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Respiratory Protection Program
for Auto Refinish Shops
- Final -
10 November 2002
&EPA
United States
Environmental Protection
Agency
744-F-02-010
2002
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Foreword
The purpose of this document is to assist auto body shops in developing a respiratory protection
program that protects the health of their employees and meets the requirements of OSHA's
Respiratory Protection standard, 29 CFR 1910.134. This document is formatted with checklists
and blank spaces to allow the individual shop to adapt the contents of the written program to the
specific hazards and respiratory protection needs of its workforce.
The program as presented, addresses typical auto refinishing activities that may require the use of
respiratory protection, including vehicle prep work, mixing and application of coatings, and
related clean-up operations. The program's contents are based on observations made during
EPA's outreach visits to auto refinish shops. However, each shop must review all of their
activities to evaluate respiratory hazards and must develop a respiratory protection program that
addresses each activity requiring respiratory protection at the worksite. In addition to the
activities listed in this document, other shop activities that may require the use of respiratory
protection include but are not limited to sanding related to body work, welding, and buffing.
DISCLAIMER
This document provides one example of how an auto refinish shop could implement the OSHA
Respiratory Protection standard. The document does not address all options available to the shop
owner in developing and implementing a program in their own shop. For example, the medical
evaluations section of this document mentions the use a licensed physician while the OSHA
standard allows the use of a physician or other licensed health care professional. Shop owners
should refer to the OSHA Respiratory Protection standard while using this document to ensure
they develop a program that meets their needs and complies with the OSHA standard.
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Prepared for:
U.S. Environmental Protection Agency
Design for the Environment Program
Auto Refinish Project
Office of Pollution Prevention and Toxics
1200 Pennsylvania Avenue
Washington DC 20460
Prepared by:
Eastern Research Group, Inc.
14555 Avion Parkway
Suite 200
Chantilly, VA20151
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Facility Name
Address
RESPIRATORY PROTECTION PROGRAM
Program Administrator
Date Last Revised
in
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TABLE OF CONTENTS
Page
1.0 PURPOSE 1
2.0 SCOPE AND APPLICATION 2
3.0 RESPONSIBILITIES 3
3.1 Program Administrator 3
3.2 Employees 4
4.0 PROGRAM ELEMENTS 5
4.1 Respirator Selection Procedures 5
4.1.1 Hazard Evaluation 5
4.1.2 Reviewing and Updating the Hazard Evaluation 5
4.1.3 NIOSH Certification 6
4.1.4 Voluntary Respirator Use 6
4.2 Medical Evaluations 7
4.2.1 Initial Medical Evaluation 7
4.2.2 Additional/Periodic Medical Evaluations 8
4.3 Fit Testing 12
4.4 Respirator Use 13
4.4.1 General Use Procedures 13
4.4.2 Emergency Procedures 13
4.4.3 Respirator Malfunction 14
4.5 Breathing Air Quality 14
4.6 Cleaning, Maintenance, Change Schedules, and Storage 15
4.6.1 Respirator Cleaning 15
4.6.2 Respirator Maintenance 16
4.6.3 Filter/Cartridge Change Schedules 17
4.6.4 Respirator Storage 17
4.6.5 Defective Respirators 18
4.7 Training 18
5.0 PROGRAM EVALUATION 19
6.0 DOCUMENTATION AND RECORDKEEPING 19
Table 1 - Required Respirator Use 3
Table 2 - Work Activities and Hazardous Substances 10
Table 3 - Employee Work Practices and Respirator UseInformation for Healthcare Providers..! 1
Attachment A - Results of Hazard Evaluation
Attachment B - Respirator Medical Evaluation Questionnaire
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i.o PURPOSE
The purpose of this Respiratory Protection Program is to protect this facility's employees from exposure
to respiratory hazards in the workplace and to comply with the requirements of OSHA's Respiratory
Protection standard, 29 CFR 1910.134. This facility has determined that employees are exposed to
respiratory hazards while performing the following routine operations in the refmish area:
Q dry sanding
Q solvent wipe-down
Q paint mixing
Q spray painting
Q spray gun cleaning
Q other tasks: .
A detailed hazard evaluation discussing the respiratory hazards associated with each of these tasks is
provided in Attachment A of this program.
