OSHA Respiratory Medical Evaluation Questionnaire 2025

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  1. Click ‘Get Form’ to open the OSHA Respiratory Medical Evaluation Questionnaire in our editor.
  2. Begin with Section 1, where you must provide your personal information. Fill in today's date, your name, age, sex, height, weight, job title, and contact number for the health care professional.
  3. In Section 2, answer questions regarding your smoking history and any respiratory or cardiovascular conditions. Circle 'Yes' or 'No' as applicable.
  4. Continue through the questionnaire by responding to each question about your health history and any previous experiences with respirators. Ensure all mandatory fields are completed.
  5. Once finished, review your answers for accuracy. Use our platform's editing tools to make any necessary adjustments before finalizing.
  6. Sign and date the form at the end. You can then save or send it directly from our editor to maintain confidentiality.

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The employer must identify a physician or other licensed health care professional (PLHCP) to perform all medical evaluations using the medical questionnaire in Appendix C of the Respiratory Protection standard or a medical examination that obtains the same information.
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.
Before wearing a respirator, workers must first be medically evaluated using the mandatory medical questionnaire or an equivalent method.
The employer shall provide a medical evaluation to determine the employees ability to use a respirator, before the employee is fit tested or required to use the respirator in the workplace. The employer may discontinue an employees medical evaluations when the employee is no longer required to use a respirator.
The employer shall provide respirators, training, and medical evaluations at no cost to the employee. Selection of respirators. This paragraph requires the employer to evaluate respiratory hazard(s) in the workplace, identify relevant workplace and user factors, and base respirator selection on these factors.
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