Mask Plan
Mask Plan
Purpose .....................................................................................................................................4
Policy .......................................................................................................................................4
Administrative Duties ..............................................................................................................4
Respirator Selection .................................................................................................................4
Respirator Types and Uses. ......................................................................................................6
Mandatory Medical Evaluations ..............................................................................................6
Request for Medical Clearance – Respirator Use Questionnaire .............................................8
Quantitative Fit Testing..........................................................................................................12
Fit Testing Procedures ............................................................................................................12
Respirator Fit Test Record .....................................................................................................16
Fit Testing Schedule ...............................................................................................................17
Facepiece Seal Protection.......................................................................................................17
Continuing Respirator Effectiveness ......................................................................................17
Maintenance and Care Procedures .........................................................................................18
Cleaning & Disinfecting Policy .............................................................................................18
Cleaning & Disinfecting Procedure ...................................................................................... 18
Storage....................................................................................................................................19
Repairs....................................................................................................................................20
Discarding of Respirators .......................................................................................................20
Training ..................................................................................................................................20
Basic Training Elements ........................................................................................................21
Program Evaluation ................................................................................................................21
Respiratory Protection Training Certification ....................................................................... 23
Purpose
Some employees of 3D Concrete LLC perform tasks that require the use of respiratory
protection and based on this exposure, we have elected to include in our health & safety policy
manual, regulations that govern the expected safe work practices when working with
respiratory protection. Contractors are expected to follow these standards as part of fulfilling
their contract with 3D Concrete LLC.
The purpose of this program is to inform interested persons, including employees that 3D
Concrete LLC is complying with the OSHA Respiratory Protection Standard, Title 29 Code of
Federal Regulations 1910.134. This program applies to all work operations where employees
or contractors may be exposed to hazards that require respiratory protection.
Policy
This Respiratory Protection Program specifies standard operating procedures to protect all
employees and independent contractors from respiratory hazards, according to the
requirements of 29 CFR 1910.134. Respirators are to be used only where engineering control of
respirator hazards is not feasible, while engineering controls are being installed, or in
emergencies.
Administrative Duties
The Respiratory Protection Program is administered by the Safety Manager. The Safety
Manager is responsible for all facets of the program and has full authority to make necessary
decisions to ensure success of this program. This authority includes purchasing equipment
necessary to implement and operate the program.
The Safety Manager will develop written detailed instructions covering each of the basic
elements in this program, and is the solely authorized to amend these instructions. The
members of this team are qualified, by appropriate training and experience that is
commensurate with the complexity of the program, to administer or oversee our Respiratory
Protection Program and conduct the required evaluations of program effectiveness.
Employees may review a copy of our Respiratory Protection Program. It is located in the Main
office. The Safety Manager reviews this program periodically to ensure its effectiveness.
Main Office:
3D Concrete LLC
600 South 21st Street
Sparks, NV 89431
Respirators are selected on the basis of respiratory hazards to which the worker is exposed and
workplace and user factors that affect respirator performance and reliability. All selections are
made by the Safety Manager.
The Safety Manager has developed detailed written standard operating procedures governing
the selection of respirators using the following guidelines:
• Identify and evaluate the respiratory hazard(s) in the workplace, including a reasonable
estimate of employee exposures to respiratory hazard(s) and an identification of the
contaminant's chemical state and physical form. Consider the atmosphere to be
immediately dangerous to life or health (IDLH) if you cannot identify or reasonably
estimate employee exposure.
• Select respirators from a sufficient number of respirator models and sizes so that the
respirator is acceptable to, and correctly fits, the user.
• Provide respirators NIOSH-certified for escape from the atmosphere in which they will be
used when they are used only for escape from IDLH atmospheres.
We provide a respirator that is adequate to protect the health of the employee and ensure
compliance with all other OSHA statutory and regulatory requirements, under routine and
reasonably foreseeable emergency situations.
• An atmosphere-supplying respirator, or
(1) An air-purifying respirator, provided that:
(2) The respirator is equipped with an end-of-service-life indicator (ESLI) certified by
NIOSH for the contaminant; or
(3) If there is no ESLI appropriate for conditions in our workplace, implement a change schedule
for canisters and cartridges that is based on objective information or data that will ensure that
canisters and cartridges are changed before the end of their service life.
At 3D Concrete LLC, persons will not be assigned to tasks requiring use of respirators nor fit
tested unless it has been determined by a “Physician or Other Licensed Health Care
Professional” that they are physically able to perform the work and use the respirator.
