Medical Evaluations:
Public Health Respiratory Protection Program Template

• Persons assigned to tasks that require respiratory protection must be physically able to perform the tasks while wearing a respirator.
   
• ____________________ (example: Community Health Services Medical Consultant, occupational health physician, personal physician) will determine individual medical clearance by a medical questionnaire and/or medical exam. Employees refusing a medical evaluation will not be allowed to work in conditions requiring respirator use.
   
• Re-evaluation will be conducted under these circumstances:
  1. Employee reports physical symptoms that are related to the ability to use a respirator. (wheezing, shortness of breath, chest pain, etc.)
  2. It is identified that an employee is having a medical problem during respirator use.
  3. The health care professional performing the evaluation determines an employee needs to be re-evaluated and the frequency of the evaluation.
  4. A change occurs in the workplace conditions that may result in an increased physiological burden on the employee.
  5. Employee facial size/shape/structure has changed significantly.
• All examinations and questionnaires are to remain confidential between the employee and __________ (example: Community Health Services Medical Consultant, personal physician).

Next: Fit Testing