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Appendix A Sample Medical Questionnaire taken from: Sec. 1910.134 Appendix C: OSHA Respirator Medical Evaluation Questionnaire Instructions: Please complete this form BEFORE your Respirator Fit Test
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To fill out appendix A - Medical, follow these steps:
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Start by reading the instructions provided on the form. Make sure you understand the requirements and guidelines for filling out the appendix A - Medical.
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Gather all the necessary medical information that is required to complete the form. This may include medical history, current medications, previous treatments, and any relevant test results.
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Begin by providing your personal information on the form, such as your full name, date of birth, and contact details.
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Complete the sections related to your medical history. This may involve answering questions about any chronic conditions, previous surgeries, allergies, or family medical history.
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Provide details about your current medications, including the names of the medications, dosages, and frequencies.
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If applicable, provide information about any ongoing treatments or therapies you are currently undergoing.
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Answer all the required questions honestly and accurately. If you're unsure about any information, it's important to consult with your healthcare provider for clarification.
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Depending on the specific instructions provided, you may need to submit the filled-out appendix A - Medical form to a designated authority or healthcare provider. Follow the instructions provided on where and how to submit the form.
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Remember, it is important to be thorough and truthful when filling out the appendix A - Medical form to ensure accurate assessment and appropriate medical care.

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Appendix A - Medical may be required for individuals who:
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Appendix A - Medical is a form used to report medical information.
Individuals with medical conditions or those seeking medical treatment.
Fill out the form with accurate and detailed medical information.
The purpose is to provide necessary medical information for documentation.
Medical conditions, treatments, and relevant medical history.
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