• An employee reports medical signs or symptoms that are related to ability to use a
respirator;
• A PLHCP, supervisor, or the respirator program administrator informs the employer that
an employee needs to be reevaluated;
• Information from the respiratory protection program, including observations made during
fit testing and program evaluation, indicates a need for employee reevaluation; or
• A change occurs in workplace conditions (e.g., physical work effort, protective clothing,
temperature) that may result in a substantial increase in the physiological burden placed
on an employee.
1. Today's date:
2. Your name:
8. A phone number where you can be reached by the health care professional who reviews this
questionnaire (include the Area Code):
10. Has your employer told you how to contact the health care professional who will review this
questionnaire (circle one): Yes/No
11. Check the type of respirator you will use (you can check more than one category):
a. N, R, or P disposable respirator (filter-mask, non- cartridge type only).
b. Other type (for example, half- or full-facepiece type, powered-air purifying, supplied-
air, self-contained breathing apparatus).
Section 2.
3. Have you ever had any of the following pulmonary or lung problems?
a. Asbestosis: Yes/No
b. Asthma: Yes/No
c. Chronic bronchitis: Yes/No
d. Emphysema: Yes/No
e. Pneumonia: Yes/No
f. Tuberculosis: Yes/No
g. Silicosis: Yes/No
h. Pneumothorax (collapsed lung): Yes/No
i. Lung cancer: Yes/No
j. Broken ribs: Yes/No
k. Any chest injuries or surgeries: Yes/No
l. Any other lung problem that you've been told about: Yes/No
4. Do you currently have any of the following symptoms of pulmonary or lung illness?
5. Have you ever had any of the following cardiovascular or heart problems?
6. Have you ever had any of the following cardiovascular or heart symptoms?
8. If you've used a respirator, have you ever had any of the following problems? (If you've never
used a respirator, check the following space and go to question 9)
9. Would you like to talk to the health care professional who will review this questionnaire about
your answers to this questionnaire: Yes/No
10. Have you ever lost vision in either eye (temporarily or permanently): Yes/No
11. Do you currently have any of the following vision problems?
12. Have you ever had an injury to your ears, including a broken ear drum: Yes/No
In general, fit testing may be either qualitative or quantitative. Qualitative fit testing (QLFT)
involves the introduction of a gas, vapor, or aerosol test agent into an area around the head of
the respirator user. If that user can detect the presence of the test agent through subjective
means, such as odor, taste, or irritation, the respirator fit is inadequate.
In a Quantitative respirator fit test (QNFT), the adequacy of respirator fit is assessed by
measuring the amount of leakage into the respirator, either by generating a test aerosol as a
test atmosphere, using ambient aerosol as a test agent, or using controlled negative pressure to
measure the volumetric leak rate. Appropriate instrumentation is required to quantify respirator
fit in QNFT. Unless specified otherwise on the Material Safety Data Sheet,3D Concrete LLC
uses Quantitive fit testing (QNFT).
1) Prior to the selection process, the employee shall be shown how to put on a respirator,
how it should be positioned on the face, how to set strap tension and how to determine
an acceptable fit. A mirror shall be available to assist the employee in evaluating the fit
and positioning of the respirator.
2) The employee will pick the respirator that correctly fits from the selection at hand.
3) The employee shall be informed that he/she is being asked to select the respirator that
provides the most acceptable fit. Each respirator represents a different size and shape,
and if fitted and used properly, will provide adequate protection.
4) The employee shall be instructed to hold each chosen facepiece up to the face and
eliminate those that do not give an acceptable fit.
5) The more acceptable facepieces are noted in case the one selected proves
unacceptable. The most comfortable mask is donned and worn for at least 5 minutes to
access comfort. If the employee is not familiar with a particular respirator, the employee
shall be directed to don the mask several times and to make adjustments to the straps
each time to become aquatinted with setting the proper tension of the straps.
6) The employee will perform a user seal check. A negative and positive pressure check is
the method used at 3D Concrete LLC. Before conducting the test, the employee shall
seat the mask on the face by moving the head from side to side and up and down slowly
while taking a few slow deep breaths. Another face piece will be selected if the
employee fails the user seal check.
7) The test shall not be conducted if there is any hair growth between the skin and the face
piece sealing surfaces, such as stubble, beard growth, mustache, beard, or sideburns
which cross the respirator sealing surface. Any type of apparel, which interferes with a
satisfactory fit, shall be removed or altered.
