any dents, distortion, and wear ? Is the cartridge face unobstructed, with no"cracks or holes ? Is the cartridge and respirator manufactured by the same company (compatible) ? Is the cartridge gasket (if applicable) cut, cracked, or missing ? Are the Inhalation/Exhalation diaphragm valve flaps stiff, decomposed, or cut ? Are the Inhalation/Exhalation diaphragm valve seats distorted, scratched, cracked, or obstructed ? Is the Exhalation valve cover distorted, scratched, cracked, or missing ? Is the Mouthbit distorted, stiff, decomposed, cut, or obstructed ? Is the Mouthbit cover stiff, distorted, missing, or has it lost tension ? Is the nose clamp stiff, distorted, missing, or has it lost tension ? Is the cartridge dated ? Is the cartridge date more than 1 year old ? Is the owners name on the respirator ? Is the respirator clean ? Note: Make sure the cartridge is clean. Never try to clean it by washing it or blowing with air. Inspect the cartridge for dents or other damage. Breathe at least once through the respirator to insure that it is functioning properly. If any odor or taste is detected, replace the air-purifying element or dispose of the respirator (if it is a disposable model). Note any actions taken to correct any deficiency found during this inspection. 00 A 040745 ONFTDFNTT Al Mouthbit Respirator Training Test Complete the following statements: 1. A mouthbit respirator is used for. T~' 2. If a mouthbit respirator is individually assigned and removed ftrorm thhee manufacturer's protective bag, then it becomes your property and needs to have your /JA and the it was opened marked on the respirator. 3. In the Solvents / EDC 1 Plant, the mouthbit respirator cartridge must be replaced / or when it is d. 4. Tt hne replacement canrtridges for mouthbit respirators are located in Bldg. /7& 2-- (the J. Circle "T" if True or "F' if False for the following statements: 6. T You need medical approval to use a mouthbit respirator. 7. T <P You need to be fit-tested to use a mouthbit respirator. 8. F 9. T <P -10. 62 F Respirator equipment is approved as a unit and pans are not interchangeable with other models. A mouthbit respirator can be used to catch process samples. The mouthbit respirator that you use in the plant is individually assigned to you. Complete the following exercises, mark with an "V" when done: 11. Demonstrate respirator. 12. Demonstrate 13. Review how 00 A O 4 0 0 4 <, CONFTDFNT T Ai Solvents / EDC 1 Annual Inspection Record Purifying Mouthbit Respirators Name : Master # : 4'3S99S- Date : } / / TS" Employer : Dow Chemical Respirator Mfg. & Model #: AO R722 Cartridge Type: Acid Gas Disassemble the respirator (if possible) and inspect the following; (Circle One) Is the body/cartridge holder free of any dents, distortion, and wear ? Is the cartridge face unobstructed, with no cracks or holes ? Is the cartridge and respirator manufactured by the same company (compatible) ? Is the cartridge gasket (if applicable) cut, cracked, or missing ? Are the Inhalation/Exhalation diaphragm valve flaps stiff, decomposed, or cut ? Are the Inhalation/Exhalation diaphragm valve seats distorted, scratched* cracked, or obstructed ? Is the Exhalation valve cover distorted, scratched, cracked, or missing ? Is the Mouthbit distorted, stiff, decomposed, cut, or obstmcted ? Is the Mouthbit cover stiff, distorted, missing, or has it lost tension ? Is the nose clamp stiff, distorted, missing, or has it lost tension ? Is the cartridge dated ? Is the cartridge date more than 1 year old ? Is the owners name on the respirator ? Is the respirator clean ? Note: Make sure the cartridge is clean. Never try to clean it by washing it or blowing with air. Inspect the cartridge for dents or other damage. $Y / Y/ Y/<? Y/0 Y/# Y/# ! Y/0 /N &N Breathe at least once through the respirator to insure that it is functioning properly. If any odor or taste is detected, replace the air-purifying element or dispose of the respirator (if it is a disposable model). Note any actions taken to correct any deficiency found during this inspection. DO A 040747 o ONF T DFNT T Al Mouthbit Respirator Training Test I. Complete the following statements: 1. A mouthbit respirator is used for. 2. If a mouthbit respirator is individually assigned and removed from the manufacturer's protective bag, then it becomes your property and needs to have your g. and the Cfo it was opened marked on the respirator. 3. In the Solvents / EDC 1 Plant, the mouthbit respirator cartridge must be replaced eJ" 6 fofet or when it is uve ft. 4. The replacement cartridges for mouthbit respirators are located in Bldg._/. 