The Washington State Department of Health (DOH) Mobile Respirator Fit Testing Program

Information, Appointment Scheduling and Pre-Fit Testing Requirements

This appointment registration page is only for facilities that are approved to receive service through the WA Department of Health N95 Mobile Fit Testing project.

  • Assisted Living Facilities
  • Skilled Nursing Facilities/Nursing Homes
  • Adult Family Homes
  • Supported Living Agencies
  • Home Care Agencies
  • Home Health Agencies
  • Hospice Agencies

Do not use this form if you are not a provider as listed above

FitTestingContractorsMap_C4PA_v3

If you have been approved; Northwest Response is only serving sites that are within the counties in BROWN.

Callam, Jefferson, Grays Harbor, Mason, Kitsap, Thurston, King, Pierce Counties.

COVID-19 STAY AT HOME

Dear Provider,

You have been directed to this page in order to schedule Respirator Fit Testing, and to complete Respiratory Medical Clearances for you and your staff who will be wearing N95 Respirators due to the COVID-19 Pandemic.

Please read the following guidance, and follow the instructions for requesting an appointment very carefully.

There are Three (3) Parts to Prepare for Fit Testing. 

Facility Information

Medical Clearances

Video

At the bottom of this page you will provide us with the information about your facility.

When you schedule your appointment, you will enter the First Name  & Last Names of all staff needing to be fit tested.

Please have your staff watch this  video

When you complete the appointment form below, you will receive a "checklist" of items that must be completed before we can conduct any fit tests.

These are the three biggest challenges to fit testing that may lead to a failed test.

    • Beards that interfere with the seal of the Respirator.
      We will not fit test persons with beards, or facial hair that interferes with the seal of the Respirator. No exceptions for any reason.
      This is an OSHA Federal Regulation and Washington State L&I Regulation.
    • Do you have staff where English is a second language with very little English comprehension?
      You must provide English to Native language translation.
    • Failure to complete the 3M Medical Evaluations.

Note: If anyone on your staff fails to complete the 3M Medical Evaluations on fit testing date, they will not be fit tested.

Below is the form to request a
Fit Test Appointment.

This form is only for persons directed here by Washington State DOH.

When you request an appointment for fit testing we will get back to you as soon as possible.  Wait times are 72 hours for a response, and up to 30 days for an appointment.

We are processing over 280 requests at this time. Please be patient.

Fill out the form (below) exactly as directed or the request will be deleted, and you will need to start over.

Important Notes:

This form is only for those facilities that qualify for the free WA DOH Mobile Fit Testing Program.

 

Please.
Do not send a second request using this form.  This form is for new request only.
To update your readiness status use this link> https://northwestresponse.com/fit-testing-status/

Who Should Be Fit Tested:

Only Fit Test personnel who are at risk.

The Check List:

When you submit this form you will get a reply from us with a checklist. There is also a button link to the checklist below. You must download the checklist to prepare for our visit.

Failure to comply with the terms as outlined in the checklist may result in your site visit being cancelled by our fit testing technician.

Northwest Response has a zero tolerance policy for facilities being unprepared for the appointed fit test date and time. Facilities that are unprepared for the fit test visit will not be eligible for a second visit for a period of 90 days.

When you have completed the Medical evaluations, and you are ready to comply with the terms of service outlined in the check list visit the link below.
https://northwestresponse.com/fit-testing-status/  Bookmark this link

Revisits: 
If we have been to your facility in the past 90 days, we cannot schedule you until we have scheduled those facilities that have not yet been seen.

If you do not see the form below it is because you are using a browser that is no longer supported, specifically Internet Explorer.

Please use Safari, Chrome or Firefox to view the appointment request form.