Respirator Evaluation Questionnaire

Appendix C of 29 CFR 1910.143 provides the document titled OSHA Respirator Medical Evaluation Questionnaire (Mandatory).

In the following slides, you will look at this questionnaire in detail. Doing so will give you an idea of what medical professionals specifically look for when it comes to evaluating employees for respirator use.

There are a few things you should note before reading the details of this questionnaire:

• Answers to Section 1 and Question 9 of Section 2 do not require a medical examination.
• Employers should also note the following instructions, which are at the beginning of the form: "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."

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