5hof> ) (the II. Circle "T" if True or "F' if False for the following statements: 6. T You need medical approval to use a mouthbit respirator. 7. T 8. 0 F 9. T 0 10. 0 F You need to be fit-tested to use a mouthbit respirator. Respirator equipment is approved as a unit and pans are not interchangeable with other models. A mouthbit respirator can be used to catch process samples. The mouthbit respirator that you use in the plant is individually assigned to you. III. Complete the following exercises, mark with an "V" when done: 11. Demonstrate respirator. 12. Demonstrate 13. Review how 2 DO A 04074B CONF TDFNTT Al Name : Solvents / EDC 1 Annual Inspection Record Air Purifying Mouthbit Respirators Date : _J____ / / J> I *-/ Master # : ^ 7p- P ( Employer : Dow Chemical Respirator Mfg. & Model #: AO R722 Cartridge Type: Acid Gas Disassemble the respirator (if possible) and inspect the following; (Circle One) Is the body/cartridge holder free of any dents, distortion, and wear ? Is the-cartridge face unobstructed, with no cracks or holes ? Is the cartridge and respirator manufactured by the same company (compatible) ? Is the cartridge gasket (if applicable) cut, cracked, or missing ? Are the Inhalation/Exhalation diaphragm valve flaps stiff, decomposed, or cut ? Are the Inhalation/Exhalation diaphragm valve seats distorted, scratched, cracked, or obstructed ? Is the Exhalation valve cover distorted, scratched, cracked, or missing ? Is the Mouthbit distorted, stiff, decomposed, cut, or obstructed ? Is the Mouthbit cover stiff, distorted, missing, or has it lost tension ? Is the nose clamp stiff, distorted, missing, or has it lost tension ? Is the cartridge dated ? Is the cartridge date more than 1 year old ? Is the owners name on the respirator ? Is the respirator clean ? Note: Make sure the cartridge is clean. Never try to clean it by washing it or blowing with air. Inspect the cartridge for dents or other damage. Breathe at least once through the respirator to insure that it is functioning properly. If any odor or taste is detected, replace the air-purifying element or dispose of the respirator (if it is a disposable model). Note any actions taken to correct any deficiency found during this inspection. A 040P49 1 CONFTDFNTTAl Mouthbit Respirator Training Test I. Complete the following statements: 1. A mouthbit respirator is used for 2. If a mouthbit respirator is individually assigned and removed from the manufacturer's bag, then it becomes your property and needs to have your and the it was opened marked on the respirator. 3. In the Solvents / EDC 1 Plant, the mouthbit respirator cartridge must be replaced or when it is ______ . / 4. V i/ T1hhee.,replacemepf%cccaarrtntrdidgg<es for mouthbit respirators are located in Bldg. / rO (the II. Circle T" if True or "F' if False for the following statements: 6. T 7. T 0 & 8. F 9. T /i) You need medical approval to use a mouthbit respirator. You need to be fit-tested to use a mouthbit respirator. Respirator equipment is approved as a unit and parts are not interchangeable with other models. A mouthbit respirator can be used to catch process samples. 10. F The mouthbit respirator that you use in the plant is individually assigned to you. III. Complete the following exercises, mark with an "V" when done: 11. Demonstrate the correct procedure to clean, maintain, and store your mouthbit respirator. 12. Demonstrate how to correctly change the cartridge of your mouthbit respirator, 13. Review how to correctly don your mouthbit respirator. 2 OO A 040750 OONFTDFNTTAl Solvents / EDC 1 Annual Inspection Record Air Pi^rif^in^^outhbit Respirators Name _______ M WAter # : O'l ??#/*****A Date : Oi II 5 / 9$ Employer : Dow Chemical Respirator Mfg. & Model #: AO R722 'Cartridge Type: Acid Gas~ oai^ Disassemble the jqsjrijator (if possible) and inspect the following; Is the body/cartridge holder free of any dents, distortion, and wear ? & t wOH Is the cartridge face unobstructed, with no cracks or holes ? Is the cartridge and respirator manufactured by the same company (compatible) ? Is the cartridge gasket (if applicable) cut, cracked, or missing ? f> Are the Inhalation/Exhalation diaphragm valve flaps stiff, decomposed, or cut ? Are the Inhalation/Exhalation diaphragm valve seats distorted, scratched, cracked, or ^ obstructed ? Is the Exhalation valve cover distorted, scratched, cracked, or missing ? Is the Mouthbit distorted, stiff, decomposed, cut, or obstructed ? Is the Mouthbit cover stiff, distorted, missing, or has it lost tension ? Is the nose clamp stiff, distorted, missing, or has it lost tension ? tt Is the cartridge