Jenkins Academy of Applied Technology

RP-001-REQ — Employer workplace instruction and verification

Respiratory Protection · v1.0.0 · October 21, 2026

Blank means pending. This form does not save entries. Print or save the completed form before closing. Record actual evidence, correction and reassessment. Keep medical questionnaires, diagnoses and clinical details out of ordinary LMS and training records. A signature or quiz is not a medical evaluation, fit test or safe-use demonstration.

Build core knowledge for required respirator use. For workers in general industry and construction. Examples use devices that fit tightly to the face and filter the air. Work in IDLH air is outside this core. Your employer must add the actual task instruction, medical review, fit test and safe-use check. This course does not qualify you to lead a program, run a fit test, use supplied air, fight fires or perform rescue.

Actual workplace instruction

Employer program, assessed task and exposure, controls, approved model, service-life plan, language needs, trainer access and emergency route.

Actual instruction/action, who performed or verified it, date, evidence reference, gaps and correction

Medical evaluation

Confidential PLHCP process before fit testing or required use; permitted recommendation and limits. Do not place medical questionnaires or diagnoses in the LMS.

Actual instruction/action, who performed or verified it, date, evidence reference, gaps and correction

Actual fit test

Appropriate accepted protocol for the exact tight-fitting make, model, style and size, with annual and applicable change triggers. The online quiz is not a fit test.

Actual instruction/action, who performed or verified it, date, evidence reference, gaps and correction

Safe-use demonstration

Teach-back and protected-area demonstration with actual approved equipment, including inspection, donning, each-donning seal check, use, doffing, care and withdrawal actions.

Actual instruction/action, who performed or verified it, date, evidence reference, gaps and correction

Employer task authorization

Employer confirms required evidence, actual task limits and restrictions before exposure. No IDLH, supplied-air, firefighting or rescue authorization is conferred.

Actual instruction/action, who performed or verified it, date, evidence reference, gaps and correction

Safe practice and teach-back

For the required-use track, confirm applicable medical prerequisites before worn practice. Use clean, suitable actual equipment in a protected area; do not create hazardous exposure. Follow manufacturer methods and appropriate accepted fit-test protocols through the actual provider. A completed form is not proof of an action that did not occur.