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Appendix C To Sec 1910134: Osha Respirator Medical Evaluation Questionnaire (mandatory)

Appendix C to Sec. 1910.134: OSHA Respirator Medical Evaluation Questionnaire (Mandatory)

This questionnaire is mandatory under OSHA's Respiratory Protection Standard (1910.134) and is used to determine if an employee is medically able to use a respirator.

Page 1

General Information

Email*

Name*

Job Title*

Department*

Supervisor's Name*

Date of Birth*

Date of Hire*

Gender*

Height*

10.

Weight*

11.

Phone Number*

12.

Emergency Contact Name*

13.

Emergency Contact Phone Number*

Description:This is the OSHA Respirator Medical Evaluation Questionnaire (Mandatory) as per Appendix C to Sec. 1910.134. This questionnaire is mandatory for employees who are required to use respirators in their workplace. It is designed to evaluate the employee's medical fitness to use a respirator and ensure that the respirator does not pose any health risks to the employee. The questionnaire is an important tool in protecting the health and safety of employees who use respirators in their work environment.

Appendix C to Sec. 1910.134 of the Occupational Safety and Health Administration (OSHA) requires employers to provide a medical evaluation questionnaire to employees who are required to use respirators in their workplace. This questionnaire is mandatory and is designed to evaluate the employee's medical fitness to use a respirator. The questionnaire is an important tool in protecting the health and safety of employees who use respirators in their work environment. The questionnaire covers a range of medical conditions that may affect the employee's ability to use a respirator safely. Employers must ensure that employees complete the questionnaire accurately and that the information provided is kept confidential. The questionnaire must be reviewed by a licensed healthcare professional who will determine if the employee is medically fit to use a respirator. If the employee is not medically fit, the employer must provide alternative work arrangements or other protective measures to ensure the employee's safety.

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