dated ? Is the cartridge date more than 1 year old ? Is the owners name on the respirator ? Is the respirator clean ? (Circle One) <5>/N 'N Y/N5 Y/ Y/dS? Y AN" ym Y/<& Y/&~ <T/N V Y/fcPT <?7N &/ N Note: Make sure the cartridge is clean. Never try to clean it by washing it or blowing with aij\ Inspect the cartridge for dents or other damage. Breathe at least once through the respirator to insure that it is functioning properly. If any odor or taste is detected, replace the air-purifying element or dispose of the respirator (if it is a disposable model). Note any actions taken to correct any deficiency found during this inspection. J HO A 040F51 OONFTDFNTTAt Mouthbit Respirator Training Test I. Complete the following statements: 1. A mouthbit respirator is used for .xc.Afic oa^--V. 2. If a mouthbit respirator is individually assigned and removed from the manufacturer's protective bag, then it becomes your property and needs to have your AMmfi______ and the OATf it was opened marked on the respirator. 3. In the Solvents / EDC 1 Plant, the mouthbit respirator cartridge must be replaced or when it is *\SCP_____ _. 4. The replacement cartridges for mouthbit respirators are located in Bldg, (the II. Circle "T" if True or "F' if False for the following statements: 6. T You need medical approval to use a mouthbit respirator. 7. T & You need to be fit-tested to use a mouthbit respirator. 8. <D F Respirator equipment is approved as a unit and parts are not interchangeable with other models. 9. T sr A mouthbit respirator can be used to catch process samples. 10. <37 F The mouthbit respirator that you use in the plant is individually assigned to you. III. Complete the following exercises, mark with an "V" when done: 11. 12. Z Demonstrate respirator. Demonstrate 13. Review how 2 no A 04075? CONFTDFNTTAL. Name : Master # : Air ft(u' /)< Solvents / EDC 1 Annual Inspection Record Purifying Mouthbit Respirators Date : ! /2 ^ 1 ^^ *-/" 3 / S? Employer : Dow Chemical Respirator Mfg. & Model #: AO R722 Cartridge Type: Acid Gas Disassemble the respirator (if possible) and inspect the following; (Circle One) Is the body/cartridge holder free of any dents, distortion, and wear ? Is the cartridge face unobstructed, with no cracks or holes ? Is thecartridge and respirator manufactured by the same company (compatible) ? Is the cartridge gasket (if applicable) cut, cracked, or missing ? Are the Inhalation/Exhalation diaphragm valve flaps stiff, decomposed, or cut ? Are the Inhalation/Exhalatiori diaphragm valve seats distorted, scratched, cracked, or obstructed ? Is the Exhalation valve cover distorted, scratched, cracked, or missing ? Is the Mouthbit distorted, stiff, decomposed, cut, or obstructed ? Is the Mouthbit cover stiff, distorted, missing, or has it lost tension ? Is the nose clamp stiff, distorted, missing, or has it lost tension ? Is the cartridge dated ? Is the cartridge date more than 1 year old ? Is the owners name on the respirator ? Is the respirator clean ? Note: Make sure the cartridge is clean. Never try to clean it by washing it or blowing with air. Inspect the cartridge for dents or other damage. #>/N 32/N y Yt Y/4 Y/&? Y/$Y/g> <Y/N N Y/4SP y/N #/N Breathe at least once through the respirator to insure that it is functioning properly. If any odor or taste is detected, replace the air-purifying element or dispose of the respirator (if it is a disposable model). Note any actions taken to correct any deficiency found during this inspection. 1 rio ^ O40?m CONFTDFNTTAl' Mouthbit Respirator Training Test Complete the following statements: 1. A mouthbit respirator is used for ~ Sj/C/ 1 ^ 2. If a mouthbit respirator is individually assigned and removed from the manufacturer's protective bag, then it becomes your property and needs to have your ^ f______and the x'' ^ it was opened marked on the respirator. 3. In the Solvents / EDO 1 Plant, the mouthbit respirator cartridge must be replaced ^ ^ or when it is /'/'A # . ^ 4. The replacement cartridges for mouthbit respirators are located in Bldg. ^ ^ (the ^ At1 c/ A). Circle "T" if True or "F* if False for the following statements: 6. T You need medical approval to use a mouthbit respirator. 7. T $ You need to be Fit-tested to use a mouthbit respirator. 8. F" Respirator equipment is approved as a unit and parts are not interchangeable with other models. 9. T 10. T F A mouthbit respirator can be used to catch process samples. The mouthbit respirator that you use in the plant is individually assigned to you. Complete the followin g exercises, mark with an "V" when done: 11. Demonstrate the correct procedure to clean, maintain, and store your mouthbit respirator. 