Engineering controls, such as local exhaust ventilation, or substitution of hazardous materials are the
primary means of protecting workers from respiratory hazards at this facility. However, for some
operations, engineering controls either are not feasible, or they do not completely control the identified
hazards. In these situations, the shop requires employees to use respirators and other protective
equipment to reduce exposure. Table 1 below lists the processes for which respirators are required at this
facility and describes the appropriate type of respirator for each process.
In addition, some employees may wish to wear respirators voluntarily while performing certain
operations for which respirators are not required under this program. This facility will review each
request for voluntary use of respirators on a case-by-case basis. As a general policy, if the voluntary use
of respiratory protection in a specific case will not jeopardize the health or safety of the worker, the shop
will provide a respirator for voluntary use during that operation. As outlined in the Scope and
Application section of this program, voluntary respirator use is subject to certain requirements of this
program.
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2.0 SCOPE AND APPLICATION
This respiratory protection program applies to all employees who perform tasks that require the use of
respirators during normal work operations. A list of these tasks and the required respiratory protection is
summarized in Table 1 below. The hazard evaluation in Attachment A of this program provides a more
detailed discussion of the hazards associated with each task and the required respiratory protection.
Some sections of this program also apply to employees who use respirators voluntarily for tasks where
respirator use is not required. Specifically, voluntary respirator users must receive the information
presented in Appendix D of OSHA's Respiratory Protection standard. In addition, unless employees are
wearing only a paper dust mask, they are subject to the medical evaluation and respirator cleaning,
maintenance, and storage requirements of this program.
Employees participating in the respiratory protection program do so at no cost to themselves. The
company pays for all training, medical evaluations, and respiratory protective equipment.
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Table 1 - Required Respirator Use at
(shop name)
Note, use the hazard evaluation information developed in Attachment A to complete this table.
Processes Requiring Respirator Use*
(check S all processes that apply)
Q Dry sanding
Q Solvent wipe-down performed outside the booth
Q Paint mixing
Q Spray painting in automotive spray booth
Q Spray gun cleaning
Q Changing spray booth filters
Q Other:
Q Other:
Required Respirator Type*
(check S applicable type of respirator)
Q Half-facepiece air-purifying respirator (APR) with
N100 filters (R100 or PI 00 filters are also
acceptable)
Q Other:
Q Half-facepiece air-purifying respirator (APR) with
organic vapor cartridges
Q Other:
Q Half-facepiece air-purifying respirator (APR) with
organic vapor cartridges
Q Other:
Q Continuous flow supplied-air respirator (SAR)
with hood or tight-fitting facepiece
Q Other:
Q Half-facepiece air-purifying respirator (APR) with
organic vapor cartridges
Q Other:
Q Half-facepiece air-purifying respirator (APR) with
N95 filters
Q Other:
(List appropriate respirator type)
(List appropriate respirator type)
* See Attachment A, Hazard Evaluation, for further information.
3.0
3.1
RESPONSIBILITIES
Program Administrator
The shop's owner,
_, has designated the following shop employee,
the Program Administrator include:
_, as the Respiratory Protection Program Administrator. Duties of
Identifying work areas, processes, or tasks for which the use of respiratory
protection is required, and evaluating the associated hazards;
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Evaluating new or modified processes to identify potential respiratory hazards;
Evaluating alternative methods of worker protection (i.e., substituting with a less
hazardous substance, installing ventilation);
Selecting appropriate respiratory protection and ensuring the equipment is
available in the shop;
Monitoring respirator use to ensure that respirators are used in accordance with
their limitations and certifications;
Arranging for and/or conducting training;
Ensuring proper storage and maintenance of respiratory protective equipment;
Arranging for and/or conducting qualitative respirator fit testing;
Administering the medical evaluation program;
Maintaining records required by the respiratory protection program;
Ensuring that employees enrolled in the program (including new hires) receive
appropriate training, annual fit testing, and periodic medical evaluation;
Evaluating this program annually; and
Updating this written program, as needed.
