OSHA Respirator Medical Evaluation - Initial

  • Information
  • Part A. Section 1.
  • Part A. Section 2.
  • Complete
Answers to questions in Section 1, and to questions 9 is Section 2 of Part A, do not require a medical examination. However, certain responses, or patterns of response, may lead to reviewer to request further information, or a medical examination, in order to reach a conclusion regarding the employee's ability to safely use a respirator.
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 healthcare professional who will review it.