12. 13. u/ Demonstrate how to correctly change the cartridge of your mouthbit respirator. Review how to correctly don your mouthbit respirator. 2 040?f>4 DO A C.ONF"1 Name : Master # : Solvents / EDC 1 Annual Inspection Record Air Purifying Mouthbit Respirators Date : I I 3Ql?C~ ^S Employer : Dow Chemical Respirator Mfg. & Model #: AO R722 Cartridge Type: Acid Gas Disassemble the respirator (if possible) and inspect the following; (Circle One) Is the body/cartridge holder free of any dents, distortion, and wear ? Is the eartridge face unobstructed, with no cracks or holes ? Is the cartridge and respirator manufactured by the same company (compatible) ? Is the cartridge gasket (if applicable) cut, cracked, or missing ? Are the Inhalation/Exhalation diaphragm valve flaps stiff, decomposed, or cut ? Are the Inhalation/Exhalation diaphragm valve seats distorted, scratched, cracked, or obstructed ? Is the Exhalation valve cover distorted, scratched, cracked, or missing ? Is the Mouthbit distorted, stiff, decomposed, cut, or obstructed ? Is the Mouthbit cover stiff, distorted, missing, or has it lost tension ? Is the nose clamp stiff, distorted, missing, or has it lost tension ? Is the cartridge dated ? Is the cartridge date more than 1 year old ? Is the owners name on the respirator ? Is the respirator clean ? Note: Make sure the cartridge is clean. Never try to clean it by washing it or blowing with air. Inspect the cartridge for dents or other damage. Breathe at least once through the respirator to insure that it is functioning properly. If any odor or taste is detected, replace the air-purifying element or dispose of the respirator (if it is a disposable model). Note any actions taken to correct any deficiency found during this inspection. 1 DO A 040P55 OONFTDFNTTAL Mouthbit Respirator Training Test Complete the following statements: 1. A mouthbit respirator is used for F^ v"*'___________ / 2. If a mouthbit respirator is individually assigned and removed from the manufacturer's protective bag, then it becomes your property and needs to have your <and the ^ it was opened marked on the respirator. 3. In the Solvents / EDC 1 Plant, the mouthbit respirator cartridge must be replaced or when it is c . '/ 4. The replacement cartridges for mouthbit respirators are located in Bldg. ' 5 A______). (the Circle "T" if True or "F' if False for the following statements: 6. T (jP You need medical approval to use a mouthbit respirator. 7. T (Jp You need to be fit-tested to use a mouthbit respirator. 8. (TP F 9. T 10. @ (f) F Respirator equipment is approved as a unit and parts are not interchangeable with other models. A mouthbit respirator can be used to catch process samples. The mouthbit respirator that you use in the plant is individually assigned to you. Complete the following exercises, mark with an "V" when done: 11. !/ / /12. 13. Demonstrate respirator. Demonstrate Review how 2 HO A 04075A r.ONFTDFNT T Al. Solvents / EDC 1 Annual Inspection Record vAfe KiKifeiSS ^^,bit Respirators Name : JiEPFSreUXOP Date : i / /fts m*r #: 24ogaei Employer : Dow Chemical & Model #: AOR722 TU*Ay* `Cartridge Type: Acid Gas f rBrA*/nVO Disassemble the^espirator (if possible) and inspect the following; (Circle One) Is the body/cartridge holder free of any dents: Is the cartridge face unobstructed, with no cracks or holes ? Is the cartridge and respirator manufactured by the same company (compatible) ? Is the cartridge gasket (if applicable) cut, cracked, or missing ? Are the Inhalation/Exhalation diaphragm valve flaps stiff, decomposed, or cut ? Are the Inhalation/Exhalation diaphragm valve seats distorted, scratched, cracked, or obstructed ? Is the Exhalation valve cover distorted, scratched, cracked, or missing ? Is the Mouthbit distorted, stiff, decomposed, cut, or obstructed ? Is the Mouthbit cover stiff, distorted, missing, or has it lost tension ? Is the nose clamp stiff, distorted, missing, or has it lost tension ? Is the cartridge dated ? Is the cartridge date more than 1 year old ? Is the owners name on the respirator ? Is the respirator clean ? ** >N Note: Make sure the cartridge is clean. Never try to clean it by washing it or blowing with air. Inspect the cartridge for dents or other damage. Breathe at least once through the respirator to insure that it is functioning properly. If any odor or taste is detected, replace the air-purifying element or dispose of the respirator (if it is a disposable model). Note any actions taken to correct any deficiency found during this inspection. 