3.2 Employees
Employees must wear respirators as required. Employees must also:
Care for and maintain their respirators as instructed and store them in a clean,
dry, sanitary location away from direct sunlight, in a sealed bag or container
(especially for organic vapor cartridges);
Inform the Program Administrator if the respirator no longer fits well or is
damaged; and
Inform the Program Administrator of any hazards they feel are not adequately
controlled in the workplace and of any other concerns they have regarding the
respiratory protection program.
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4.0 PROGRAM ELEMENTS
4.1 Respirator Selection Procedures
The Program Administrator will select respirators to be used in the shop, based on the identified hazards
and in accordance with applicable OSHA standards.
4.1.1 Hazard Evaluation
The Program Administrator will conduct a hazard evaluation using the hazard evaluation form in
Attachment A. In the hazard evaluation, the Program Administrator will evaluate each operation,
process, and work area to identify respiratory hazards that may be present during routine operations or in
foreseeable non-routine (maintenance or emergency) situations. The hazard evaluation process includes:
1. Listing all hazardous substances, such as paints, hardeners, reducers, and
solvents used in the workplace, by operation (e.g., surface preparation, paint
mixing, spraying, etc.). This information may be obtained by surveying the
workplace, reviewing material safety data sheets (MSDSs), and talking with
employees. (See Attachment A and Table 2.)
2. Reviewing work processes to determine where and how exposures to these
hazardous substances may occur.
3. Reviewing work practices and engineering controls, such as ventilation units and
booths, to determine whether modifications or maintenance could further reduce
respiratory hazards.
4. Conducting exposure monitoring to quantify hazardous exposures. This work is
performed by (e.g., the shop's Workers'
Compensation insurance carrier, whose services may be free or offered at a reduced rate, or an
industrial hygiene services contractor).
The results of the current hazard evaluation for this facility are contained in Attachment A. (Note:
Attachment A also contains a form that can be copied and used by the Program Administrator for
evaluating new or additional tasks.)
4.1.2 Reviewing and Updating the Hazard Evaluation
The Program Administrator will review and update the hazard evaluation as needed, for example, when
process changes potentially affect exposure, or in response to employee concerns. The Administrator
must be informed whenever the refmish shop adds new equipment, changes work processes, or uses new
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materials (such as a new type of paint or solvent). Additionally, any employee who feels that respiratory
protection is needed during a particular activity should speak to the Program Administrator. The
Program Administrator will evaluate the potential hazard, arranging for outside assistance (e.g.,
evaluation by an industrial hygiene consultant) as necessary. If results indicate a need for respiratory
protection, the Program Administrator will notify employees by providing them with a copy of the
results. All other elements of this program will be in effect for those tasks and this program will be
updated accordingly.
4.1.3 NIOSH Certification
All respirators must be certified by the National Institute for Occupational Safety and Health (NIOSH)
and must be used in accordance with the terms of that certification. Also, all filters, cartridges, and
canisters must be labeled with the appropriate NIOSH approval. The label must not be removed or
defaced while it is in use. As required by the NIOSH approval, employees will use only filters and
cartridges made by the manufacturer of the respirator facepiece. The filters of one manufacturer will not
be used on the facepiece made by another manufacturer.
4.1.4 Voluntary Respirator Use
Some employees may wish to wear respirators voluntarily while performing tasks that the Program
Administrator has determined do not require respiratory protection. This shop will provide respirators at
no charge to employees for voluntary use as follows: (Check all that apply.)
Q Employees may wear a half-facepiece APR with an organic vapor cartridge when
performing solvent wipe-down activities inside the ventilated spray booth.
Q Employees may wear an N95 dust mask while sweeping shop floors.
Q Employees in the shop may wear N95 dust masks while sanding is performed by another
employee in the shop.
G Other voluntary respirator use:
All employees who voluntarily wear any of the above respirators will receive a copy of Appendix D of
the OSHA standard. (This appendix details the requirements for voluntary use of respirators by
employees.) Employees voluntarily choosing to wear APRs must comply with the procedures for
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medical evaluations and respirator use, cleaning, maintenance, and storage. These additional provisions
do not apply to employees voluntarily wearing dust masks.
The Program Administrator will authorize voluntary use of respiratory protective equipment requested by
other workers, or for other processes, on a case-by-case basis. The decision will be based on specific
workplace conditions and, if necessary, the results of the medical evaluations.
