New Jersey Department of Health

PEOSH Unit

Documentation of Respirator Training

Name of EMS Agency

The following individual has successfully completed Respiratory Protection Training for use of N-95/N-99/N-100 disposable particulate respirators. The training included the elements required by the PEOSH Respiratory Protection Standard (29 CFR 1910.134(k)).

Name of EMS Responder

Date of Training

Type of Training

Initial OR Refresher
Name of Instructor

Title

Phone

Day:	Evening:

OCC-22

JAN 13

OCC-22, Documentation of Respirator Training

occ-22, occ, documentation, respirator, training, PEOSH, occupational, EMS responder, emergency medical services

EWHITE

2010-01-27

NJDOH