Form ETB 1211A Rev 1 FP ETB 1211A Rev 1 FP Determination of Wearability (CCER)

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

Atch_26_Wearability Test.xlsx

Att 26 Wearability Test

OMB: 0920-0109

Document [xlsx]
Download: xlsx | pdf

Overview

OMB Form #
Test Information


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 20 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: Test Information

DETERMINATION OF WEARABILITY (CCER)




PROCEDURE NO. TEB-CCER-STP-0610










Date

Manufacturer

TN

Model

Serial #

Manufacturing Date



Phenol:

Leak Rate

Capacity

Subject Height

Subject Weight Initial



Subject Weight Final



Unit Weight Initial

Unit Weight Final

Starting O2

End O2







Test Duration



Technician(s)









Comments








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