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Medical Evaluations and Fit Testing

Respirator User Medical Evaluations
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One of the primary components of the Respiratory Protection Program involves the requirement for employees to receive a medical evaluation to make sure they can use respirators.

The employer must 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.

The medical evaluation must obtain the information requested by the Respirator Medical Evaluation Questionnaire in 1910.134, Sections 1 and 2, Part A of Appendix C.

Follow-up Medical Examination

The employer must ensure that a follow-up medical examination is provided for an employee who gives a positive response (yes) to any question among questions 1 through 8 in Section 2 of the questionnaire or whose initial medical examination demonstrates the need for a follow-up medical examination. Here are the topics that are covered in the first 8 questions in the questionnaire:

medical exam
  1. smoking
  2. conditions such as seizures, diabetes, allergies, claustrophobia, etc.
  3. pulmonary or lung problems such as asbestosis, asthma, silicosis, etc.
  4. symptoms of pulmonary or lung illness such as shortness of breath, coughing, etc.
  5. cardiovascular or heart problems such as heart attack, angina, high blood pressure, etc.
  6. cardiovascular or heart symptoms such as pain, tightness, irregular heartbeat, etc.
  7. taking medication for lung problems, heart trouble, blood pressure, seizures, etc.
  8. prior problems using respirators like eye irritation, allergies, anxiety, fatigue, etc.

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

Medical Determination


In determining the employee's ability to use a respirator, the employer must obtain a written recommendation regarding the employee's ability to use the respirator from the PLHCP. The recommendation must provide only the following information:

  • 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;
  • the need, if any, for follow-up medical evaluations; and
  • a statement that the PLHCP has provided the employee with a copy of the PLHCP's written recommendation.

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 must provide a PAPR if the PLHCP's medical evaluation finds that the employee can use it. If a subsequent medical evaluation finds the employee is medically able to use a negative pressure respirator, then the employer is no longer required to provide a PAPR.

Additional Medical Evaluations

At a minimum, the employer must provide additional medical evaluations that comply with the requirements of this section if:

  • an employee reports medical signs or symptoms that are related to their ability to use a respirator;
  • a PLHCP, supervisor, or the respirator program administrator informs the employer that an employee needs to be re-evaluated;
  • information from the respiratory protection program, including observations made during fit testing and program evaluation, indicates a need for employee reevaluation; or
  • a change occurs in workplace conditions (e.g., physical work effort, protective clothing, or temperature) that may result in a substantial increase in the physiological burden placed on an employee.

Fit Testing

Fit Testing – OSHA
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The primary purpose of fit testing is to identify the specific make, model, style, and size of respirator best suited for each employee. In addition, fit testing also reinforces respirator training by having wearers review the proper methods of donning and wearing the respirator. Employees must be medically evaluated and found eligible to wear the respirator selected for their use prior to fit testing.

Fit testing is required for all negative or positive pressure tight-fitting facepiece respirators using the protocols detailed in 1910.134, Appendix A. The OSHA respiratory protection standard requires fit testing be performed:

  • before an employee first starts wearing a respirator in the work environment,
  • whenever a different respirator facepiece is used, and
  • at least annually thereafter.

Demonstrating and Selecting a Respirator Model

Prior to the actual fit test, the employee should:

  • wear the respirator to be tested for at least five minutes prior to the start of the test;
  • be given a description of the fit test and the exercises he or she will perform during the test;
  • be shown how to put on a respirator, position it on the face, set strap tension, and determine an acceptable fit;
  • be allowed to choose a respirator from a sufficient number of models and sizes so the employee can find an acceptable and correctly fitting respirator. When choosing the respirator, the employee should take into account;
    • the position of the mask on the face, nose, and cheeks;
    • room for eye protection; and
    • room to talk -- a user seal check must be conducted.
  • be fit tested for each respirator that will be assigned.

Retesting: If the employee finds the fit of the respirator to be unacceptable, he or she must be given a reasonable opportunity to select a different respirator and to be retested. Retesting is required whenever there are changes in an employee’s physical condition that could affect the respirators fit. Such conditions include, but are not limited to:

  • facial scarring,
  • dental changes (e.g., wearing new dentures),
  • cosmetic surgery, or
  • an obvious change in body weight.