1 DO A 040DF7 CONFTDFNTTA1 Mouthbit Respirator Training Test I. Complete the following statements: 1. A mouthbit respirator is used for ESCAPE. Oliuy 2. If a mouthbit respirator is individually assigned and removed from the manufacturer's protective bag, then it becomes your property and needs to have your MAMIE V/i: and the DATE. it was opened marked on the respirator. 3. In the Solvents / EDC 1 Plant, the mouthbit respirator cartridge must be replaced AWlUALCf or when it is USED AfTtP) 4. The replacement cartridges for mouthbit respirators are located in Bldg. . PETE, ms (the II. Circle "T" if True or "F' if False for the following statements: - 6. T (p You need medical approval to use a mouthbit respirator. 7. T (fp 68 * t )F You need to be fit-tested to use a mouthbit respirator. Respirator equipment is approved as a unit and parts are not interchangeable with other models. aT *-JO. O F A mouthbit respirator can be used to catch process samples. The mouthbit respirator that you use in the plant is individually assigned to you. Ill Complete the following exercises, mark with an "V" when done: 11. Demonstrate respirator. 12. Demonstrate 13. Review how 2 00 A 04075A C.ONFTDFNTTAl Solvents / EDC 1 Annual Inspection Record Air Purifying Mouthbit Respirators Name Master # /. i\\ M E 3-3 L fc Date : t / ^ Employer : Dow Chemical Respirator Mfg. & Model #: AO R722 Cartridge Type: Acid Gas Disassemble the respirator (if possible) and inspect the following; (Circle One) Is the body/cartridge holder free of any dents, distortion, and wear ? Is the cartridge face unobstructed, with no-cracks or holes ? Is the cartridge and respirator manufactured by the same company (compatible) ? Is the cartridge gasket (if applicable) cut, cracked, or missing ? Are the Inhalation/Exhalation diaphragm valve flaps stiff, decomposed, or cut ? Are the Inhalation/Exhalation diaphragm valve seats distorted, scratched, cracked, or obstructed ? Is the Exhalation valve cover distorted, scratched, cracked, or missing ? Is the Mouthbit distorted, stiff, decomposed, cut, or obstructed ? Is the Mouthbit cover stiff, distorted, missing, or has it lost tension ? Is the nose clamp stiff, distorted, missing, or has it lost tension ? Is the cartridge dated ? Is the cartridge date more than 1 year old ? Is the owners name on the respirator ? Is the respirator clean ? Note: Make sure the cartridge is clean. Never try to clean it by washing it or blowing with air. Inspect the cartridge for dents or other damage. Breathe at least once through the respirator to insure that it is functioning properly. If any odor or taste is detected, replace the air-purifying element or dispose of the respirator (if it is a disposable model). Note any actions taken to correct any deficiency found during this inspection. DO A 04075^ 1 rONFTDFNTTAl Mouthbit Respirator Training Test I. Complete the following statements: 1. A mouthbit respirator is used for trsc _______ cv /y______ 2. If a mouthbit respirator is individually assigned and removed from the manufacturer's protective bag, then it becomes your property and needs to have your rJ _____ and the d it was opened marked on the respirator. 3. In the Solvents / EDC 1 Plant, the mouthbit respirator cartridge must be replaced /4^,-w/. II. or when it is u_S p ________ . 4. The replacement cairtnridges for mouthbit respirators are located in Bldg. 12_ (the JA II. Circle "T" if True or "F' if False for the following statements: 6. T (iF) You need medical approval to use a mouthbit respirator. 7. T e You need to be fit-tested to use a mouthbit respirator. 8. F Respirator equipment is approved as a unit and parts are not interchangeable with other models. f9. y A mouthbit respirator can be used to catch process samples. 10. T> F The mouthbit respirator that you use in the plant is individually assigned to you. III. Complete the following exercises, mark with an "V" when done: 11. y yy 12. i/ 13. Demonstrate respirator. Demonstrate Review how 2 DO A 040?A0 CONFTOFNTt Al \Jkhf Name Solvents / EDC 1 Annual Inspection Record Air Purifying Mouthbit Respirators liu&M&ue. Date : / !