1910.134(e): Respirator medical evaluation

(e) Medical evaluation. Using a respirator may place a physiological burden on employees that varies with the type of respirator worn, the job and workplace conditions in which the respirator is used, and the medical status of the employee. Accordingly, this paragraph specifies the minimum requirements for medical evaluation that employers must implement to determine the employee's ability to use a respirator. 2,653 citations

(1) General. The employer shall provide a 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. The employer may discontinue an employee's medical evaluations when the employee is no longer required to use a respirator. Open (e)(1) 2,526 citations

(2) Medical evaluation procedures. Open (e)(2) 22 citations

(i) The employer shall identify a physician or other licensed health care professional (PLHCP) to perform medical evaluations using a medical questionnaire or an initial medical examination that obtains the same information as the medical questionnaire. Open (e)(2)(i) 17 citations

(ii) The medical evaluation shall obtain the information requested by the questionnaire in Sections 1 and 2, part A of appendix C of this section. 5 citations

(3) Follow-up medical examination. Open (e)(3) 5 citations

(i) The employer shall ensure that a follow-up medical examination is provided for an employee who gives a positive response to any question among questions 1 through 8 in Section 2, part A of appendix C or whose initial medical examination demonstrates the need for a follow-up medical examination. 5 citations

(ii) The follow-up medical examination shall include any medical tests, consultations, or diagnostic procedures that the PLHCP deems necessary to make a final determination.

(4) Administration of the medical questionnaire and examinations. Open (e)(4) 19 citations

(i) The medical questionnaire and examinations shall be administered confidentially during the employee's normal working hours or at a time and place convenient to the employee. The medical questionnaire shall be administered in a manner that ensures that the employee understands its content. Open (e)(4)(i) 16 citations

(ii) The employer shall provide the employee with an opportunity to discuss the questionnaire and examination results with the PLHCP. 3 citations

(5) Supplemental information for the PLHCP. Open (e)(5) 10 citations

(i) The following information must be provided to the PLHCP before the PLHCP makes a recommendation concerning an employee's ability to use a respirator: Open (e)(5)(i) 6 citations

(A) The type and weight of the respirator to be used by the employee; 2 citations

(B) The duration and frequency of respirator use (including use for rescue and escape);

(C) The expected physical work effort; 1 citations

(D) Additional protective clothing and equipment to be worn; and

(E) Temperature and humidity extremes that may be encountered.

(ii) Any supplemental information provided previously to the PLHCP regarding an employee need not be provided for a subsequent medical evaluation if the information and the PLHCP remain the same.

(iii) The employer shall provide the PLHCP with a copy of the written respiratory protection program and a copy of this section. Open (e)(5)(iii) 4 citations

When the employer replaces a PLHCP, the employer must ensure that the new PLHCP obtains this information, either by providing the documents directly to the PLHCP or having the documents transferred from the former PLHCP to the new PLHCP. However, OSHA does not expect employers to have employees medically reevaluated solely because a new PLHCP has been selected.

(6) Medical determination. In determining the employee's ability to use a respirator, the employer shall: Open (e)(6) 52 citations

(i) Obtain a written recommendation regarding the employee's ability to use the respirator from the PLHCP. The recommendation shall provide only the following information: Open (e)(6)(i) 52 citations

(A) Any limitations on respirator use related to the medical condition of the employee, or relating to the workplace conditions in which the respirator will be used, including whether or not the employee is medically able to use the respirator; Open (e)(6)(i)(a)

(B) The need, if any, for follow-up medical evaluations; and Open (e)(6)(i)(b) 1 citations

(C) A statement that the PLHCP has provided the employee with a copy of the PLHCP's written recommendation. 3 citations

(ii) If the respirator is a negative pressure respirator and the PLHCP finds a medical condition that may place the employee's health at increased risk if the respirator is used, the employer shall provide a PAPR if the PLHCP's medical evaluation finds that the employee can use such a respirator; if a subsequent medical evaluation finds that the employee is medically able to use a negative pressure respirator, then the employer is no longer required to provide a PAPR.

(7) Additional medical evaluations. At a minimum, the employer shall provide additional medical evaluations that comply with the requirements of this section if: Open (e)(7) 17 citations

(i) An employee reports medical signs or symptoms that are related to ability to use a respirator; 3 citations

(ii) A PLHCP, supervisor, or the respirator program administrator informs the employer that an employee needs to be reevaluated; Open (e)(7)(ii) 11 citations

(iii) Information from the respiratory protection program, including observations made during fit testing and program evaluation, indicates a need for employee reevaluation; or 2 citations

(iv) A change occurs in workplace conditions (e.g., physical work effort, protective clothing, temperature) that may result in a substantial increase in the physiological burden placed on an employee.