need to be medically cleared to wear respirators before commencing use. All respirators
generally place a burden on the employee. Negative pressure respirators restrict
breathing, some respirators can cause claustrophobia and self-contained breathing
apparatuses are heavy. Each of these conditions may adversely affect the health of some
employees who wear respirators. A physician or other licensed health care professional
operating within the scope of his/her practice needs to medically evaluate employees to
determine under what conditions they can safely wear respirators.
1910.134(e). Medical Evaluation.
1910.134 Appendix C. OSHA Respirator Medical Evaluation Questionnaire (Mandatory).
(e) Medical evaluation. Using a respirator may place a physiological burden on employees that varies with the type of respirator worn, the job and workplace conditions in which the respirator is used, and the medical status of the employee. Accordingly, this paragraph specifies the minimum requirements for medical evaluation that employers must implement to determine the employee's ability to use a respirator.
(e)(1) General. The employer shall provide a medical evaluation to determine the employee's ability to use a respirator, before the employee is fit tested or required to use the respirator in the workplace. The employer may discontinue an employee's medical evaluations when the employee is no longer required to use a respirator.
(e)(2)(i) The employer shall identify a physician or other licensed health care professional (PLHCP) to perform medical evaluations using a medical questionnaire or an initial medical examination that obtains the same information as the medical questionnaire.
(e)(3)(i) The employer shall ensure that a follow-up medical examination is provided for an employee who gives a positive response to any question among questions 1 through 8 in Section 2, Part A of Appendix C or whose initial medical examination demonstrates the need for a follow-up medical examination.
(e)(4)(i) The medical questionnaire and examinations shall be administered confidentially during the employee's normal working hours or at a time and place convenient to the employee. The medical questionnaire shall be administered in a manner that ensures that the employee understands its content.
(e)(5)(ii) Any supplemental information provided previously to the PLHCP regarding an employee need not be provided for a subsequent medical evaluation if the information and the PLHCP remain the same.
(e)(5)(iii) The employer shall provide the PLHCP with a copy of the written respiratory protection program and a copy of this section. Note to Paragraph (e)(5)(iii): When the employer replaces a PLHCP, the employer must ensure that the new PLHCP obtains this information, either by providing the documents directly to the PLHCP or having the documents transferred from the former PLHCP to the new PLHCP. However, OSHA does not expect employers to have employees medically reevaluated solely because a new PLHCP has been selected.
(e)(6)(i)(A) Any limitations on respirator use related to the medical condition of the employee, or relating to the workplace conditions in which the respirator will be used, including whether or not the employee is medically able to use the respirator;
(e)(6)(ii) If the respirator is a negative pressure respirator and the PLHCP finds a medical condition that may place the employee's health at increased risk if the respirator is used, the employer shall provide a PAPR if the PLHCP's medical evaluation finds that the employee can use such a respirator; if a subsequent medical evaluation finds that the employee is medically able to use a negative pressure respirator, then the employer is no longer required to provide a PAPR.
(e)(7)(iv) A change occurs in workplace conditions
(e.g., physical work effort, protective clothing, temperature) that may result in a
substantial increase in the physiological burden placed on an employee.
Appendix C to Sec. 1910.134: OSHA Respirator Medical Evaluation Questionnaire (Mandatory)
To the employer: Answers to questions in Section 1, and to question 9 in Section 2 of Part A, do not require a medical examination.
To the employee:
Can you read (circle one): Yes/No
Your employer must allow you to answer this questionnaire during normal working hours, or at a time and place that is convenient to you. To maintain your confidentiality, your employer or supervisor must not look at or review your answers, and your employer must tell you how to deliver or send this questionnaire to the health care professional who will review it.
Part A. Section 1. (Mandatory) The following information must be provided by every
employee who has been selected to use any type of respirator (please print).