Policies and Procedures for Using Respirators


Written procedures: It is important to develop standard procedures for respirator use. These should include all information and guidance necessary for their proper selection, use, and care. Also include possible emergency and routine uses of respirators.

Physical ability to use: Make sure employees are not assigned to tasks requiring respirators unless they are physically able to adequately perform the work and use the equipment. If there is any question or concern about using the respirator, a local physician must determine what health and physical conditions are pertinent. In such cases, periodically review the respirator user's medical status.

Face seal protection: To assure proper protection, check the facepiece fit using the manufacturer's facepiece fittings instructions, each time he or she puts on the respirator.

Do not wear respirators when conditions prevent a good face seal. Such conditions may be a growth of beard, sideburns, a skull cap that projects under the facepiece, or temple pieces on glasses. Also, the absence of one or both dentures can seriously affect the fit of a facepiece. It's important to conduct periodic evaluation of worker compliance with this requirement.

Corrective glasses or goggles: Corrective glasses or goggles, or other personal protective equipment, must be worn in such a way that does not interfere with the seal of the facepiece to the face. In some cases, a full-facepiece respirator or powered air-purifying respirator (PAPR) may be more comfortable and less cumbersome than the combination of a half-mask and chemical goggles. OSHA's current standard on respiratory protection allows the use of contact lenses with respirators where the wearer has successfully worn such lenses before. However, wearing contact lenses in contaminated atmospheres is not permitted.

If corrective spectacles or goggles are required, they must not affect the fit of the facepiece.

Skin or Eye Irritation: Skin or eye irritation can result from wearing a respirator in hot, humid conditions as well as in contaminated environments. Irritation can cause considerable distress to employees, causing them to remove or adjust the respirator or to stop using the respirator at all. To prevent skin or eye irritation employees should leave the respirator use area to wash their faces and respirator facepieces as needed.

Vapor or Gas Breakthrough: Whenever the employee can detect vapor or gas breakthrough (by odor, taste, and/or irritation effects) or a change in breathing resistance or leakage of the facepiece, the employee must leave the respirator use area to replace the respirator or the filter, cartridge, or canister elements.

Impairments: Because respirators must be in good working condition to function, they should not be used if they have been impaired in any way. Impairments include a broken strap, loss of respirator shape, and a face seal that can no longer be maintained. Respirators that are not properly functioning must be replaced, repaired, or discarded.

Identification of Filters, Cartridges, and Canisters

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The employer must ensure that all filters, cartridges, and canisters used in the workplace are labeled and color coded with the NIOSH approval label and that the label is not removed and remains legible. Replace those filters, cartridges, and canisters that have damaged color codes or labels. All cartridges are assigned a color designating the type of contaminant they filter as shown in the chart to the right.

Where Respirator Use is not Required

An employer may provide respirators at the request of employees or permit employees to use their own respirators if the employer determines such respirator use will not in itself create a hazard.

If the employer determines any voluntary respirator use is permissible, the employer must provide the respirator users with the information contained in Appendix D of the standard.

In addition, the employer must establish and implement those elements of a written respiratory protection program necessary to ensure that any employee using a respirator voluntarily is medically able to use the respirator and the respirator is cleaned, stored, and maintained so its use does not present a health hazard to the user. Exception: Employers are not required to include in a written respiratory protection program those employees whose only use of respirators involves the voluntary use of filtering face pieces (dust masks).


Before beginning this quiz, we highly recommend you review the module material. This quiz is designed to allow you to self-check your comprehension of the module content, but only focuses on key concepts and ideas.

Read each question carefully. Select the best answer, even if more than one answer seems possible. When done, click on the "Get Quiz Answers" button. If you do not answer all the questions, you will receive an error message.

Good luck!

1. When is the employer required by OSHA to ensure a follow-up medical examination is provided for an employee?

2. What must the employer do if the PLHCP finds a medical condition that may place the employee's health at risk using a negative pressure respirator?

3. What is the primary purpose of respirator fit testing?

4. Which of the following conditions could prevent a good respirator face seal?

5. What should you do if a cartridge on your respirator is missing the NIOSH label?

Have a great day!

Important! You will receive an "error" message unless all questions are answered.