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Appendix C to Sec. 1910.134: OSHA Respirator Medical Evaluation Questionnaire (Mandatory) To employer: Answers to questions in Section 1, and to question 9 in Section 2 of Part A, don require a medical.

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This guide provides detailed instructions on how to efficiently complete the Resp. Med. Eval..doc online. Users will find step-by-step information tailored to support their experience in filling out this mandatory medical evaluation questionnaire.

Follow the steps to complete your questionnaire online.

  1. Click ‘Get Form’ button to obtain the form and open it in the editor.
  2. Begin with Part A, Section 1. Fill in today's date, your name, age, sex, height, weight, job title, a reachable phone number, and the best time for the health care professional to contact you.
  3. Confirm whether your employer has provided information on how to reach the health care professional.
  4. Select the type of respirator you will use. You can check more than one option as applicable.
  5. Answer whether you have previously worn a respirator, and if so, specify the type.
  6. Proceed to Part A, Section 2. Answer all questions 1-9, circling 'yes' or 'no' as appropriate.
  7. For questions regarding smoking, lung and cardiovascular health, respond truthfully to ensure an accurate evaluation.
  8. Complete the questions related to your ability to use a respirator and any previous issues encountered while using one.
  9. Continue to respond to additional voluntary questions if you are using a full-facepiece respirator or SCBA.
  10. Review all fields to ensure accuracy, then save your changes, and choose to download, print, or share the completed form as necessary.

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Medical Evaluations for Respirator Usage People with underlying medical conditions may put themselves at risk if they work while wearing one. So the Occupational Safety and Health Administration (OSHA) requires medical evaluation before any employee can even be fit-tested for — let alone wear — a respirator.

The employer must identify a physician or other licensed health care professional (PLHCP) to perform all medical evaluations using the medical questionnaire in Appendix C of the Respiratory Protection standard or a medical examination that obtains the same information. (See Paragraph (e)(2)(i).)

Voluntary use of a filtering facepiece respirator does not require medical evaluation.

Fit testing is required before any employee wears a respirator. A fit test allows an employee to select a respirator based on comfort, making sure the respirator fits correctly on his or her face.

Medical Evaluations for Respirator Usage People with underlying medical conditions may put themselves at risk if they work while wearing one. So the Occupational Safety and Health Administration (OSHA) requires medical evaluation before any employee can even be fit-tested for — let alone wear — a respirator.

Respirator Clearance (OSHA 1910.134) From a medical standpoint, all respirator-wearing personnel shall have a medical evaluation, provided by the department, to determine the employee's ability to use a respirator. This medical evaluation should occur prior to the employee being allowed to wear a respirator.

Answer: The respiratory protection standard requires an initial 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.

A respirator medical evaluation is a health assessment that determines if an employee is medically fit to wear a respirator on the job.

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