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Get the free Medical Clearance for Respirator use Questionnaire (.pdf) - kdheks

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To the employer: Answers to questions in Section 1, and to question 9 in Section 2 of Part A, do not require a medical examination. To the employee: Can you read (circle one): Yes/No Your employer
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Medical clearance for a respirator is a medical evaluation done to ensure an individual is fit to wear a respirator.
Employees who are required to wear a respirator as part of their job are required to file for medical clearance.
Medical clearance for a respirator can be filled out by a healthcare provider or occupational health professional.
The purpose of medical clearance for a respirator is to ensure that the individual's health condition does not pose a risk while wearing a respirator.
Medical history, physical examination results, and any restrictions or limitations related to respirator use must be reported on the medical clearance form.
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