1 West Clinton Fire District

2 Best Practice
3 Respiratory Protection Program
4 Best Practice No. 805
5
6 Draft 8/14/13 A
7 I. Purpose
8
9 The elements described in this program are designed to ensure the safe and effective usage of
10 respiratory protection for West Clinton Fire Department members (hereafter called Fire Department).
11 Since most firefighting emergencies are conducted under IDLH conditions, SCBA’s will be used.
12
13 II. Program Administration
14
15 The Respiratory Protection Program is comprised of these documents:
16 1. Respiratory Protection Program Best Practice No. 805
17 2. FIT Testing Best Practice No. 807
18 3. List of Service Providers Best Practice No. 701
19 4. Physical Policy No. 201
20 5. SCOTT SCBA Inspection Procedure Best Practice No. 804
21
22 West Clinton 1st Assistant Chief (hereafter called 1st Asst. Chief) is responsible for the overall
23 implementation and maintenance of the respiratory protection program.
24
25 The 1st Asst. Chief’s duties include:
26
27  Determining which tasks require respiratory protection.
28  Selecting the proper respirator for a specific application.
29  Conducting employee training and conducting fit testing.
30  Ensuring that employees clean, maintain and properly store respirators.
31  Conducting a periodic evaluation of the respiratory program to ensure that it is
32 achieving its desired goal.
33  Insures the quality of the air in the cascade system and Scott bottles
34
35 The Chief, Assistant Chiefs, and Line Officers are responsible for:
36
37  Ensuring that appropriate, approved type respirators are available for use.
38  Ensuring that employees wear the required respirators.
39  Conducting periodic inspections to ensure employees are maintaining their
40 respirators, which would include cleaning, sanitizing, and proper storage.
41
42 The Fire Department members (hereafter called employees) are responsible for:
43
44  Using the respiratory protection in accordance with the training received.
45  Inspecting, cleaning, sanitizing, and proper storage of their respirator.
1
46
47
48 III. Respiratory Selection
49
50 The 1st Asst. Chief is responsible for selecting the appropriate respirators based upon the following
51 elements:
52
53  The type(s) and concentrations of airborne contaminant(s).
54  The characteristics and location of the hazardous area.
55  The workers= activities in the hazardous area.
56  The capabilities and limitations of the respirators.
57  Duration of respirator use.
58  Selection will be made according to Apractices for Respiratory Protection@
59 American National Standards Institute (ANSI) Z88.2-1980.
60  Only respirators having NIOSH approval will be used.
61
62 Respirators currently approved for use are as follows:
63
RESPIRATOR
MANUFACTURER MODEL WORK TASK
SCOTT AIR-PAK Fire fighting
NxG2 4.5 30 min
TC-13F-517

64
65 NOTE: A copy of the hazard determination for each task is maintained and is contained in
66 the respiratory selection section.
67
68 IV. Maintenance, Cleaning, Inspection, and Storage
69
70 Asst. Chiefs and Line Officers will ensure that employees properly clean and maintain the
71 respirators. The following items will be included in the maintenance program:
72
73  Cleaning and sanitizing.
74  Disassemble components from the respirator and inspect for any defects.
75  Immerse the respirator and components in warm soapy water (120-130F). NOTE:
76 air-purifying filters and cartridges must never be washed. The respirator facepiece
77 and components should be gently scrubbed to remove all dirt. Care must be taken
78 not to damage any of the components.
79  Rinse the respirator and components.
2
 80  Sanitize the respirators and components by immersing them into a chlorine bleach
81 solution (approximately one ounce household bleach (Clorox) to one quart of
82 water).
83  Rinse components and allow to dry.
84  Inspect, test, and repair if necessary.
85  Storage should separate the respirator from sunlight, caustic and toxic chemicals that
86 may cause the deterioration of the respirator (mask and other parts).
87
88 Weekly inspections are done during the normal Monday night Quick Call:
89
90 ▀ Insure the Scott bottle air pressure is above 40
91 ▀ Insure the PASS alarm works
92 ▀ Insure all the straps are fully open
93 ▀ Insure the facepeice is clean
94 ▀ Inspect to see if any parts are damaged
95 ▀ Report any problems to the Officer on duty and note comments on the Quick Call
96 Sheet for the particular vehicle being checked
97
98 Monthly inspections
99
100 ▀ See SCOTT SCBA Inspection Procedure Best Practice No. 804
101 ▀ Report any problems to the Officer on duty and note comments on the
102 RESPIRATOR INSPECTION RECORD I for the particular SCBA unit being
103 checked
104
105 Inspect before and after each use for the following:
106
107  Deterioration of any rubber or silicone parts.
108  Conditions of components (filters, cartridges, valves, etc.).
109  Tightness of all connections.
110  Check any end-of-service life indicators.
111  SCBA alarms, regulators, gauges, etc.
112  SCBA cylinder pressure.
113
114 Battery replacements
115
116 ▀ The batteries are replaced twice a year for the PASS alarm and facepeice voice
117 amplifier. See SCOTT SCBA Inspection Procedure Best Practice No. 804 for details.
118
119 V. Breathing Air Quality
120
121 Breathing air must meet the minimum requirements for Grade D breathing air described in
122 ANSI/Compressed Gas Association Commodity Specification for Air, G-7.1-1989.
123
124 The 1st Asst. Chief will insure that:
125

