Medical Screening: Respiratory Protection

“Employer shall provide a medical evaluation to determine the employee’s ability to use a respirator, before the employee is fit tested or required to use the respirator in the workplace.”

On this page:
Components of medical evaluation
Physiologic effects of respirator use
Potential contraindications to respirator use
When to medically certify
How often should recertification be performed?
Medical recommendation forms

Components of medical evaluation

A physician or other licensed health care professional must perform the medical evaluation using OSHA’s respirator medical evaluation questionnaire or an initial medical exam that obtains the same information as the OSHA questionnaire.

• OSHA’s respirator medical evaluation questionnaire is mandatory and must be performed prior to fit testing.
  • OSHA Respirator Medical Evaluation Questionnaire (Mandatory)
    Appendix C to Respiratory Protection Standard; respirator medical evaluation questionnaire.
• Physical exam-at physician’s discretion.
  
• Chest X-ray, pulmonary function tests, EKG at physician’s discretion.

Information Needed By Physician

Information needed by physician (before or at evaluation):

• Type of respirator used
• Frequency of use
• Duration of use
• Physical demands while wearing respirator
• Environmental conditions (heat, etc.)
• Other protective equipment worn

Follow-up Physical Examination

A follow-up physical evaluation is required for anyone who gives a positive response to any question 1-8 and can be given at physician’s discretion.

• As required by initial certification
• Will include any tests the physician determines are necessary

Physician or Other Licensed Health Care Professional
An individual whose legally permitted scope of practice (i.e., license, registration, or certification) allows him/her to independently provide, or be delegated the responsibility to provide, some or all of the health care services required by paragraph (e), Medical evaluation.”

Physiologic effects of respirator use

• Pulmonary effects:
  • increased breathing resistance
  • increased work of breathing
  • decreased endurance
  • decrease in exercise performance
• Cardiac effects:
  • increased cardiac work
  • increased heart rate
  • increased blood pressure
• Claustrophobia
• Anxiety
• Hyperventilation

Potential contraindications to respirator use

• Severe pulmonary disease
• Severe cardiac disease
• Uncontrolled hypertension
• Claustrophobi
• Facial abnormalities that prevent good fit

When to medically certify

• Respirators place several physiological stresses on wearers-stresses that particularly involve the pulmonary and cardiac systems.
• Respirators typically used by health care workers are generally lightweight, and the physiological stresses they create are usually small.
• Therefore, most workers can safely wear respirators.
  
  
• Primary pre-use certification
  • Because most health care workers wear the very light, disposable half-mask respirator, CDC Guidelines recommend that a health questionnaire be the initial step in the evaluation.
  • If results from this evaluation are essentially normal, the employee can be cleared for respirator wear.
  • Further evaluation, possibly including a directed physical examination and/or spirometry, should be considered in cases in which potential problems are suggested on the basis of the questionnaire results.
    
    
• Routine periodic recertification
  • The provider may request to periodically recertify the wearer. There is no definite standard or requirement.
    
    
• Evaluation of users having problems
  • Recertification is recommended if the employee reports medical signs or symptoms related to the ability to use a respirator, the employer determines that an employee needs to be reevaluated, or a change occurs in workplace conditions that may substantially increase the physiological burden on an employee.
  • Recertification may also be necessary if information from the respirator program indicates a need.

How often should recertification be performed?

• No definite standard or requirement
• Physician discretion
• Some recommendations:
  • <35 years of age, every 4-5 years
  • 35-45 years of age, every 2 years>
  • 45 years of age, every year

Medical recommendation forms

• OSHA Respirator Medical Evaluation Questionnaire (Mandatory)
  Appendix C to Respiratory Protection Standard; respirator medical evaluation questionnaire.
  
• Respirator Medical Recommendation Form (PDF)
  This form outlines the results of the Occupational Safety and Health Administration (OSHA) Respirator Medical Evaluation and is to be filled out by a licensed medical provider based on the review of the OSHA Respirator Medical Evaluation Questionnaire (above).

Step 5: Provide Training

see also>> Medical Evaluations: Public Health Respiratory Protection Program Template