b'Comments: (please print) fit tested due to: PassFail (Make, Model, Style, Size) Signature Name Could not beFit Test Respirator Fit Tested(Quantitative): Portacount Model #______________Occupational Health Dynamic Model #:____________ TM Type of OSHA accepted fit test protocol used:___Isoamyl Acetate ___Irritant Smoke______________________________________________________________________ Signature: If other local, state or federal regulations apply (such as MSHA), you may list them here: Fit testing conducted in compliance with OSHA Standard 1910.134(F). Name of Fit Tester: Date:________________ State:_____Zip:_________Tel: City: Address: Company: RESPIRATOR FIT TEST RECORD(Qualitative): ___Saccharin___Bitrex'