8) If the employee exhibits difficulty in breathing during the test, she or he will be referred to
a physician or other licensed health care professional to determine whether the
employee can wear a respirator while performing his or her duties.
9) If the employee finds the fit of the respirator unacceptable, the employee may select a
different respirator and be re-tested.
10) Exercise regimen. A description of the fit test and the responsibilities the employee must
adhere to during the test. The description shall include the exercises and an explanation
of how to perform them. The respirator to be used in the test will be worn 5 minutes
before the start of the fit test.
11) Other Personal Protective Equipment the employee will wear as normal part of the work
process must be worn during the test.
Normal breathing. In a normal standing position, without talking the employee shall
breathe normally.
Deep breathing. In a normal standing position, the employee shall breathe slowly
and deeply, taking caution so as not to hyperventilate.
Turning head side to side. Standing in place, the employee shall slowly turn
his/her head from side to side between the extreme positions on each side. The
head shall be held at each extreme momentarily so the employee can inhale at
each side.
Moving head up and down. Standing in place, the employee shall slowly move
his/her head up and down. The employee shall be instructed to inhale at the up
position (i.e. when looking toward the ceiling).
Grimace. The employee shall grimace by smiling or frowning. (This applies only to
QNFT testing, it is not performed for QLFT.)
Bending over. The employee shall bend at the waist as if he/she were to touch
his/her toes. Jogging in place shall be substituted for this exercise in those test
environments such as shroud type QNFT or QLFT units that do not permit bending
over at the waist.
Talking. The employee shall talk out loud slowly and loud enough so as to be heard
clearly by the test conductor. The employee can read from prepared text such as
the Rainbow Passage (see below), count backward from 100, or recite a memorized
poem or song.
Rainbow Passage: When the sunlight strikes raindrops in the air, they act like a prism and form
a rainbow. The rainbow is a division of white light into many beautiful colors. Theses take the
shape of a long round arch, with its path high above, and its two ends apparently beyond the
horizon. There is, according to legend, a boiling pot of gold at one end. People look, but no one
ever finds it. When a man looks for something beyond his reach, his friends say he is looking for
the pot of gold at the end of the rainbow.
Each test exercise shall be performed for one minute except for the grimace exercise, which
shall be performed for 15 seconds. The employee shall be questioned by the test conductor
regarding the comfort of the respirator upon completion of the protocol. If it has become
Clean Shaven
Facial Scar
1-2 Day Beard Growth
Dentures Absent
2 + Days Beard Growth
Glasses
Moustache
Fit Checks:
Acknowledgement:
• Before any of our employees are required to use any respirator with a negative or
positive pressure tight-fitting face piece;
• Whenever a different respirator face piece (size, style, model, or make) is used;
• At least annually;
• When the employee, subsequently after passing a QLFT or QNFT, notifies the company,
supervisor or PLHCP that the fit of the respirator is unacceptable, that employee will be
retested with a different respirator face piece.
• Facial hair that comes between the sealing surface of the face piece and the face or
that interferes with valve function; or
• Any condition that interferes with the face-to-face piece seal or valve function.
For all tight-fitting respirators, ensure that employees perform a user seal check each time they
put on the respirator.
• To wash their faces and respirator face pieces as necessary to prevent eye or
skin irritation associated with respirator use; or
• Respirator issued for the exclusive use of an employee must be cleaned and disinfected
as often as necessary to be maintained in a sanitary condition.
• Respirators issued to more than one employee must be cleaned and disinfected before
being worn by different individuals.
• Respirators maintained for emergency use must be cleaned and disinfected after each
use.
• Respirators used in fit testing and training must be cleaned and disinfected after each
use.
Instructions
• Wash components in warm (43°C [110°F] maximum) water with a mild detergent or with
a cleaner recommended by the manufacturer. A stiff bristle (not wire) brush may be used
to facilitate the removal of dirt.
• When the cleaner used does not contain a disinfecting agent, respirator components
should be immersed for two minutes in one of the following:
• Reassemble face piece, replacing filters, cartridges, and canisters where necessary.
Storage
Storage of respirators must be done properly to ensure that the equipment is protected and not
subject to environmental conditions that may cause deterioration. We ensure that respirators
are stored to protect them from damage, contamination, dust, sunlight, extreme temperatures,
excessive moisture, and damaging chemicals. In addition, emergency respirators are kept
accessible to the work area and are clearly marked as containing emergency respirators; and
stored in accordance with any applicable manufacturer instructions.
