<p>Appendix J</p><p>UCI EH&S RESPIRATORY PROTECTION PROGRAM EVALUATION</p><p>Date of Evaluation: Name of Evaluator: Name of Respirator User: Issue Date of Respirator/Training Date:</p><p>Thank you for assisting in the evaluation of the Respiratory Protection Program. Please take a few moments to review the following elements with respirator user.</p><p>Does the respirator fit?1 Yes No If not, explain:</p><p>Does the respirator interfere with the user’s workplace performance?2 Yes No If so, explain:</p><p>Is the respirator used to protect only against the hazard(s) identified in the Yes No Respiratory Hazard Evaluation (RHE)?3 If not, explain:</p><p>Is the respirator used only during the workplace conditions identified in Yes No the Respiratory Hazard Evaluation (RHE)?3 If not, explain:</p><p>Is the respirator stored and maintained properly?4 Yes No If not, explain:</p><p>1 Fit can be determined by observation and by asking the user if they detect the contaminant. 2 Interference can be determined by observation and by asking the user if they detect the contaminant. 3 Request for and review the RHE as needed prior to the assessment. 4 Proper maintenance can be determined by observation; Inspect the respirator storage location.</p><p>D:\Docs\2017-12-14\00892b3491108272f838462d101480ed.doc</p>