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Respirator medical appendix c 2026

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The document is a Respirator Medical Evaluation Questionnaire provided by the Rochester Institute of Technology, designed for employees selected to use various types of respirators. It includes mandatory sections for personal information, medical history, and potential respiratory or cardiovascular issues. The questionnaire aims to assess the employee's fitness for respirator use while ensuring confidentiality and compliance with OSHA regulations.

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Click ‘Get Form’ to open the respirator medical appendix c in the editor.
Begin with Part A, Section 1. Fill in today's date, your name, date of birth, sex, height, weight, job title/department name, and a contact phone number for the health care professional.
Answer question 9 regarding employer communication about contacting the health care professional. Then check the type of respirator you will use.
Proceed to Part A, Section 2. Answer questions 1 through 9 regarding your smoking history and any pulmonary or cardiovascular conditions.
Continue answering questions related to any previous injuries or symptoms that may affect your ability to use a respirator.
Complete any additional questions in Part B as necessary based on your work environment and exposure risks.
Once all sections are filled out accurately, review your answers for completeness before submitting the form via email as instructed.

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What disqualifies you from wearing a respirator?

People with claustrophobia may not be able to wear a full facepiece or hooded respirator. People with vision problems may have trouble seeing while wearing a mask or hood (there are special masks for people who need glasses). Employees must be medically evaluated before assigned to use a respirator.

What is included in a respirator fit test?

Fit testing uses a test agent, either qualitatively detected by the wearers sense of taste, smell, or involuntary cough (irritant smoke) or quantitatively measured by an instrument, to verify the respirators fit.

What part of the OSHA respirator medical evaluation is mandatory?

Section 2. (Mandatory) Questions 1 through 9 below must be answered by every employee who has been selected to use any type of respirator (please circle yes or no). 1. Do you currently smoke tobacco, or have you smoked tobacco in the last month?

What is a medical evaluation for a respirator?

A physician or other licensed health care provider (PLHCP) reviews the questionnaire responses to determine if the employee has any symptoms or conditions that could undermine the effectiveness of a respirator. A follow-up medical exam and testing may also be performed before rendering a final decision.

What does a respirator medical evaluation consist of?

This information includes: the type and weight of the respirator to be used by the employee; the duration and frequency of respirator use; the expected physical work effort; additional protective clothing and equipment to be worn; and the temperature and humidity extremes that may be encountered.

osha respiratory evaluation form

Respirator Medical Evaluation Questionnaire PDF OSHA respirator medical evaluation requirements OSHA respirator Medical Evaluation Questionnaire OSHA Respirator Medical Evaluation Questionnaire Appendix C OSHA Respirator Medical clearance Form appendix c to § 1910.134: osha respirator medical evaluation questionnaire (mandatory) Respirator medical evaluation online OSHA respirator Medical Evaluation Questionnaire Word document

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How much does a respirator medical evaluation cost?

Online Respirator Medical Evaluations It costs only $29 per person and, theres no minimum order or hidden costs.

What type of respirator is required for Level C?

Level C PPE Ensemble Elements Respiratory Protection Full-face or half-mask, negative pressure air purifying respirator (APR) Escape Mask1 Clothing Hooded chemical-resistant clothing Overalls Two-piece chemical splash suit Disposable chemical-resistant overalls Chemical-resistant inner suit (e.g., Tyvek coveralls)17 more rows

Respirator medical appendix c 2026

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What disqualifies you from wearing a respirator?

What is included in a respirator fit test?

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What is a medical evaluation for a respirator?

What does a respirator medical evaluation consist of?

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