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  • Osha Respirator Medical Evaluation Questionnaire - Hvfd.com

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OSHA RESPIRATOR MEDICAL EVALUATION QUESTIONNAIRE Date: Age: Sex: Chart #: SSN: Name: ID # Employer Name: Job Title: Department: TO THE EMPLOYER Answer to questions in Section 1, and to question 9.

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Medical evaluations are required even for voluntary respirator usage in the workplace. The only exception is for voluntary use of disposable filtering facepiece respirators – in which case 3M still recommends having workers undergo the medical evaluation.

The medical evaluation section of OSHA's Respiratory Protection standard, 1910.134(e), states that the employer will determine each employee's fitness to wear a respirator by way of either the administration of a medical questionnaire (Appendix C of the standard), or a physical examination that elicits the same ...

Respirator medical evaluations are designed to ensure employees exposed to respirable toxins are properly protected. The results of the respirator medical evaluation also help employers make informed decisions about which employees can use respirators under specific environmental conditions and physical demands.

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.

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. Once filled out, this form must be given to the PLHCP.

George's Respiratory Questionnaire (SGRQ) Type of questionnaire-description. Disease-specific instrument designed to measure impact on overall health, daily life, and perceived well-being in patients with obstructive airways disease.

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?

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.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232