Instructions for N95 Mask Fitting

Nursing students who need to be fitted for an N95 mask are required to:

  • Obtain a Student Information Form from their clinical faculty member.This form must be completed and signed by the clinical faculty of record.
  • Complete student information in the upper section of the PLHCP Written Statement for Respirators 
  • Fill out the Respirator Medical Questionnaire. Please write your name on EACH page. 
  • Return all forms to Cindy Medakovic, BH 371.
  • Once the questionnaire is reviewed by Dr. Smith at the Student Health Center, the written statement will be returned to the School of Nursing. The student must pick up this statement at the School of Nursing before going for mask fitting.
  • Students must bring Written Statement to agency (eg. Concentra) for mask fitting, or make an appointment with their health care provider if specified by Dr. Smith.
  • Submit a copy of your verification of mask fitting to the School of Nursing, Attention: Cindy Medakovic