^~P !?S Master # Employer : Dow Chemical Respirator Mfg. & Model #: AO R722 Cartridge Type: Acid Gas Disassemble the respirator (if possible) and inspect the following; (Circle One) Is the body/cartridge holder free of any dents, distortion, and wear ? Is thecartridge face unobstructed, with no cracks or holes ? Is the cartridge and respirator manufactured by the same company (compatible) ? Is the cartridge gasket (if applicable) cut, cracked, or missing ? Are the Inhalarion/Exhalation diaphragm valve flaps stiff, decomposed, or cut ? Are the Inhalation/Exhalation diaphragm valve seats distorted, scratched, cracked, or obstructed ? Is the Exhalation valve cover distorted, scratched, cracked, or missing ? Is the Mouthbit distorted, stiff, decomposed, cut, or obstructed ? Is the Mouthbit cover stiff, distorted, missing, or has it lost tension ? Is the nose clamp stiff, distorted, missing, or has it lost tension ? Is the cartridge dated ? Is the cartridge date more than 1 year old ? Is the owners name on the respirator ? Is the respirator clean ? JUN JC/N n Y/jsU Y /_-- Y/_bU y /j, Y/J Y ANy /ji. Y/N Y/.N Y/7T ^7n Note: Make sure the cartridge is clean. Never try to clean it by washing it or blowing with air. Inspect the cartridge for dents or other damage. Breathe at least once through the respirator to insure that it is functioning properly. If any odor or taste is detected, replace the air-purifying element or dispose of the respirator (if it is a disposable model). Note any actions taken to correct any deficiency found during this inspection. HO A 040?*- 1 CONFTDFNTTAl Mouthbit Respirator Training Test I. Complete the following statements: 1. A mouthbit respirator is used for, tsfo* OuU_____ 2. If a mouthbit respirator is individually assigned and removed from thejnanufacturer's protective bag, then it becomes your property and needs to have your A and the it was opened marked on the respirator. 3. In the Solvents / EDC L Plant, the mouthbit respirator cartridge must be replaced ^ or when it is A* fiAT/jL. 4. The replacement cartridges for mouthbit respirators are located in Bldg. /7e/ (the 'Zfen XwfveVMK___ ). II. Circle "T" if True or "F' if False for the following statements: 6. T F You need medical approval to use a mouthbit respirator. 7. T F You need to be Fit-tested to use a mouthbit respirator. 8. JT__ F Respirator equipment is approved as a unit and parts are not interchangeable with other models. 9. T A mouthbit respirator can be used to catch process samples. 10. T F The mouthbit respirator that you use in the plant is individually assigned to you. III. Complete the following exercises, mark with an "V" when done: 11. _ Demonstrate the correct procedure to clean, maintain, and store your mouthbit respirator. 12. ^ Demonstrate how to correctly change the cartridge of your mouthbit respirator. Review how to correctly don your mouthbit respirator. 2 00 A 040?6? CONFTDFNTIAl. Name : Solvents / EDC 1 Annual Inspection Record Air Purifying Mouthbit Respirators Date Z ?/ 9s' Master # : Employer : Dow Chemical Respirator Mfg. & Model #: AO R722 Cartridge Type: Acid Gas Disassemble the respirator (if possible) and inspect the following; Is the body/cartridge holder free of any dents, distortion, and wear ? Is the cartridge face unobstructed, with no cracks or holes ? Is th6 cartridge and respirator manufactured by the same company (compatible) ? Is the cartridge gasket (if applicable) cut, cracked, or missing ? Are the Inhalation/Exhalation diaphragm valve flaps stiff, decomposed, or cut ? Are the Inhalation/Exhalation diaphragm valve seats distorted, scratched, cracked, or obstructed ? Is the Exhalation valve cover distorted, scratched, cracked, or missing ? Is the Mouthbit distorted, stiff, decomposed, cut, or obstructed ? Is the Mouthbit cover stiff, distorted, missing, or has it lost tension ? Is the nose clamp stiff, distorted, missing, or has it lost tension ? Is the cartridge dated ? Is the cartridge date more than 1 year old ? Is the owners name on the respirator ? Is the respirator clean ? (Circle One) /N V Y/tfP Y/P Y/&? Y Y /<$? Y/$> yaP Y/W >/N 'N Note: Make sure the cartridge is clean. Never try to clean it by washing it or blowing with air. Inspect the cartridge for dents or other damage. Breathe at least once through the respirator to insure that it is functioning properly. If any odor or taste is detected, replace the air-purifying element or dispose of the respirator (if it is a disposable model). Note any actions taken to correct any deficiency found during this inspection. 1 DO ^ 040?^3 DpMTt Al conf t Mouthbit Respirator Training Test I. Complete the following statements: 1. A mouthbit respirator is used for _________ 2. If a mouthbit respirator is individually assigned and removed from the manufacturer's protective bag, then it becomes your property and needs to have vour /y fan ? and the 6 V' it was opened marked on the respirator. 3. In the Solvents / EDC 1 Plant, the mouthbit respirator cartridge must be replaced_____________ or when it is. avi, II. 4. The replacement cartridges for mouthbit respirators are located in Bldg. /?