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Osha respirator medical evaluation questionnaire word document

Osha respirator medical evaluation questionnaire fillable 2026

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The document is an OSHA Mandatory Respiratory Questionnaire designed for employees selected to use respirators. It includes sections for personal information, medical history, and specific questions regarding respiratory and cardiovascular health. 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 OSHA Respirator Medical Evaluation Questionnaire in our editor.
Begin with Part A, Section 1. Fill in your employer's name, today's date, and your personal information including name, social security number, address, and contact numbers.
Continue by providing your date of birth, sex, height, weight, job title, and a reachable phone number for the health care professional.
In Section 2 of Part A, answer all mandatory questions regarding your smoking history and any respiratory or cardiovascular conditions you may have experienced.
Complete any additional questions related to previous occupations or hazardous exposures in Part B. Ensure all answers are accurate for proper evaluation.

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What are OSHAs two checks for wearing a respirator?

∎ Paragraph (a)(2) requires employers to provide employees with respirators that are applicable and suitable for the purpose intended when such equipment is necessary to protect the health of the employee. This paragraph contains definitions of important terms used in the regulatory text.

What needs to be checked when inspecting a respirator?

Examine air-purifying elements for: Correct cartridge, canister, or filter. Correct/incorrect installation, loose connections, missing or worn gaskets, or cross-threading in holder.

What are the two types of respirator protection?

There are two main types of respiratory protectionair-purifying respirators (APRs) and atmosphere-supplying respirators (ASRs). Each respirator type provides a different level of protection based on its design.

Does OSHA require an annual medical evaluation of a respirator?

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.

What are the two kinds of respirator fit checks?

There are two types of fit tests: qualitative and quantitative. Qualitative fit testing is a pass/fail test method that uses your sense of taste or smell, or your reaction to an irritant in order to detect leakage into the respirator facepiece. Qualitative fit testing does not measure the actual amount of leakage.

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What are the two quick checks for wearing a respirator?

User Seal Checks A user seal check is a quick procedure you conduct every time you wear a respirator to make sure you donned the respirator properly. The user seal check can be either a positive pressure or negative pressure check. The appropriate type of user seal check depends on the respirator.