Medical evaluations are performed to help determine an employee's ability to wear a respirator. A physician or other licensed health care provider (PLHCP) must make that determination using OSHA's medical questionnaire (1910.134 Appendix C) or a medical exam that obtains the same information.

When you send an employee for this evaluation, you need to provide to the PLHCP information about the respirator the employee will wear and the working conditions. The enclosed Respiratory Protection Medical Evaluation Record, can be used for that purpose. Additionally, the PLHCP's written recommendation regarding an employee's ability to wear a respirator can be recorded on this form. (The PLHCP is responsible for giving a copy of the written recommendation to the employee.) This recommendation is used by the employer in determining the employee's ability to use a respirator.

All other medical records, including the medical questionnaire, if used, are considered confidential and should not be stored with your written respirator program. Those records should only be made available under the requirements of 1910.1020, Access to Employee Exposure and Medical Records.

Medical Evaluation Record

Medical Evaluation Questionnaire