Respirators can potentially cause health conditions such as respiratory problems and impaired cognitive function. The OSHA mandates that questionnaires are completed to ensure that all employees are assessed for respirator-related health risks. Non-compliance can lead to serious health issues for the employee and legal penalties for the employer.

Using a template for the questionnaire streamlines the review process for medical professionals. It presents the required health information in a consistent format, making it easier to identify potential health risks accurately.

An effective OSHA respirator medical evaluation questionnaire form requires the following sections:

• Introduction: Instructions for employers and employees.
• Employee Information: Personal details, job title, contact information, and respirator usage history.
• Health Questions: Comprehensive yes/no questions covering pulmonary, cardiovascular, and other health issues.
• Specific Respirator Questions: Additional questions for full-facepiece respirator or SCBA users about vision, hearing, and musculoskeletal issues.
• Declaration: The employee's verification of the accuracy of the provided information.
• Reviewer’s Section: The healthcare professional's evaluation, approved respirator types for the employee, restrictions, and signature.

Your OSHA respirator medical evaluation questionnaire form should be exportable to PDF so it can be viewed on all devices.