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NEW MEXICO STATE UNIVERSITYRespirator Medical Evaluation Questionnaire (revised 2018) Department: Campus Phone Number: Campus Address: Supervisor Name (See memo: Program Change: New procedure for
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How to fill out respirator medical evaluation questionnaire

01
To fill out the respirator medical evaluation questionnaire, follow these steps:
02
Start by reading the entire questionnaire carefully to understand the information being requested.
03
Provide your personal information accurately, including your name, contact details, and any relevant identification numbers.
04
Answer each question honestly and to the best of your knowledge.
05
If you are unsure about any specific question, leave it blank instead of guessing.
06
Consult with a healthcare professional if you need assistance or clarification regarding any question on the questionnaire.
07
Once you have completed all the sections, review your answers to ensure they are complete and accurate.
08
Submit the filled-out questionnaire to the appropriate authority, as directed.

Who needs respirator medical evaluation questionnaire?

01
The respirator medical evaluation questionnaire is generally required for individuals who are involved in specific work environments that require the use of respiratory protection.
02
This includes but is not limited to:
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- Healthcare workers who may come into contact with airborne infectious diseases.
04
- Industrial workers who are exposed to hazardous substances and need respiratory protection.
05
- Emergency responders and firefighters who may face potential respiratory hazards.
06
- Construction workers involved in activities such as sanding, painting, or working with chemicals.
07
Ultimately, anyone who is required to wear a respirator at their workplace should complete a respirator medical evaluation questionnaire to ensure their health and safety.
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