Labor & Industries (L&I), Washington State

Respirators Chapter 296-842, WAC

Effective Date:12/01/09

Medical Evaluation

For printing

Provide medical evaluation

WAC 296-842-14005

WAC 296-842-14005

Provide medical evaluations

Exemption: This section does NOT apply to employees who only use: Filtering-facepiece respirators voluntarily. See WAC 296-842-11005 for voluntary use requirements; or Escape-only respirators that are mouthpiece, loose-fitting, or hooded respirators.

 

Important:

• If an employee has been provided with a medical evaluation addressing respirator use, as required by another chapter, that evaluation will meet the requirements of this section.
• Using a respirator can create physical risks for an employee each time it is worn. The extent of these risks depends on these factors:

  - Type of respirator;

  - Environmental conditions of the work;

  - Physical demand of the work;

  - Use of the protective clothing;

  - Employee's health status.

  • Follow the medical evaluation process, Steps 1 through 7 in this section, to provide medical evaluations for employees at no cost to them.

Helpful Tool: Planning for Medical Evaluations This information can help you prepare for employee medical evaluations. You can find a copy of this form in the Resources section of this chapter.

 

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;
or
• 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 don’t 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 12 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 chapter.

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 296-842-22005 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;
or

– 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;
or
• An employee gives any positive response to questions 1-8 in Part 2 or to questions 1-6 in Part 3 of the DOSH Medical Evaluation Questionnaire in WAC 296-842-22005.

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 shouldn’t wear a negative-pressure air-purifying respirator and is able to wear a PAPR.

Reference: See WAC 296-842-13005 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