4.2 Medical Evaluations
Employees who are required to wear respirators, or who voluntarily wear respirators other than dust
masks, must have a medical evaluation before they can wear a respirator on the job.
4.2.1 Initial Medical Evaluations
Employees are not permitted to wear respirators until a physician has determined that they are medically
able to do so. Any employee refusing the medical evaluation will not be allowed to work in an area
requiring respirator use.
A licensed physician at the following medical clinic, , which provides
all company medical services, will provide the medical evaluations required for respirator use. Medical
evaluation procedures are as follows:
The medical evaluation will be conducted using the questionnaire in Appendix C of the
OSHA Respiratory Protection standard (provided as Attachment B to this program). The
Program Administrator will provide a copy of this questionnaire to all employees
requiring medical evaluations.
The company will assist employees who are unable to read the questionnaire.
All affected employees will be given a copy of the medical questionnaire to fill out,
along with a stamped and addressed envelope for mailing the questionnaire directly to
the company physician. Employees will be permitted to fill out the questionnaire on
company time.
Follow-up medical exams will be granted to employees as required by the OSHA
standard, and/or as deemed necessary by the physician.
Upon request, employees will be granted the opportunity to discuss their questionnaire
and exam results with the physician.
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The Program Administrator has provided the physician with a copy of this program; a
copy of OSHA's Respiratory Protection standard; the list of hazardous substances used
at this site, grouped by task (see Table 2); and for each employee requiring evaluation, a
completed copy of Table 3 with the following information: the employee's work area or
job title, proposed respirator type and weight, length of time the employee is required to
wear the respirator, expected physical work load (light, moderate, or heavy), potential
temperature and humidity extremes, and any additional protective clothing and
equipment to be worn.
Any employee required for medical reasons to wear a positive-pressure air-purifying
respirator will be provided with a powered air-purifying respirator (PAPR). (Note that
this substitution does not apply to spray painting activities; spray painting activities
always require the use of a SAR operated in the positive pressure mode.)
4.2.2 Additional/Periodic Medical Evaluations
After an employee has received clearance and has begun to wear a respirator, medical evaluations will be
provided according to the following schedule: (e-g-, annually). The
Program Administrator worked with the licensed physician to determine this required frequency based on
an evaluation of the shop's respiratory hazards and related respirator use. Additional medical evaluations
will be provided under the following circumstances:
Employee reports signs and/or symptoms related to their ability to use a respirator, such
as shortness of breath, dizziness, chest pains, or wheezing;
The physician or supervisor informs the Program Administrator that the employee needs
to be reevaluated;
Information from this program, including observations made during fit testing and
program evaluation, indicates a need for reevaluation; or
A change occurs in workplace conditions that may result in an increased physiological
burden on the employee.
This facility will receive from the physician a written clearance indicating only whether or not the
employee is medically qualified to wear a respirator. All completed medical questionnaires, medical
records, and the results of exams and any medical tests will remain confidential between the
employee and the physician.
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The following employees are currently included in the shop's medical surveillance program for respirator
users. (Include names of voluntary users except those using paper dust masks only.)
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Table 2 - Work Activities and Hazardous Substances at
(shop name)
JSsfot
Note: The table lists hazardous substances used in a representative auto refinishing shop. Refer to your MSDSs for the products used in each task to identify
other hazardous materials that your employees may be exposed to while performing each task.