2. Your name:__________________________________________________________
3. Your age (to nearest year):_________________________________________
4. Sex (circle one): Male/Female
5. Your height: __________ ft. __________ in.
6. Your weight: ____________ lbs.
7. Your job title:_____________________________________________________
8. A phone number where you can be reached by the health care professional who reviews this questionnaire (include the Area Code): ____________________
9. The best time to phone you at this number: ________________
10. Has your employer told you how to contact the health care professional who will review this questionnaire (circle one): Yes/No
11. Check the type of respirator you will use (you can check more than one category):
12. Have you worn a respirator (circle one): Yes/No
If "yes," what type(s):____________________________________________ _____________________________________________________________________
Part A. Section 2. (Mandatory) Questions 1 through 9 below must be answered by every employee who has been selected to use any type of respirator (please circle "yes" or "no").
1. Do you currently smoke tobacco, or have you smoked tobacco in the last month: Yes/No
2. Have you ever had any of the following conditions?
3. Have you ever had any of the following pulmonary or lung problems?
4. Do you currently have any of the following symptoms of pulmonary or lung
5. Have you ever had any of the following cardiovascular or heart problems?
6. Have you ever had any of the following cardiovascular or heart symptoms?
7. Do you currently take medication for any of the following problems?
8. If you've used a respirator, have you ever had any of the following problems?
(If you've never used a respirator, check the following space and go to question 9:)
9. Would you like to talk to the health care professional who will review this questionnaire about your answers to this questionnaire: Yes/No
Questions 10 to 15 below must be answered by every employee who has been selected to use either a full-facepiece respirator or a self-contained breathing apparatus (SCBA). For employees who have been selected to use other types of respirators, answering these questions is voluntary.
10. Have you ever lost vision in either eye (temporarily or permanently): Yes/No
11. Do you currently have any of the following vision problems?
12. Have you ever had an injury to your ears, including a broken ear drum: Yes/No
13. Do you currently have any of the following hearing problems?
14. Have you ever had a back injury: Yes/No
15. Do you currently have any of the following musculoskeletal problems?
Part B Any of the following questions, and other questions not listed, may be added to the questionnaire at the discretion of the health care professional who will review the questionnaire.
1. In your present job, are you working at high altitudes (over 5,000 feet) or in a
place that has lower than normal amounts of oxygen: Yes/No
2. At work or at home, have you ever been exposed to hazardous solvents, hazardous
airborne chemicals (e.g., gases, fumes, or dust), or have you come into skin contact with
hazardous chemicals: Yes/No
3. Have you ever worked with any of the materials, or under any of the conditions,
4. List any second jobs or side businesses you have:___________________ _______________________________________________________________________
5. List your previous occupations:_____________________________________ _______________________________________________________________________
6. List your current and previous hobbies:________________________________ _______________________________________________________________________
7. Have you been in the military services? Yes/No
8. Have you ever worked on a HAZMAT team? Yes/No
9. Other than medications for breathing and lung problems, heart trouble, blood
pressure, and seizures mentioned earlier in this questionnaire, are you taking any other
medications for any reason (including over-the-counter medications): Yes/No
10. Will you be using any of the following items with your respirator(s)?
11. How often are you expected to use the respirator(s) (circle "yes" or
"no" for all answers that apply to you)?:
12. During the period you are using the respirator(s), is your work effort:
b. Moderate (200 to 350 kcal per hour): Yes/No
c. Heavy (above 350 kcal per hour): Yes/No
13. Will you be wearing protective clothing and/or equipment (other than the
respirator) when you're using your respirator: Yes/No
14. Will you be working under hot conditions (temperature exceeding 77 deg. F): Yes/No
15. Will you be working under humid conditions: Yes/No
16. Describe the work you'll be doing while you're using your respirator(s):
17. Describe any special or hazardous conditions you might encounter when you're using
your respirator(s) (for example, confined spaces, life-threatening gases):
18. Provide the following information, if you know it, for each toxic substance that
you'll be exposed to when you're using your respirator(s):
19. Describe any special responsibilities you'll have while using your respirator(s)
that may affect the safety and well-being of others (for example, rescue, security):