General Industry
Who is covered: Every employee required to use a respirator must receive a medical evaluation to determine ability to use a respirator before fit testing or use; also when re-evaluation triggers arise.
Evaluation performed by: PLHCP — physician or other licensed health care professional
🩺 Baseline / Pre-Placement
Before the employee is fit tested or required to use a respirator in the workplace — 1910.134(e)(1)
- OSHA Respirator Medical Evaluation Questionnaire — Appendix C (Mandatory), Part A Section 1 (mandatory for all): today's date, name, age, sex, height, weight, job title, contact phone, best time to call, confirmation employer communicated PLHCP contact info, respirator type to be used, previous respirator experience and types
- Part A Section 2, Questions 1–9 (mandatory for all users): Q1 tobacco use; Q2 seizures/diabetes/breathing allergies/claustrophobia/smell impairment; Q3 prior lung conditions (asthma, emphysema, TB, silicosis, lung cancer, rib fractures); Q4 current pulmonary symptoms (exertional dyspnea, cough, wheeze, hemoptysis, chest pain); Q5 prior cardiovascular conditions (heart attack, stroke, angina, heart failure, arrhythmia, hypertension); Q6 current cardiovascular symptoms; Q7 current medications for breathing, heart, BP, or seizures; Q8 prior respirator-related problems; Q9 desire to discuss with PLHCP (Q9 does not trigger a medical examination per Appendix C preamble)
- Part A Section 2, Questions 10–15 (additionally mandatory for full-facepiece and SCBA users): Q10 prior vision loss; Q11 current eye issues (contact lenses, glasses, color blindness); Q12 prior ear injuries (ruptured eardrum); Q13 current hearing problems; Q14 prior back injury; Q15 current musculoskeletal limitations
- Part B questions at PLHCP discretion
- PAPR provision — 1910.134(e)(6)(ii): if a PLHCP medical evaluation finds an employee cannot use a negative-pressure respirator, but can use a powered air-purifying respirator (PAPR), the employer shall provide a PAPR
Abnormal results & exposure-event protocols
Abnormal Results & Exposure-Event Protocols
- Employee gives a positive response to any question among questions 1 through 8 in Section 2, Part A of Appendix C (note: a 'yes' to Q9 — desire to discuss with PLHCP — does not by itself require a medical examination), OR the initial medical exam indicates a need for follow-up — 1910.134(e)(3)(i)-(ii) 1910.134(e)(3)(i)-(ii): Employer provides a FOLLOW-UP medical examination by the PLHCP; the follow-up exam includes any medical tests, consultations, or diagnostic procedures the PLHCP deems necessary to make a determination of fitness to use a respirator. Tests: Medical examination by the PLHCP, Any medical tests, consultations, or diagnostic procedures the PLHCP deems necessary (e.g., spirometry or chest X-ray ONLY if the PLHCP deems them necessary — not mandated by the standard)
- Additional medical re-evaluation required when: (i) the employee reports medical signs/symptoms related to ability to use a respirator; (ii) a PLHCP, supervisor, or respirator program administrator informs the employer that re-evaluation is needed; (iii) information from the respiratory protection program (including observations during fit testing or program evaluation) indicates a need; or (iv) a workplace change occurs that may substantially increase the physiological burden on the employee. 1910.134(e)(7): Provide an additional medical evaluation (questionnaire or exam as appropriate) to re-determine the employee's ability to use the respirator. Tests: Repeat medical evaluation via Appendix C questionnaire or examination, as indicated by the trigger
Reporting Requirements
| Who performs the evaluation | PLHCP (physician or other licensed health care professional whose scope of practice permits the services in paragraph (e)) |
|---|---|
| Reported to employer | PLHCP provides a WRITTEN RECOMMENDATION limited to: (1) any limitations on respirator use related to the employee's medical condition 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; (2) the need, if any, for follow-up medical evaluations; and (3) a statement that the PLHCP has provided the employee a copy of the written recommendation — 1910.134(e)(6)(i). No clinical findings or diagnoses are disclosed. |
| Reported to / for the employee | PLHCP must provide the employee a copy of the PLHCP's written recommendation. |
| Time limits | Evaluation must be completed before fit testing or first respirator use. No fixed turnaround stated for the recommendation beyond that it precede respirator use. |
| Recordkeeping | Medical evaluation records (questionnaire and PLHCP recommendation) retained per 29 CFR 1910.1020 — duration of employment plus 30 years. The completed questionnaire is confidential to the PLHCP; the employer is not given the questionnaire itself. |
Medical Removal Protection
No medical removal protection — this is a medical clearance/evaluation to use a respirator, not a removal-based surveillance program. There is NO fixed periodic interval; re-evaluation is trigger-based (see abnormal_protocols).