Task
Dry sanding
Solvent wipe-down
Paint mixing
Spray painting
Spray gun cleaning
Filter maintenance
Sweeping and clean-up
Other:
Other:
Hazardous substances (and ingredients listed on selected MSDSs)
Dust: generated bv sanding hardened epoxv and polvurethane paint and small amounts of body filler, which may contain lead
Other:
Solvent wipe solution (acetone, methyl ethyl ketone, toluene, xylene, acetates, and light aliphatic solvent naphtha)
Other:
Primers (barium sulfate; titanium dioxide; methyl isobutyl ketone, xylene, toluene, ethylbenzene, butyl acetate)
Basecoats, various colors (titanium dioxide, pigments, methyl isobutyl ketone, ethyl acetate, butyl acetate, toluene, ethylbenzene, xylene, lead and
chromium)
Clearcoat (toluene, xylene, methyl ethyl ketone, ethyl acetate, butyl acetate)
Hardener (80% hexamethylene diisocyanate polymer and 20% of butyl acetate)
Paint thinner (mineral spirits)
Other:
Primers (barium sulfate; titanium dioxide; methyl isobutyl ketone, xylene, toluene, ethylbenzene, butyl acetate)
Basecoats, various colors (titanium dioxide, pigments, methyl isobutyl ketone, ethyl acetate, butyl acetate, toluene, ethylbenzene, xylene, lead, and
chromium)
Clearcoat (toluene, xylene, methyl ethyl ketone, ethyl acetate, butyl acetate)
Hardener (80% hexamethylene diisocyanate polymer and 20% of butyl acetate)
Other:
Gun cleaning solvent (methyl ethyl ketone)
Other:
Dust (from paint mist on filters)
Other:
Dust (dry paint)
Other:
(fill in as applicable)
(fill in as applicable)
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Table 3 - Employee Work Practices and Respirator Use - Information for Healthcare Providers
Employee Name: Job Title: Date:
[Note: Fill out the form below for each employee who receives a medical evaluation to wear a respirator.]
Task (check all that apply)
Q Dry sanding
Q Solvent wipe-down
Q Paint mixing
Q Spray painting
Q Spray gun cleaning
Q Filter maintenance
Q Sweeping and clean-up
Q Other:
Proposed Respirator 1
Q half-face APR
Q other:
Q half-face APR
Q other:
Q half-face APR
Q other:
Q hooded SAR
Q other:
Q half-face APR
Q other:
Q half-face APR
Q other:
Q half-face APR
(voluntary user)
(fill in as applicable)
Amount of
time respirator
worn per day 2
Physical
work load 3
Q light
Q moderate
Q heavy
Q light
Q moderate
Q heavy
Q light
Q moderate
Q heavy
Q light
Q moderate
Q heavy
Q light
Q moderate
Q heavy
Q light
Q moderate
Q heavy
Q light
Q moderate
Q heavy
Other PPE used while wearing respirator
safety glasses, nitrile gloves, long-sleeve workshirt
splash goggles, nitrile gloves, long-sleeve workshirt
painter's suit, chemical splash goggles, nitrile gloves
painter's suit, splash goggles, nitrile gloves
splash goggles, nitrile gloves, long-sleeve workshirt
painter's suit, safety glasses, nitrile gloves
safety glasses
1 - Respirator weights: half-face APR weighs approximately 9 ounces, hooded SAR weighs approximately 8 ounces.
2 - Remaining hours each day are spent on masking, paperwork, and other low hazard tasks in the shop or office.
3 - Temperature and humidity extremes: Minimum shop temperature is ° F. Maximum shop temperature is ° F. Q High humidity is possible (check if appropriate).
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4.3 Fit Testing
Fit testing is required for the use of APRs and tight-fitting SARs but not for loose-fitting SARs (hooded
SARs). Employees who wear respirators voluntarily may also be fit tested upon request.
Employees who are required to wear respirators will be fit tested:
Prior to being allowed to wear any respirator with a tight-fitting facepiece (for example a
half-facepiece APR);
Annually; and
When there are changes in the employee's physical condition that could affect respirator
fit (e.g., obvious change in body weight, facial scarring, etc.).
Employees will be fit tested with the make, model, and size of respirator that they will actually wear.
Employees will be provided with several models and sizes of respirators so that they may find an optimal
fit.
The Program Administrator has contracted with
(e.g., the respirator supplier or an industrial hygiene services contractor) to provide qualitative fit tests to
all employees using tight-fitting respirators. The fit tests will be provided on an annual basis (or more
frequently where needed). The contractor provides fit tests, in accordance with one or more of the
following the OSHA-approved Qualitative Fit Test (QLFT) Protocols in Appendix A (A3-4) of the
Respiratory Protection standard (check all that apply):
Q Saccharin (use with particulate filter)
G Bitrex aerosol (use with particulate filter)
Q Isoamyl acetate (use with organic vapor cartridge)
Q Irritant smoke (use with PI00 series particulate filter)
The Program Administrator has determined that a Quantitative Fit Test (QNFT) is not required for the
respirators used under current conditions at this refinish shop. If conditions affecting respirator use
change at the shop, the Program Administrator will evaluate each situation on a case-by-case basis to
determine whether a QNFT is required.