3
126  purchased air shall have a certificate of analysis.
127  cylinders are tested and maintained in accordance with DOT regulations (49 CFR
128 parts 173 and 178).
129  ensure that high levels of oxygen or air containing more than 23.5% oxygen is not
130 used in compressed air systems.
131  air fittings are incompatible with all other gas fittings.
132
133 Indicate the measures to be taken to ensure that air quality is at least Grade D.
134
135 ▀ All air is purchased from an approved supplier. See List of Service Providers Best
136 Practice No. 701 for supplier.
137 ▀ The Fire Department has no air compressor to fill the air bottles.
138 ▀ The West Fire District has only one cascade system to fill SCOTT air bottles and it is
139 located at Station 1.
140 ▀ The 1 Asst Chief insures the contractor services the cascade system annually and
141 the records are given to the Chief for filing.
142 ▀ The 1 Asst. Chief gives the certificates of the air analysis to the Chief for filing.

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 RESPIRATOR INSPECTION RECORD I

SELF-CONTAINED BREATHING APPARATUS

MONTHLY CHECKLIST

RESPIRATOR TYPE: SCBA SCOTT AIR-PAK S.N. AND MODEL NO: NXG2 4.5

YEAR: INSPECTED BY:

LOCATION: West Clinton Fire District USER: West Clinton Fire Department

ITEMS CHECKED J F M A M J J A S O N D

RUBBER FACEPIECE

RUBBER HEAD HARNESS

RUBBER HOSE

AO@ RING CONNECTOR

EXHALATION VALVE

INHALATION VALVE

FACEPIECE LENS

HARNESS

BACKPACK

CLEANLINESS

INSTRUCTION SHEET

fog proof

AIR CYLINDER PRESSURE

CYLINDER VALVE

BYPASS VALVE

MAINLINE VALVE

LOW PRESSURE ALARM

REGULATOR DIAPHRAGM

REGULATOR FUNCTION

DEMAND

PRESSURE DEMAND

STORAGE BOX
Comments:
Storage ACCEPTABLE  NOT ACCEPTABLE 

All respirators must be properly stored to protect them from damage due to environmental factors (sunlight,
temperature extremes, etc.) and chemicals.

5
 1 VI. TRAINING
2
3 All employees who are required to use respiratory protection will be instructed on the proper
4 selection, use, and limitations of this equipment. This training will be provided prior to any
5 assignment requiring the use of such equipment. The training, conducted by the 1st Asst. Chief or his
6 designated person. Training may include live burns, confidence course, hands on putting on and
7 taking off the SCBA unit, changing of air bottles, classroom discussions and demonstrations, and
8 other exercises.
9
10 The 1st Asst. Chief will also include information on:
11
12  Nature of the respiratory hazard and what may happen if the respirator is not used
13 properly.
14  Engineering and administrative controls being used and the need for the respirator as
15 added protection.
16  The particular type of respirator was selected since it provides a positive pressure in
17 the facepeice in IDLH environments. Limitations of the selected respirator.
18 Methods of donning the respirator and checking the fit (negative and positive
19 checks) and operation.
20  Proper wear of the respirator. Respirator maintenance and storage.
21  Proper method for handling emergency situations including the use of two in and
22 two out protocols, and;
23  A record of employee names and dates and type of initial training and subsequent
24 refresher training will be recorded placed in the Chief’s files..
25
26 VII. Training Record
27
28 NAME:____________________________________________
29
30 TYPE OF RESPIRATOR: _____SCBA SCOTT AIR-PAK_________
31
32 DATE:_______________
33
34
35 TRAINER NAME :________________________________
36
37 COMMENTS:
38
39 ▀ There will be annual training on the use of SCBA’s.
40 ▀ See FIT Testing Best Practice No. 807 for details for annual FIT testing.
41
42 VIII. Fit Testing
43
44 It is well-recognized that no one respirator will fit every individual. Therefore, to provide the appropriate respirator, fit
45 testing will be performed to ensure a tight seal between the facepiece and wearer.
46
47 NOTE: See attached training record.
48
6
49
50
51
52
53 IX. Procedures for Proper Use of Respirators in Routine and Reasonably Foreseeable Emergency Situations:
54
55 NOTE: Appropriate procedures will be attached with this document, i.e, Accountability.

