This questionnaire is used to determine whether or not you have a medical condition that may affect your ability to safely wear respirator. We anticipate being able to approve most people for respirator use based on the ques-tionnaire alone. In some case we may ask for more information or additional testing. All medical information is considered confidential.
To the employee: Your employer must allow you to answer this questionnaire during normal working hours or at time and place that is convenient to you.Part A. Section 1 (Mandatory). The following information must be provided by every employee who has been selected to use any type of respirator (please print).