*> ? ibA< ----------- )* Circle "T" if True or "F' if False for the following statements: (the 6. F 7. T % 8. ft F You need medical approval to use a mouthbit respirator. You need to be fit-tested to use a mouthbit respirator. Respirator equipment is approved as a unit and parts are not interchangeable with other models. 9. A mouthbit respirator can be used to catch process samples. 10. F The mouthbit respirator that you use in the plant is individually assigned to you. III. Complete the following exercises, mark with an "V" when done: 11. ^ Demonstrate the correct procedure to clean, maintain, and store your mouthbit respirator. 12. Demonstrate how to correctly change the cartridge of your mouthbit respirator. 13. Review how to correctly don your mouthbit respirator. 2 Oo hip 40 Top NT ^64 U/ Solvents / EDC 1 Annual Inspection Record Air Purifying Mouthbit Respirators Namee : *:ffcXT______ Master Date Employer Dow Chemical Respirator Mfg. & Model #: AO R722 Cartridge Type: Acid Gas Disassemble the respirator (if possible) and inspect the following; (Circle One) Is the body/cartridge holder free of any dents, distortion, and wear ? Is the cartridge face unobstructed, with no cracks or holes ? Is the cartridge and respirator manufactured by the same company (compatible) ? Is the cartridge gasket (if applicable) cut, cracked, or missing ? Are the Inhalation/Exhalation diaphragm valve flaps stiff, decomposed, or cut ? Are the Inhalation/Exhalatiort diaphragm valve seats distorted, scratched, cracked, or obstructed ? Is the Exhalation valve cover distorted, scratched, cracked, or missing ? Is the Mouthbit distorted, stiff, decomposed, cut, or obstructed ? Is the Mouthbit cover stiff, distorted, missing, or has it lost tension ? Is the nose clamp stiff, distorted, missing, or has it lost tension ? Is the cartridge dated ? Is the cartridge date more than 1 year old ? Is the owners name on the respirator ? Is the respirator clean ? Note: Make sure the cartridge is clean. Never try to clean it by washing it or blowing with air. Inspect the cartridge for dents or other damage. Breathe at least once through the respirator to insure that it is functioning properly. If any odor or taste is detected, replace the air-purifying element or dispose of the respirator (if it is a disposable model). Note any actions taken to correct any deficiency found during this inspection. DO A 040 CONFTOFNTTAl Mouthbit Respirator Training Test I. Complete the following statements: 1. A mouthbit respirator is used for ^__________ -- 2. If a mouthbit respirator is individually assigned and removed front the manufacturer's protective bag, then it becomes your property and needs to have your l/at-m*. and the CWfcL it was opened marked on the respirator. 3. In the Solvents / EDC 1 Plant, the mouthbit respirator cartridge must be replaced L or when it is fj. tt/A 4. Thej^lacement cartridges for mouthbit respirators are located in Bldg. /7^^ (the II. Circle "T" if True or "F' if False for the following statements: (^p)6. T You need medical approval to use a mouthbit respirator. 7. T (f) You need to be fit-tested to use a mouthbit respirator. 68. F Respirator equipment is approved as a unit and parts are not interchangeable with other models. 9. {f) A mouthbit respirator can be used to catch process samples. 10. F The mouthbit respirator that you use in the plant is individually assigned to you. III. Complete the following exercises, mark with an "V" when done: S 11. Demonstrate the correct procedure to clean, maintain, and store your mouthbit respirator. 12. Demonstrate how to correctly change the cartridge of your mouthbit respirator. 13. Review how to correctly don your mouthbit respirator. DO A 040P66 CONFTDFNTTAL Solvents / EDC 1 Annual Inspection Record ifying Mouthbit Respirators Name : Date : Master # : Employer : Dow Chemical Respirator Mfg. & Model #: AO R722 Cartridge Type: Acid Gas" Disassemble the respirator (if possible) and inspect the following; (Circle One) Is the body/cartridge holder free of any dents, distortion, and wear ? Is the cartridge face unobstructed, with no cracks or holes ? Is the cartridge and respirator manufactured by the same company (compatible) ? Is the cartridge gasket (if applicable) cut, cracked, or missing ? Are the Inhalation/Exhalation diaphragm valve flaps stiff, decomposed, or cut ? Are the Inhalation/Exhalation diaphragm valve seats distorted, scratched, cracked, or obstructed ? Is the Exhalation valve cover distorted, scratched, cracked, or missing ? Is the Mouthbit distorted, stiff, decomposed, cut, or obstructed ? Is the Mouthbit