7
 TRAINING RECORD

NAME TYPE OF RESPIRATOR DATE

SCBA SCOTT AIR-PAK
SCBA SCOTT AIR-PAK
SCBA SCOTT AIR-PAK
SCBA SCOTT AIR-PAK
SCBA SCOTT AIR-PAK
SCBA SCOTT AIR-PAK
SCBA SCOTT AIR-PAK
SCBA SCOTT AIR-PAK
SCBA SCOTT AIR-PAK
SCBA SCOTT AIR-PAK
SCBA SCOTT AIR-PAK
SCBA SCOTT AIR-PAK
SCBA SCOTT AIR-PAK
SCBA SCOTT AIR-PAK
SCBA SCOTT AIR-PAK
SCBA SCOTT AIR-PAK

TRAINER NAME: _______________________________

DATE:____________

8
 RESPIRATOR FIT TEST RECORD

A) Employee: ________________________________________________________
Employee Job Title/Description: firefighter______________________________
B) Respirator Selected: __SCBA__________________________________________
Manufacturer:___SCOTT AIR-PAK_____________________________________
NIOSH Approval Number: ___NIOSH info on file___________________
Model:____NXG2 45_____________________________
Date of Purchase: _______________
C) Conditions which could Affect Respirator Fit: (Check all that apply):
Clean Shaven YES  NO 
Beard Growth YES  NO  (if beard growth is below sealing
area, fit testing not permitted)
Moustache YES  NO 
Dentures YES  NO 
Weight Loss/Gain YES  NO 
Facial Scar YES  NO 
Dentures Absent YES  NO 
Glasses YES  NO 

If any of the above interferes with the function or seal of the respirator, fit testing is not
permitted unless the condition is corrected.

Comments:

D) Qualitative Fit Testing (Check all methods used)

Isoamyl Acetate PASS  FAIL 
Irritant Smoke PASS  FAIL 
Bitrex Solution PASS  FAIL 
Saccharin Test PASS  FAIL 
Qualitative Fit Testing PASS  FAIL 

Quantitative Fit Testing

Instrument Used: __________________
Make: __________________
Model: __________________
Serial Number: __________________
Fit Factor: __________________ PASS  FAIL 
Instrument printout: YES  NO 
NOTE: If ‘Yes’ box is checked above, attach instrument printout to back of page.
Comments:

Name of Person Conducting Test:_____________________________________

Signature: _______________________________________________________
Date:___________________

9
 WORKSHEET FOR SELECTION OF RESPIRATOR

Location:__West Clinton Fire District___________

Process/Operation: __fire fighting______________

Reason for requesting respirator evaluation:

Requested by: ______________________________

I. Employee exposure evaluation:

Contaminant(s) or other respiratory hazard(s):

Estimated concentration(s):
(Reference sampling reports or show calculations as appropriate)

Chemical state of contaminant(s):

Physical form (including particle size distribution) of contaminant(s):

Appropriate exposure limit(s):

II. Respirator Determination:

Exposure is not characterized (cannot identify or reasonably estimate the employees’

exposure).

Exposure is considered IDLH. Go to Section III c.

10
 Worksheet for Selection of Respirator - III c.

III. Respirator Selection

a. Atmosphere is considered to be Immediately Dangerous to Life or Health

(IDLH) so West Clinton firefighters will use an SCBA. Respirators for IDLH
atmospheres are limited to: Indicate make, model, and approval number of the
respirator selected and indicate any limitations on its use.

NOTE: Only self-contained breathing apparatus (SCBA) with a minimum 30-

minute air supply or a full facepiece, positive-pressure supplied-air
respirator with an auxiliary air supply is acceptable.

