important:

If you have provided an employee with a medical evaluation addressing respirator use, as required by another chapter, that evaluation will meet the requirements of this section.

You 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:

• Are required to use respirators

• Voluntarily use respirators that are not filtering-facepiece respirators

Note:	You may use a previous employer's medical evaluation for an employee if you can:
	• Show the employee's previous work and use conditions were substantially similar to yours
	and
	• 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 your medical evaluations.

Note:

If you select a different LHCP, you do not need to have new medical evaluations done.

Step 3: Make sure your LHCP has the following information before the evaluation is completed:

• Information describing the respirators employees may use, including the weight and type.

• How the respirators will be used, including:

– How often the respirator will be used, for example, daily, or once a month

– The duration of respirator use, for example, a minimum of one hour, or up to twelve hours

– The employee's expected physical work effort

– Additional personal protective clothing and equipment to be worn

– Temperature and humidity extremes expected during use

• A copy of your written respiratory protection program and this part.

Note:	• You may choose to send the questionnaire to the LHCP ahead of time, giving time to review it and add any necessary questions
	• 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:

You may use online questionnaires if the questions are the same and requirements of this section are met.

• Administer the examination or questionnaire at no cost to employees:

– During the employee's normal working hours

– At a time and place convenient to the employee

• Maintain employee confidentiality during examination or questionnaire administration:

– Do not view employee's answers on the questionnaire

– 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.

• Make sure employees understand the content of the questionnaire.

• 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:

• The LHCP needs more information to make a final recommendation

• 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:
	• Employee consultation with the LHCP such as a telephone conversation to evaluate positive questionnaire responses
	• Medical exams
	• Medical tests or other diagnostic procedures.

Step 6: Obtain a written recommendation from the LHCP that contains only the following medical information:

• Whether or not the employee is medically able to use the respirator

• Any limitations of respirator use for the employee

• What future medical evaluations, if any, are needed

• 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.

Note:	• You may discontinue medical evaluations for an employee when the employee no longer uses a respirator.
	• If you have staff conducting your 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:
		– Your licensed health care professional (LHCP) recommends them; for example, periodic evaluations at specified intervals.
		– A respirator program administrator or supervisor informs you 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.

PDFWAC 296-307-60405

Provide medical evaluations.