Inspection
In order to assure the continued reliability of respirator equipment, it must be inspected on a
regular basis. The frequency of inspection is related to the frequency of use. Here are our
frequencies for inspection:
1. For respirator function, tightness of connections, and the condition of the various parts
including, but not limited to, the face piece, head straps, valves, connecting tube, and
cartridges, canisters or filters; and
Repairs
Respirators that fail an inspection or are otherwise found to be defective are removed from
service, and are discarded or repaired.
Discarding of Respirators
Respirators that fail an inspection or are otherwise not fit for use and cannot be repaired must
be discarded. The respirator is marked as “unsafe” and the elastomeric headband is removed.
Additionally, a red tag should be attached to the respirator that reads “Unsafe for use – discard”.
Training
The most thorough respiratory protection program will not be effective if employees do not wear
respirators, or if wearing them, do not do so properly. The only way to ensure that our
employees are aware of the purpose of wearing respirators, and how they are to be worn is to
train them. Simply put, employee training is an important part of the respiratory protection
program and is essential for correct respirator use.
• Respiratory hazards to which our employees are potentially exposed during routine and
emergency situations, and
• Proper use of respirators, including putting on and removing them, any limitations on
their use, and their maintenance.
Both training parts are provided prior to requiring an employee to use a respirator in our
workplace. However, if an employee has received training within 12 months addressing the
seven basic elements of respiratory protection (see "Basic Training Elements" below) and 3D
Concrete LLC and the employee can demonstrate that he/she has knowledge of those elements,
then that employee is not required to repeat such training initially.
Yet, we do require all of our employees to be retrained annually and when the following
situations occur:
• Changes in the workplace or the type of respirator render previous training obsolete;
• Inadequacies in the employee's knowledge or use of the respirator indicate that the
employee has not retained the requisite understanding or skill; or
• Any other situation arises in which retraining appears necessary to ensure safe
respirator use.
The Safety Manager shall file the completed record for the duration of the employees’
employment with 3D Concrete LLC.
Basic Training Elements- NRMCA respirator training video and Test included.
Our employees are trained sufficiently to be able to demonstrate knowledge of at least these
basic elements:
• Why the respirator is necessary and how improper fit, usage, or maintenance can
compromise the protective effect of the respirator.
• How to use the respirator effectively in emergency situations, including situations where
the respirator malfunctions?
• How to inspect, put on, take off, use and check the seals of the respirator.
• What procedures are used for maintenance and storage of the respirator.
• How to recognize medical signs and symptoms that may limit or prevent the effective
use of the respirator.
It is inherent in respirator use that problems with protection, irritation, breathing resistance,
comfort, and other respirator-related factors occasionally arise in most respirator protection
programs. Although it is not possible to eliminate all problems associated with respirator use, we
try to eliminate as many problems as possible to improve respiratory protection and encourage
employee acceptance and safe use of respirators. By having our program administrator
thoroughly evaluate and, as necessary, revise our Respiratory Protection Program, we can
eliminate problems effectively.
The Safety Manager evaluates the performance of our employees and independent contractors
as it relates to respiratory protection and makes revisions to this program as needed. Program
evaluation, performed annually by the Safety Manager involves the following:
Any problems that are identified during this assessment must be corrected. Factors to assess
include, but are not limited to:
• Respirator fit (including the ability to use the respirator without interfering with effective
workplace performance)
• Appropriate respirator selection for the hazards to which the employee is exposed
• Proper respirator uses under the workplace conditions the employee encounters
This is to certify that the following training criteria have been delivered to the employee listed
below:
Why the respirator is necessary and how improper fit, usage, or maintenance can
compromise the protective effect of the respirator.
How to use the respirator effectively in emergency situations, including situations where the
respirator malfunctions.
How to inspect, put on, take off, use and check the seals of the respirator.
How to recognize medical signs and symptoms that may limit or prevent the effective use of
the respirator.
An understanding that employee owned respirators can not be used unless approved by the
employee’s manager and the Safety Manager.
An understanding that respirators can not be worn in areas where respiratory protection is
not required.
I have demonstrated an understanding of the above topics to the trainer. I understand that
retraining will be required if there are changes in the work process, type of respiratory protection
changes, if I display a need to be retrained or at the discretion of management.
Employee Signature: