Voluntary Use Respirator Request Form - Risk Management 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin with Section 1, Employee Certification. Fill in your name and specify the contaminants for which you wish to use a respirator. Clearly list the associated tasks, ensuring you detail each task accurately.
  3. Sign and date the form at the bottom of Section 1. Also, include your department and building information.
  4. Proceed to Section 2, Supervisor Certification. Your supervisor must sign and date this section, along with their printed name and contact information.
  5. Leave Section 3 blank; this will be completed by the program administrator after submission.
  6. Once all sections are filled out, save your document and submit it as instructed to the Respiratory Protection Program Administrator.

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While theres not a written respiratory program requirement for voluntary filtering respirator use, your employee must ensure their respirator is appropriately maintained, cleaned and stored. This will prevent health issues, interference with ability to perform on the job and future health hazards.
If respiratory protection is not required, but employees voluntarily choose to use their own or employer-provided respiratory protection, even when such protection is not mandated, the employer is NOT required to have a full Respiratory Protection Program as indicated, but must still ensure that the employees are
In general, Appendix D advises you: to read and follow the manufacturers instructions provided with the respirator. to choose respirators that have been certified by NIOSH for protection against the contaminant of concern; to keep track of your respirator so that you do not use someone elses respirator by mistake; and.
If employers allow the voluntary use of elastomeric facepiece and powered air-purifying respirators (after determining that such use will not itself create a hazard), the employer must implement the elements of a written respiratory protection program necessary to ensure that employees voluntarily using such
Medical evaluations are required even for voluntary respirator usage in the workplace.

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