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Click ‘Get Form’ to open the Medical Screening: Respiratory Protection form in the editor.
Begin by filling out your personal information, including your name, job title, and contact details. Ensure that you print clearly for legibility.
In Part 1, provide your background information such as gender, date of birth, height, and weight. This section is crucial for assessing your respiratory health.
Proceed to Part 2 and answer all health-related questions honestly. Indicate 'Yes' or 'No' for each condition listed to ensure accurate evaluation.
If applicable, complete Part 3 regarding additional questions for users of specific respirators. This helps in understanding any unique needs you may have.
Finally, review all entries for accuracy before signing and dating the form at the bottom. Your signature validates the information provided.

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What disqualifies you from wearing a respirator?

The individuals who can perform respirator fit tests generally fall into a few categories: Occupational Health and Safety Personnel. Role: These professionals are often part of an organizations health and safety team. Certified Fit Testing Administrators. Industrial Hygienists. Safety Officers and Managers.

What is included in the respiratory protection program?

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.

How often is respirator medical evaluation required?

At a minimum the employer must provide additional evaluations if an employee shows signs or symptoms that are related to their ability to wear a respirator. There is not a specific annual requirement for medical evaluations in the standard.

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Medical Screening: Respiratory Protection - Minnesota Dept 2025

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What disqualifies you from wearing a respirator?

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