cover stiff, distorted, missing, or has it lost tension ? Is the nose clamp stiff, distorted, missing, or has it lost tension ? Is the cartridge dated ? Is the cartridge date more than 1 year old 2. _ -- ------------------- Is the owners name on the respirator ? Is the respirator clean ? Note: Make sure the cartridge is clean. Never try to clean it by washing it or blowing with air. Inspect the cartridge for dents or other damage. Breathe at least once through the respirator to insure that it is functioning properly. If any odor or taste is detected, replace the air-purifying element or dispose of the respirator (if it is a disposable model). Note any actions taken to correct any deficiency found during this inspection. DO A 040767 CONFTDFNTTAL Mouthbit Respirator Training Test I. Complete the following statements: 1. A mouthbit respirator is used for 2. If a mouthbit respirator is individually assigned and removed from the manufacturer's protective bag, then it becomes your property and needs to have your and the it was opened marked on the respirator. 3. In the Solvents / EDC 1 Plant, the mouthbit respirator cartridge must be replaced or when it is . 4. The replacement cartridges for mouthbit respirators are located in Bldg. (the II. Circle "T" if True or "F* if False for the following statements: 6. T You need medical approval to use a mouthbit respirator. 7. T You need to be fit-tested to use a mouthbit respirator. 8. F Respirator equipment is approved as a unit and parts are not interchangeable with other models. 9. T<jp A mouthbit respirator can be used to catch process samples. 10. (jlT) F The mouthbit respirator that you use in the plant is individually assigned to you. ill. Complete the following exercises, mark with an "V" when done: 11. 412. ^ Demonstrate respirator. Demon strate 13. ^ Review how 2 040?0B DO 0 Name : Y<d Solvents / EDC 1 Annual Inspection Record Air Purifying Mouthbit Respirators Dale : ___ f / / 7 / Master # : Employer : Dow Chemical Respirator Mfg. & Model #: AO R722 Cartridge Type: Acid Gaf Disassemble the respirator (if possible) and inspect the following; (Circle One) Is the body/cartridge holder free of any dents, distortion, and wear ? Is the cartridge face unobstructed, with no cracks or holes ? Is the cartridge and respirator manufactured by the same company (compatible) ? Is the cartridge gasket (if applicable) cut, cracked, or missing ? Are the Inhalation/Exhalation diaphragm valve flaps stiff, decomposed, or cut ? Are the Inhalation/Exhalation diaphragm valve seats distorted, scratched, cracked, or obstructed ? Is the Exhalation valve cover distorted, scratched, cracked, or missing ? Is the Mouthbit distorted, stiff, decomposed, cut, or obstructed ? Is the Mouthbit cover stiff, distorted, missing, or has it lost tension ? Is the nose clamp stiff, distorted, missing, or has it lost tension ? Is the cartridge dated ? Is the cartridge date more than 1 year old ? Is the owners name on the respirator ? Is the respirator clean ? Note: Make sure the cartridge is clean. Never try to clean it by washing it or blowing with air. Inspect the cartridge for dents or other damage. Breathe at least once through the respirator to insure that it is functioning properly. If any odor or taste is detected, replace the air-purifying element or dispose of the respirator (if it is a disposable model). Note any actions taken to correct any deficiency found during this inspection. 1 Dn A H40P69 CONFTDFNTIAl Mouthbit Respirator Training Test I. Complete the following statements: 1. A mouthbit respirator is used for =h 2. If a mouthbit respirator is individually assigned and removed from the manufacturer's protective bag, then it becomes your property and needs to have your 5 . and the 7) n it was opened marked on the respirator. 3. In the Solvents / EDC 1 Plant, the mouthbit respirator cartridge must be replaced m- or when it is _______ . /l 4. The replacement cartridges for mouthbit respirators are located in Bldg. /~?o > (the II. Circle "T" if True or "F' if False for the following statements: 6. T (5 You need medical approval to use a mouthbit respirator. 7. T <3> You need to be fit-tested to use a mouthbit respirator. 8. 3 F Respirator equipment is approved as a unit and parts are not interchangeable with other models. 9. T A mouthbit respirator can be used to catch process samples. 10. (T) F The mouthbit respirator that you use in the plant is individually assigned to you. III. Complete the following exercises, mark with an "V" when done: 11. Demonstrate respirator. 12. Demonstrate 13. Review how 2 DO A 040P70 C.ONF T DFNT T Al