（HSE管理文件）FREP-04-HSE-2035.004.doc

附件4 ATTACHMENT 4 员工使用呼吸器测试卡 EMPLOYEE FIT TEST CARD FREP PMC员工使用呼吸器测试卡 员工姓名： __________________ ________________ 工作证号码：: _____________ ___________________ 测试的日期： ______ ______ 有效期至: ____ ______ 测试使用的激发剂： _____________________ _______ 测试参数（定量性）：_________________ _________ 生产厂商：_________________________ _________ 型号：: _____________________ 尺寸： _______________ 测试负责人签名：__________________________________ _____ ______ 该员工已经获得医学认定，他/她可以在本项目工作中使用呼吸器。 日期： _____________________________________ 提供医学检查（许可）的医师姓名：_________________________________ 有效期至：________________________ ATTACHMENT D EMPLOYEE FIT TEST CARD FREP IPMT EMPLOYEE FIT TEST CARD EMPLOYEE NAME: _________________________________ BADGE #: ____ ________ SSN:____________________ DATE OF FIT TEST: ____________ EXP. DATE: __________ CHALLENGE AGENT: _____________ __________________ FIT FACTOR quantitative : ____________________________ MANUFACTURER: __________________________________ MODEL #: _____________________ SIZE: _______________ SIGNATURE OF PERSON ADMINISTERING TEST: ___________________________________________________ This employee has been medically qualified to wear a respirator for his/her work on this project. Date: _____________________________________ Name of physician providing medical clearance:____________________ ______ Expiration Date: ___________________ _________ 呼吸保护程序 附件4 Respiratory Protection Procedures, Attachment 4 Page 1 of 2 福建炼油乙烯项目IPMT Fujian Refining Ethylene Project IPMT 联合石化专有 FREP Proprietary 联合石化专有 FREP Proprietary