ETB-1028 Rev 5 Fit Testing Report

[NIOSH] Information Collection Provisions in 42 CFR Part 84 - Tests and Requirements for Certification and Approval of Respiratory Protective Devices

Atch_18_Fit Tests STP-9 and 10.xls

OMB: 0920-0109

Document [xlsx]
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Overview

OMB Form #
Data collected


Sheet 1: OMB Form #

Form Approved
OMB No. 0920-0109
Exp. Date xx/xx/20xx





Public reporting burden of this collection of information is estimated to average 10 minutes per response, including the time for reviewing instruction, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSD Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-0109).

Sheet 2: Data collected

Task Number: 26564

Manufacturer: Sundstrom Safety AB

Item Tested: H06-8021, H06-7021, H02-1321, R01-0605, T06-0116, T06-0103, R06-0121
Minimum Fit Factor:






Subject Facesize Facepiece Result
Trial 1 Trial 2
2320 2 One Size Pass N/A
2313 4 One Size Pass N/A
1908 4 One Size Pass N/A
2328 4 One Size Pass N/A
2329 4 One Size Pass N/A
2315 7 One Size Pass N/A
2316 7 One Size Pass N/A
2317 7 One Size Pass N/A
2326 7 One Size Pass N/A
2314 8 One Size Pass N/A
2324 8 One Size Pass N/A
2311 9 One Size Pass N/A
2312 10 One Size Pass N/A
2323 10 One Size Pass N/A













































Overall Result: Pass







Test Operator: Jeremy Simons Date: 8/31/2023










Comments:



Only 14 of the 18 test participants were needed since no failures occurred.





Was all equipment verified to be in calibration throughout testing? Yes













































Equipment used in Testing


Name GAGEPak # Calibration Due
TSI Photometer 000155 2/6/2025
TSI Dust Trak II 000560 5/2/2024




























File Typeapplication/vnd.ms-excel
AuthorTerry Thorton
Last Modified ByMoore, Susan M. (CDC/NIOSH/NPPTL)
File Modified2023-10-26
File Created2009-02-19

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