Get Section 5199 Appendix B Alternate Respirator Medical Evaluation - Dir Ca

Filling out the Section 5199 Appendix B Alternate Respirator Medical Evaluation online is a crucial step for individuals selected to use respirators for protection against infectious aerosols. This guide provides a comprehensive, step-by-step approach to ensure you complete the form accurately and efficiently.

Follow the steps to fill out the questionnaire correctly.

1. Click ‘Get Form’ button to access the questionnaire and open it in your preferred editor.
2. Provide the current date in the designated field. This helps maintain an accurate record of your submission.
3. Enter your full name as requested. Accurate identification is important for processing your evaluation.
4. Fill in your job title. This information helps in understanding the context of your respirator use.
5. Indicate your age rounded to the nearest year. This data is necessary for health and safety assessments.
6. Circle your sex as instructed. This information may assist in evaluating any related health aspects.
7. Measure and enter your height in feet and inches. Additionally, provide your weight in pounds for health evaluation.
8. Include a phone number where you can be reached, along with the area code. This ensures you can be contacted for any follow-up.
9. Specify the best time to reach you via the phone number provided. Clarity on this is beneficial for timely communication.
10. Respond to whether your employer has instructed you on contacting the health care professional. A 'Yes' or 'No' is required.
11. Check the type of respirator you will be using by selecting from the listed options, allowing multiple selections as necessary.
12. Indicate whether you have previously worn a respirator by circling 'Yes' or 'No.' If 'Yes,' specify what type(s) you have used.
13. Answer all questions in Section 2 by circling 'Yes' or 'No' as applicable. Provide details if necessary, particularly any specifics related to your health.
14. For any medications you are taking for breathing or heart issues, be sure to answer accordingly and indicate whether they are under control.
15. Sign and date the response section at the end of the form to authenticate your submission.
16. Once completed, save your changes, and download or print the form as needed. Share it with your employer or health care professional as required.

Complete your Section 5199 Appendix B Alternate Respirator Medical Evaluation online today.