IMPORTANT:
If the employer has provided an employee with a medical evaluation addressing respirator use, as required by another chapter, that evaluation will meet the requirements of this section.
The employer must follow the medical evaluation process, Steps 1 through 7 in this section, to provide medical evaluations for employees at no cost to them.
Medical Evaluation Process
Step 1: Identify employees who need medical evaluations and determine the frequency of evaluations from Table 7. Include employees who:
(a) Are required to use respirators;
OR
(b) Voluntarily use respirators that are not filtering-facepiece respirators.
Note: | The employer may use a previous employer's medical evaluation for an employee if the employer can: |
| 1. Show the employee's previous work and use conditions were substantially similar to the employer's; |
| AND |
| 2. Obtain a copy of the licensed health care professional's (LHCP's) written recommendation approving the employee's use of the respirator chosen by you. |
Step 2: Identify a licensed health care professional (LHCP) to perform the medical evaluations.
Note: | If the employer selects a different LHCP, they do not need to have new medical evaluations done. |
Step 3: Make sure the LHCP has the following information before the evaluation is completed:
(a) Information describing the respirators employees may use, including the weight and type.
(b) How the respirators will be used, including:
(i) How often the respirator will be used, for example, daily, or once a month;
(ii) The duration of respirator use, for example, a minimum of one hour, or up to twelve hours;
(iii) The employee's expected physical work effort;
(iv) Additional personal protective clothing and equipment to be worn;
(v) Temperature and humidity extremes expected during use.
(c) A copy of the employer's written respiratory protection program and this part.
Notes: | 1. The employer may choose to send the questionnaire to the LHCP ahead of time, giving time to review it and add any necessary questions. |
| 2. The LHCP determines what questions to add to the questionnaire, if any; however, questions in Parts 1-3 may not be deleted or substantially altered. |
Step 4: Administer the medical questionnaire in WAC
296-307-61605 to employees,
OR provide them a medical exam that obtains the same information.
Note: | The employer may use online questionnaires if the questions are the same and requirements of this section are met. |
(a) Administer the examination or questionnaire at no cost to employees:
(i) During the employee's normal working hours;
OR
(ii) At a time and place convenient to the employee.
(b) Maintain employee confidentiality during examination or questionnaire administration:
(i) Do not view employee's answers on the questionnaire;
(ii) Do not act in a manner that may be considered a breach of confidentiality.
Note: | Providing confidentiality is important for securing successful medical evaluations. It helps make sure the LHCP gets complete and dependable answers on the questionnaire. |
(c) Make sure employees understand the content of the questionnaire.
(d) Provide the employee with an opportunity to discuss the questionnaire or exam results with the LHCP.
Step 5: Provide follow-up evaluation for employees when:
(a) The LHCP needs more information to make a final recommendation;
OR
(b) An employee gives any positive response to questions 1-8 in Part 2
OR to questions 1-6 in Part 3 of the WISHA medical evaluation questionnaire in WAC
296-307-61605.
Note: | Follow-up may include: |
| 1. Employee consultation with the LHCP such as a telephone conversation to evaluate positive questionnaire responses; |
| 2. Medical exams; |
| 3. Medical tests or other diagnostic procedures. |
Step 6: Obtain a written recommendation from the LHCP that contains only the following medical information:
(a) Whether or not the employee is medically able to use the respirator;
(b) Any limitations of respirator use for the employee;
(c) What future medical evaluations, if any, are needed;
(d) A statement that the employee has been provided a copy of the written recommendation.
Step 7: Provide a powered, air-purifying respirator (PAPR) when the LHCP determines the employee should not wear a negative-pressure air-purifying respirator AND is able to wear a PAPR.
Reference: | See WAC 296-307-602 for requirements regarding selection of air-purifying respirators. |
Notes: | 1. The employer may discontinue medical evaluations for an employee when the employee no longer uses a respirator. |
| 2. If the employer has staff conducting its medical evaluations, they may keep completed questionnaires and findings as confidential medical records, if they are maintained separately from other records. |
Use Table 7 to determine medical evaluation frequency.
Table 7
Evaluation Frequency
Type of Evaluation: | When required: |
Initial medical evaluations | • Before respirators are fit-tested or used in the workplace. |
Subsequent medical evaluations | • If any of these occur: |
| | – The employer's licensed health care professional (LHCP) recommends them; for example, periodic evaluations at specified intervals. |
| | – A respirator program administrator or supervisor informs the employer that an employee needs reevaluation. |
| | – Medical signs or symptoms (such as breathing difficulties) are: |
| | | ■ Observed during fit-testing or program evaluation |
| | | OR |
| | | ■ Reported by the employee |
| | – Changes in worksite conditions such as physical work effort, personal protective clothing, or temperature that could substantially increase the employee's physiological stress. |