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4.4 Respirator Use
Respiratory protection is required for the following personnel:
Details regarding the tasks, exposure hazards, and required respirator are contained in the hazard
evaluation in Attachment A.
4.4.1 General Use Procedures
Employees will use their respirators under conditions specified by this program, and in
accordance with the training they receive on the use of each particular model. In
addition, the respirator shall not be used in a manner for which it is not certified by
NIOSH or by its manufacturer.
Employees shall conduct user seal checks each time they wear their respirator.
Employees shall use either the positive or negative pressure check (depending on which
test works best for them) specified in Appendix B-l of the Respiratory Protection
standard.
Employees are not permitted to wear tight-fitting respirators if they have any condition,
such as facial scars, facial hair, or missing dentures, that prevents them from achieving a
good seal. Employees are not permitted to wear headphones, jewelry, or other articles if
they interfere with the facepiece-to-face seal.
4.4.2 Emergency Procedures
The Program Administrator has determined that small spills in the mixing area constitute the only
foreseeable emergency requiring respiratory protection. Check the following, as applicable:
G Employees are required to wear half-facepiece air-purifying respirators while performing
mixing. (See hazard evaluation for paint mixing in Attachment A.) No additional
respiratory protection is required for foreseeable emergencies..
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Employees are not required to use respiratory protection while performing routine paint
mixing, but are required to wear half-facepiece air-purifying respirators for responding to
small spills. The respirators are stored in the following location: .
Other (list specific respiratory protection requirements):
4.4.3 Respirator Malfunction
APR Respirator Malfunction: For any malfunction of an APR (e.g., such as contaminant breaking
through the filter or cartridge, facepiece leakage, or improperly working valve), the respirator wearer
must stop performing the task and inform the area supervisor that the respirator is not functioning
properly. The employee should then go to the following designated safe location:
to maintain the respirator. The supervisor must ensure that the employee receives the needed parts to
repair the respirator, or is provided with a new respirator.
Supplied Air Respirator Malfunction: If a painter in the spray booth experiences a problem with the
respirator hood or airline, the employee should stop work, exit the booth immediately, and report the
malfunction to the area supervisor. If the problem cannot be fixed immediately, a tight-fitting full-
facepiece APR equipped with an organic vapor filter with an N95 particulate prefilter may be used
during spray painting activities until the SAR system is repaired. In such cases, all other provisions of
this program must still be met (training, fit tests, medical evaluations, change schedules).
4.5 Breathing Air Quality
Only Grade D quality breathing air is used for supplied air respirators (SARs). This shop uses the
following equipment to provide Grade D breathing air as specified in ANSI/Compressed Gas Association
Commodity Specification for Air (G-7.1-1989)1: (Check all that apply.)
G Fresh air pump: the pump and the air inlet are placed in the following
location: .
Q Shop compressor with appropriate filters, monitors, and alarms
American National Standards Institute (ANSI).
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Testing conducted on the following date, , has confirmed that the
equipment provides air meeting the ANSI/CGA specifications. (Test results are available at the
following location: .)
Air filters for the pump/compressor are changed on a schedule set according to the manufacturer's
guidelines. The change schedule and records are available at the following
location: .
Air is pumped through an opening in the wall to the breathing air hose connections in the spray booth.
The breathing air hoses are made by the same manufacturer as the respirators used in the booth and are
incompatible with the compressed air fittings for the spray gun air hoses.
4.6 Cleaning, Maintenance, Change Schedules, and Storage
4.6.1 Respirator Cleaning
Each employee is issued a respirator for his or her exclusive use. Employees must regularly (at least
once a week) clean and disinfect their respirator(s) (excluding dust masks) at the designated respirator
cleaning station at the following location: .
Employees must use the following procedures when cleaning and disinfecting respirators:
Disassemble respirator, removing any filters, canisters, or cartridges;
Wash the facepiece and associated parts in a mild detergent with warm water. Do not
use organic solvents;
Rinse completely in clean warm water;
Wipe the respirator facepiece with the following type of disinfectant wipes:
. (Check with the respirator manufacturer to identify
an appropriate disinfecting agent that will not damage the respirator facepiece, seals, or
valves.)
