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FINAL ACCIDENT PREVENTION PLAN <br /> COMPLIANCE AGREEMENT <br /> Page 2 of 2 <br /> RESPIRATOR FIT-TEST TRAINING: I have been trained in the proper selection, fit, care, <br /> cleaning, and maintenance, and storage of the respirator(s)that I will wear. I have been fit- <br /> tested in accordance with the criteria in the contractor's/my employer's Respiratory Protection <br /> program and have received a satisfactory fit. I have been assigned my individual respirator. I <br /> have been taught how to properly perform positive and negative pressure fit check upon <br /> donning negative pressure respirator each time. Respirator Use is Not Anticipated for this <br /> Contract. <br /> MEDICAL EXAMINATION: I have had a medical examination within the last twelve (12) <br /> months, which was paid for by my employer. The examination included: health history, <br /> pulmonary function tests and may have included an evaluation of a chest x-ray. A physician <br /> made determination regarding my physical capacity to perform work tasks on the project while <br /> wearing protective equipment including a respirator. I was personally provided a copy of the <br /> results of that examination. My employer's industrial hygienist evaluated the medical <br /> certification provided by the physician and checked the appropriate blank below. The <br /> physician determined that there: <br /> Were no limitations to performing the required work tasks <br /> Were identified physical limitations to performing the required work tasks <br /> Date medical examination completed <br /> CERTIFICATION <br /> Em to ee's/Visitor's Si nature ' <br /> Date <br /> Printed Name <br /> VERIFICATION <br /> OTIE SSHO Signature <br /> Date <br /> Printed Name <br />