Type of Respirator: ___SCBA__________________________

Manufacturer:_______SCOTT AIR-PAK________________

Model No.: __NXG2 4.5_30 min______________

Approval No.: ___TC-13F-517_______________

Limitations:__________________________________________

Procedures to be used for accountability (reference the appropriate section of written

respiratory protection program and/or confined space entry program and give brief
description here, or attach accountability procedures).

▀ For structure fires, there is a two-in two-out protocol with accountability tags
collected to keep information on the firefighters in the structure.
▀ For grass/brush, dumpster, and car fires, the firefighters will be in visual contact.
▀ For HAZMAT situations, there is a two firefighter group for fire fighting only if
allowed by the orange “Emergency Response Guidebook”.

Approved by the West Clinton Board of Fire Commissioners on June 2005.

11
 1 X. Medical Evaluation
2
3  Interior firefighters, some exterior firefighters, and some Rescue Squad members
4 may be assigned to tasks that require the use of SCBA’s and will have a medical
5 evaluation to determine if they are able to perform the work while wearing a
6 respirator. See Physical Policy No. 201 for the details of medical testing.
7
8  The medical evaluations will be accomplished through West Clinton’s licensed
9 health care professional (PLHCP). See List of Service Providers Best Practice No.
10 701 for details.
11
12  The evaluation will be given prior to an employee being allowed to wear a
13 respirator. Periodic examinations will be conducted as necessary based on the
14 PLHCP professional opinion(s) and any other contributing factors (i.e., change in
15 physical status, anatomy, vision, hearing, etc.).
16
17 ▀ The following is a tracking aid for the Program Administrator.
18
19 Medical Questionnaire Routing
20
21
22 Name:___________________________________________________________
23
24 Date Questionnaire Given: ________________
25
26 Date Evaluated by PLHCP: _______________
27
28 Date Referred for Physical: ________________
29
30 Results of Physical and/or Questionnaire:
31
32 Pass (Can Wear Respirator) or Fail (Restricted Duty)
33
34
35
36
37 Program Administrator: ______________________
38
39 Date:___________
40
41
42 ▀ The Program Manager will annually review the breathing testing being done
43 during physical testing for those who use SCBA’s. A written report will be given
44 to the Chief for filing and the report can also be used as the basis for amending the
45 Physical Policy No. 201.
46 XI. Program Evaluation
47
48 The PESH Respiratory Protection Standard requires the Program Manager to conduct evaluations of
49 the workplace to ensure that the written respiratory protection program is being properly
50 implemented, and to consult employees to ensure that they are using the respirators properly.
51
52 1) The Program Manager shall conduct evaluations at least yearly of the workplace as
53 necessary to ensure that the provisions of this current Best Practice written program
54 are being effectively implemented and that it continues to be effective.
55
56 2) The Program Manager shall regularly consult employees required to use respirators to
57 assess the employees= views on program effectiveness and to identify any problems.
58 Any problems that are identified during this assessment shall be corrected. Factors
59 to be assessed, include, but are not limited to:
60
61 a) Respirator fit (including ability to use the respirator without interfering with
62 effective workplace performance);
63 b) Appropriate respirator selection for the hazards to which the employee is
64 exposed;
65 c) Proper respirator use under the workplace conditions the employee
66 encounters; and
67 d) Proper respirator maintenance.
68
69 3) The Program Manager should hold a meeting(s) with the users of the SCBA to
70 determine any problems and any suggestions. A written report of the meeting can be
71 used as the basis to amend this Best Practice and any other Policies or Best Practices.
72 The written meeting report is given to the Chief for filing.
73
74 XII. Recordkeeping
75
76 This section requires the employer to establish and retain written information regarding medical
77 evaluations, fit testing, and the respirator program. The Chief places these documents in his files; air
78 quality testing certificates, FIT Testing results, and program evaluation reports from Program
79 Manager, The District Secretary places these records in the member’s personnel folder; FIT testing
80 results, and PLHCP’s summary of physical exam. West Clinton’s licensed health care professional
81 (PLHCP) will retain these records; confidential results of physical exam including SCBA breathing
82 testing.
83
84
85 This Best Practice was approved by the West Clinton Board of Fire Commissioners on August
86 14, 2013 and becomes effective on August 14, 2013. This Best Practice supersedes any previous
87 Best Practice, Standard Operating Guideline (SOG), or Standard Operating Procedures (SOP) on
88 the Respiratory Protection Program for SCBA use, inspection, and selection.
89