Ehs 701 8 2025

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The document is a medical assessment form for respirator use issued by the NYS Department of Civil Service. It requires employees to provide personal and health information to evaluate their fitness for using various types of respirators. The form includes mandatory questions about respiratory, cardiovascular, and other health conditions, as well as details about the employee's job duties and potential exposure to hazardous materials. The purpose is to ensure safety and compliance with health regulations.

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Click ‘Get Form’ to open the ehs 701 8 document in the editor.
Begin by filling out the 'Agency Requesting Medical Assessment' section. Enter your agency name, address, contact name, agency code, and telephone numbers as required.
Proceed to 'Part A', Section 1. Here, provide mandatory employee information including today's date, weight, height, job title, and contact details. Ensure all fields are completed accurately.
Answer the questions regarding your respirator use in Section 2. Check 'YES' or 'NO' for each question and provide explanations where necessary.
In Section 3, answer any additional questions related to full-facepiece respirators or SCBA usage. This section is crucial for ensuring safety during respirator use.
Complete Part B if applicable, detailing exposure to hazardous materials and any special conditions you may encounter while using a respirator.
Finally, review all entries for accuracy before signing at the bottom of the form. Use our platform's features to save or print your completed document.

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