Construction
Who is covered: Construction respiratory protection standard (1926.103) incorporates 1910.134 by reference — the SAME medical evaluation requirements apply to construction workers required to use respirators.
Evaluation performed by: PLHCP — physician or other licensed health care professional
🩺 Baseline / Pre-Placement
Before the employee is fit tested or required to use a respirator in the workplace — 1910.134(e)(1)
- OSHA Respirator Medical Evaluation Questionnaire — Appendix C (Mandatory), Part A, Section 1 (basic info: name, age, height, weight, job title, respirator type) and Section 2 (mandatory medical-history/symptom questions, Q1-8 cardiopulmonary; Q10-15 mandatory for full-facepiece/SCBA users) — covering tobacco use; seizures/diabetes/allergies/claustrophobia; pulmonary conditions (asthma, emphysema, TB, lung cancer); current respiratory symptoms (shortness of breath, cough, wheeze, chest pain); cardiovascular history/symptoms (heart attack, angina, arrhythmia); current cardiac/respiratory/BP/seizure medications; prior respirator-use problems
- Alternatively, an initial medical examination that obtains the SAME information as the Appendix C questionnaire (equivalent entry pathway)
- Appendix C Part B questions at the PLHCP's discretion (occupational exposures, work intensity/duration, environmental conditions, additional protective clothing)
- PAPR provision — 1910.134(e)(6)(ii) (incorporated by reference via 29 CFR 1926.103): if a PLHCP medical evaluation finds an employee cannot use a negative-pressure respirator, but can use a powered air-purifying respirator (PAPR), the employer shall provide a PAPR
Abnormal results & exposure-event protocols
Abnormal Results & Exposure-Event Protocols
- Employee answers 'yes' to any of questions 1-8 in Section 2, Part A of Appendix C, OR the initial medical exam shows a need 1910.134(e)(3)(i)-(ii): Employer provides a FOLLOW-UP medical examination by the PLHCP; the follow-up exam includes any medical tests, consultations, or diagnostic procedures the PLHCP deems necessary to make a determination of fitness to use a respirator. Tests: Medical examination by the PLHCP, Any medical tests, consultations, or diagnostic procedures the PLHCP deems necessary (e.g., spirometry or chest X-ray ONLY if the PLHCP deems them necessary — not mandated by the standard)
- Additional medical re-evaluation required when: (i) the employee reports medical signs/symptoms related to ability to use a respirator; (ii) a PLHCP, supervisor, or respirator program administrator informs the employer that re-evaluation is needed; (iii) information from the respiratory protection program (including observations during fit testing or program evaluation) indicates a need; or (iv) a workplace change occurs that may substantially increase the physiological burden on the employee. 1910.134(e)(7): Provide an additional medical evaluation (questionnaire or exam as appropriate) to re-determine the employee's ability to use the respirator. Tests: Repeat medical evaluation via Appendix C questionnaire or examination, as indicated by the trigger
Reporting Requirements
| Who performs the evaluation | PLHCP (physician or other licensed health care professional whose scope of practice permits the services in paragraph (e)) |
|---|---|
| Reported to employer | PLHCP provides a WRITTEN RECOMMENDATION limited to: whether the employee is medically able to use the respirator; any limitations on respirator use (including for emergency/high-burden conditions); the need for a follow-up medical evaluation; and a statement that the PLHCP has provided the employee a copy of the recommendation. No clinical findings or diagnoses are disclosed. |
| Reported to / for the employee | PLHCP must provide the employee a copy of the PLHCP's written recommendation. |
| Time limits | Evaluation must be completed before fit testing or first respirator use. No fixed turnaround stated for the recommendation beyond that it precede respirator use. |
| Recordkeeping | Medical evaluation records (questionnaire and PLHCP recommendation) retained per 29 CFR 1910.1020 — duration of employment plus 30 years. The completed questionnaire is confidential to the PLHCP; the employer is not given the questionnaire itself. |
Medical Removal Protection
No medical removal protection — this is a medical clearance/evaluation to use a respirator, not a removal-based surveillance program. There is NO fixed periodic interval; re-evaluation is trigger-based (see abnormal_protocols).
Required Forms & Reference Definitions
Appendix C — OSHA Respirator Medical Evaluation Questionnaire (Mandatory) 29 CFR 1910.134 App. C; 8 CCR 5144 App. C
The mandatory respirator medical evaluation questionnaire. Part A Section 1 collects basic information and respirator-use history; Part A Section 2 asks mandatory cardiopulmonary medical-history and symptom questions (with additional mandatory questions for full-facepiece/SCBA users); Part B contains optional questions the PLHCP may add. An equivalent initial medical exam obtaining the same information may be used instead.