Air dry in a clean area;
Reassemble the respirator and replace any defective parts; and
Place in a clean, dry plastic bag or other air tight container.
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Note: The Program Administrator will ensure that there is an adequate supply of appropriate cleaning
and disinfection material at the cleaning station. If supplies are low, employees should contact the
Program Administrator.
4.6.2 Respirator Maintenance
Employees must carefully maintain respirators to ensure that the equipment functions properly and
provides the intended protection. Maintenance involves a thorough visual inspection for cleanliness and
defects. Employees will replace worn or deteriorated parts prior to use, following the recommendations
of the manufacturer. If regulators or alarms for SARs require repair, the equipment will be sent to the
manufacturer's authorized service center. The following checklist will be used when inspecting
respirators:
Q Facepiece:
cracks, tears, or holes
facemask distortion
cracked or loose lenses/face shield
Q Headstraps:
breaks or tears
broken buckles
Valves:
residue or dirt
cracks or tears in valve material
Filters/Cartridges:
NIOSH approval label
gaskets
cracks or dents in housing
proper cartridge for hazard
Air Supply Systems:
breathing air quality/grade
condition of supply hoses
hose connections
settings on regulators and valves
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An employee experiencing a problem with a respirator may leave the work area and go to the following
safe location: , to replace a damaged component,
or to inspect the respirator if vapor breakthrough or leakage around the facepiece is detected. Employees
may also leave the area to wash their faces and respirator facepieces to prevent any eye or skin irritation.
4.6.3 Filter/Cartridge Change Schedules
N9 5 or Nl 00 Filters
Employees wearing APRs with N95 or N100 filters for protection against paint chips and other
particulates shall change the cartridges on their respirators when the filters appear dusty. If employees
begin to experience difficulty breathing (i.e., resistance) while wearing respirators with these types of
cartridges, it is a sure sign that the cartridges need changing.
Organic Vapor Cartridges
Based on discussions with the respirator distributor about workplace exposure conditions, employees
wearing APRs with organic vapor cartridges shall change the cartridges on their respirators on the
following schedule: (e-g-, at the end of each work week) to ensure
the continued effectiveness of the respirators.
4.6.4 Respirator Storage
Whenever respirators are not in use, they must be stored in a clean, dry area, away from direct sunlight,
and in accordance with the manufacturer's recommendations. Each employee must clean and inspect his
or her own respirator, using the steps outlined in this program. Workers store their respirators in sealed
plastic bags in the following location: . They must label their
respirator storage bags with their names and must keep their respirators in their own bags.
The Program Administrator maintains the supply of respirators and respirator components in their
original manufacturer's packaging in the following location: .
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4.6.5 Defective Respirators
Respirators that are defective or have defective parts shall be taken out of service immediately. If, during
an inspection, an employee discovers a problem with a respirator, the employee is to bring the defect to
the attention of the Program Administrator. The Program Administrator will decide whether to:
Temporarily take the respirator out of service until it can be repaired;
Perform a simple fix on the spot, such as replacing a headstrap; or
Dispose of the defective respirator.
When a respirator is disposed of or taken out of service, the employee will be given a replacement of the
same make, model, and size. Respirators out of service for an extended period of time will be tagged as
out of service. All tagged-out respirators will be kept in the following location until repaired or disposed
of: .
4.7 Training
The Program Administrator provides training to respirator users. The training covers the contents of this
shop's Respiratory Protection Program, individual responsibilities under the program, and information
about the OSHA Respiratory Protection standard. All employees are trained prior to using a respirator in
the workplace. The training course covers the following topics:
This Respiratory Protection Program;
OSHA Respiratory Protection standard;
Respiratory hazards encountered here and their health effects;
Proper selection and use of respirators;
Limitations of respirators;
Respirator donning and user seal (fit) checks;
Fit testing;
Maintenance and storage; and
Medical signs and symptoms limiting the effective use of respirators.
Employees are retrained annually or as needed (e.g., if they change departments and need to use a
different respirator). Employees must demonstrate their understanding of the topics covered in the
training through hands-on exercises and a written test. Respirator training is documented by the Program
Administrator. This documentation must include the type, model, and size of respirator for which each
employee has been trained and fit tested.
