Permit Request • CampusOptics

Please complete all fields to request Risk Management | Occupational Safety to complete a fit test. A separate submission for each person is required. You will need the make, model and size of your respirator. If this request is approved you will receive instructions on the next steps by email.

Requester Info

Email Address* Required

Phone Number* Required

First Name* Required

Last Name* Required

Permit Date & Time

Start Date* Required

Start Time* Required

Expiration Date

Expiration Time

Location

Name* Required

Additional Location Details

Basic Information

Please enter the UNT email address of the individual to be fit tested.* Required

Department * Required

Supervisor* Required

Do you currently have the respirator you will be using?* Required

What will you be exposed to when using this respirator?* Required

Please provide the Make, Model and size of your respirator* Required

You will be required to be clean shaven for the fit test, is that acceptable to you?* Required

Add Supporting Documents

Add files to upload as supporting documentation along with your permit request.

Files

Requester Info

Permit Date & Time

Location

Basic Information More information

Add Supporting Documents

Basic Information