RESPIRATOR MEDICAL EVALUATION QUESTIONNAIRE (MANDATORY). EMPLOYEE: Your employer must allow you to answer this questionnaire during. 21 Jun OSHA RESPIRATOR MEDICAL EVALUATION QUESTIONNAIRE. TO THE EMPLOYEE. Can you read? (Circle one). No. Yes. Answers to. TO THE EMPLOYEE. Can you read? (circle one) Yes No. Your employer must allow you to answer this questionnaire during normal working hours, or at a time .

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Do you currently have any of the following symptoms of pulmonary or lung illness?

Have you ever had any of the following cardiovascular or heart symptoms? You will NOT be charged if you cannot be cleared by online evaluation. Your employer has chosen this online service to give you the opportunity to obtain this clearance in an easy and cost-efficient manner. Have you ever had any of the following pulmonary or lung problems? Have to stop for breath when walking at your own pace on level ground: Would you like to talk to the health care professional who will review this questionnaire about your answers to this questionnaire: The employee does not need to leave work site.

OSHA Respirator Medical Evaluation Questionnaire – ®, Home

At home have you been exposed to hazardous solvents, hazardous airborne chemicals e. All employees who use respirators for their job are required to complete a medical evaluation that complies with 29 CFR Medicla does not mean you cannot wear a respirator.

This questionnaire will take approximately minutes to complete. Respiratory Protection Program Advisor.

If “yes,” describe these exposures: A SCBA is a full-face respirator with supplied breathing air from an attached compressed air bottle that is worn by the employee. It is not designed to take into account all of the on-going or one-time medical issues a person may have.


List any second jobs or side businesses you have: Shortness of breath when walking fast on level ground or walking up a slight qestionnaire or incline:.

Upon completion of the medical questionnaire, your result will be displayed indicating whether you may proceed to fit testing or not. This certification is for employees that are required to use the following respirators: N, R, or P disposable respirator filter-mask, non-cartridge type only Other type for example, half- or full-facepiece type, powered-air purifying, supplied-air, self-contained breathing apparatus Note: To begin, it will be necessary to enter an access code supplied by your Respiratory Protection Program Administrator.

If you’ve never used a respirator, check the following space and go to question 9: If you have not been selected to wear or to use either a full-face respirator or a self-contained breathing apparatus SCBAit is not necessary to answer questions in Section 3, tespirator If you need further testing and cannot be cleared online you owe nothing.

The Online Respirator Medical Evaluation has a web-based interactive questionnaire, which gives you immediate notification of efaluation results. Medical clearance for respirator use from RapidMEQ. Would you like to talk to the health care professional who will review this questionnaire about your answers to this questionnaire:.

If you have medical problems that fall outside of the approval structure of this on-line evaluation, you may not receive a medical clearance from this process.

After online payment the employer will receive a code employees respiraator use to pay for online instant medical respirator clearance.

Delays mediacl failure rates are minimized getting your employees to work sooner. Successful completion of the questionnaire will allow you to proceed to respirator fit testing. Describe any special responsibilities you’ll have while using your respirator that may affect the safety and well-being of others e. Barb Razer at The evaluation can be completed from any Internet-capable computer, and results are transmitted immediately.


If “yes,” were you exposed to biological or chemical agents either in training or combat:. Do you currently smoke questionniare, or have you smoked tobacco in the last month: Employees required to wear disposable respirators with N, R or P ratings; half mask; or full-face respirators need this clearance. It is essential that you answer every question. If you were not cleared to wear a respirator, you owe nothing.

The majority of people receive this medical clearance simply by filling out this questionnaire and do not need further evaluation by a physician or other licensed health care professional. In the past two years, have you noticed your heart skipping Or missing a beat: This online medical evaluation is based on the answers that you provide. Describe any special or hazardous conditions you might encounter when you’re using your respirator e.

$24.99 Online Instant Medical Clearance to Wear Respirator

YOU lose nothing by completing the questionnaire. When OSHA requires a respirator, the employee must fill out a questionnaire as part of the medical evaluation.

Once you have checked emdical answers, submit questionnaire. Most people can certify just by completing this evaluation and do not need additional follow-up with a physician or other licensed health care professional.

The employee must know the type of respirator that will be worn: Have you ever had any of the following cardiovascular or heart problems?