Get the free Respirator Medical Evaluation Questionnaire - nmsu

This questionnaire is used to evaluate the medical fitness of employees selected to use respirators, as part of the Respiratory Safety Program at New Mexico State University, ensuring compliance with

How to fill out respirator medical evaluation questionnaire

How to fill out Respirator Medical Evaluation Questionnaire

1. Obtain the Respirator Medical Evaluation Questionnaire form from your employer or safety office.
2. Fill out personal information including your name, date, and contact details at the top of the form.
3. Answer each question honestly, including any medical history, current medications, and respiratory issues.
4. Complete the sections regarding your occupation and how often you use a respirator.
5. Provide information about any previous respirator use and any symptoms you experience while wearing a respirator.
6. Review your answers to ensure all information is accurate and complete.
7. Sign and date the questionnaire at the bottom.
8. Submit the completed questionnaire to the designated health professional or employer as instructed.

Who needs Respirator Medical Evaluation Questionnaire?

1. Employees who are required to use respirators as part of their job to protect against airborne contaminants.
2. Individuals who have a history of respiratory conditions or other health issues that may be affected by respirator use.
3. Workers in industries such as construction, manufacturing, or healthcare where respirators are mandated.
4. Anyone who has been advised by a health professional to complete a medical evaluation for respirator use.

People Also Ask about

How much does the 3M respirator medical evaluation cost?

Sign up, take the questionnaire, and get instant results with the 3M Online Respirator Medical Evaluation Service. It costs only $29 per person (and you can create up to seven different respirator profiles) – and, there's no minimum orders or hidden costs.

What is a respirator medical evaluation questionnaire?

A respirator medical evaluation is a health assessment that determines if an employee is medically fit to wear a respirator on the job.

How much does respirator fit testing cost?

Answer: The respiratory protection standard requires an initial 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.

Do you need a medical evaluation to use a respirator?

Respirator Clearance (OSHA 1910.134) This medical evaluation should occur prior to the employee being allowed to wear a respirator. A respirator clearance only clears the employee to wear a respirator and the general type of respirator they can use. It does not medically clear an officer for duty.

How often is an OSHA respirator questionnaire 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.

What disqualifies you from wearing a respirator?

Facial deformities and facial hair, where the respirator forms a seal to the face; 2. Perforated tympanic membranes; 3. Respiratory diseases affecting pulmonary function; 4. Symptomatic coronary artery disease, significant arrhythmias, or history of recent myocardial infarction; 5.

How much does a respirator medical evaluation cost?

Sign up, take the questionnaire, and get instant results with the 3M Online Respirator Medical Evaluation Service. It costs only $29 per person (and you can create up to seven different respirator profiles) – and, there's no minimum orders or hidden costs. Create an account.

For pdfFiller’s FAQs

What is Respirator Medical Evaluation Questionnaire?

The Respirator Medical Evaluation Questionnaire is a form used to assess an individual's medical fitness for wearing a respirator. It evaluates respiratory health, history of medical conditions, and any other factors that could affect the safe use of respiratory protection.

Who is required to file Respirator Medical Evaluation Questionnaire?

Employees who are required to wear respirators as part of their job duties must complete the Respirator Medical Evaluation Questionnaire to ensure they are medically able to safely use the equipment.

How to fill out Respirator Medical Evaluation Questionnaire?

To fill out the Respirator Medical Evaluation Questionnaire, individuals should carefully read each question and provide truthful and accurate responses regarding their health history, any current medical conditions, and details related to their respiratory health.

What is the purpose of Respirator Medical Evaluation Questionnaire?

The purpose of the Respirator Medical Evaluation Questionnaire is to identify any potential health concerns that may prevent an individual from safely using a respirator, thus ensuring the safety and effectiveness of respiratory protection measures.

What information must be reported on Respirator Medical Evaluation Questionnaire?

The Respirator Medical Evaluation Questionnaire requires reporting of personal health information, including but not limited to respiratory and cardiovascular health, history of lung disease, medications being taken, symptoms of respiratory issues, and any previous experiences with respirators.