18
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5.0 PROGRAM EVALUATION
The Program Administrator will conduct periodic evaluations of the workplace to ensure that the
provisions of this program are being implemented. The evaluations will include regular consultations
with employees who use respirators, site inspections, air monitoring, and a review of records.
Problems will be noted in an inspection log and addressed by the Program Administrator. These findings
will be reported to the shop's management, and the report will list plans to correct deficiencies in the
respirator program and target dates for the implementation of those corrections.
6.0 DOCUMENTATION AND RECORDKEEPING
The Program Administrator will maintain the documentation and records listed below in the following
location:
A written copy of this program and OSHA's Respiratory Protection standard. Note, the
program and standard shall be accessible to all employees upon request.
Copies of training and fit test records. These records will be updated as new employees
are trained, as existing employees receive refresher training, and as new fit tests are
conducted.
The results of any air monitoring and of SAR breathing air quality tests.
Copies of the physician's written recommendation regarding each employee's ability to
wear a respirator. Note, the completed medical questionnaire and the physician's
documented findings are confidential and will remain at the physician's office.
Affected employees are provided access to these records.
Unless otherwise noted above, all documentation and records related to the respiratory protection
program will be accessible to affected employees (or their designated representatives) only.
19
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ATTACHMENT A:
RESULTS OF HAZARD EVALUATION FOR
(hop name)
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Hazard Evaluation For: Dry Sanding
Activities:
(Describe types of dry sanding activities.)
Hazards: Dust from sanding may irritate the eyes, nose, throat, and/or lungs. Depending on the source, this dust
may also have other hazardous characteristics that can cause additional adverse health effects. For example, dust
exposure may result from sanding hardened epoxy, polyurethane paint, and small amounts of body filler, which may
contain lead.
Controls: The following controls and procedures are used to minimize health hazards associated with dry sanding
activities (check all that apply):
Q Sanding jobs are performed primarily using vacuum sanders.
Q Painters are required to minimize the amount of dry sanding performed without vacuum sanders or
other local exhaust ventilation. (E.g., painters instructed to use wet sanding methods as much as
possible).
Q All sanding is performed at a prep station equipped with the following type of local exhaust
ventilation: (e.g., downdraft or crossdraft ventilation).
Q Other:
Respiratory Protection:
Q Half-facepiece air-purifying respirators (APRs), with N100 filters are required for employees
performing dry sanding without vacuum sanders or other local exhaust ventilation systems.
Q Respirators are not required: All sanding jobs are performed using vacuum sanders.
Q Respirators are not required: Personal breathing zone monitoring indicates that employee exposure
levels are below the OSHA permissible exposure limits for workers performing dry sanding tasks.
Employee exposure monitoring was conducted on the following date(s): .
The monitoring results are available at the following location: .
Q Other:
The following employees perform sanding tasks (list each employee's name and the amount of time they spend
on this task in a typical day):
A-l
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Hazard Evaluation For: Solvent Wipe-Down
Activities: Painters wipe car parts with organic solvent-laden rags to remove oil, grease, wax, and residual dust from
surfaces.
Hazards: Solvent wipe solutions contain the following hazardous substances: acetone, methyl ethyl ketone, toluene,
xylene, acetates, and light aliphatic solvent naphtha. List other hazardous materials present in your solvent products
(see your MSDS for the product):
Organic solvents may irritate the eyes, nose, throat, and/or lungs. Some solvents affect the nervous system, causing
headaches, confusion, and other problems (see the MSDS for information on the health hazards of specific solvents).
The following products are used for this task: .
Controls: The following controls and procedures are used to minimize health hazards associated with solvent wipe-
down activities (check all that apply):
Q Painters perform solvent wipe-down in a spray booth or prep station equipped with the following
type of local exhaust ventilation: (e.g., downdraft,
semi-downdraft, crossdraft).
Q To help keep the organic vapors to a minimum, painters are required to use organic solvents
sparingly, i.e., to use just enough solvent for an effective wipe-down.
Q Painters perform solvent wipe-down near the following source(s) of ventilation:
(specify ventilation type/design).
Q Other:
Respiratory Protection:
Q Half-facepiece APRs with organic vapor cartridges must be worn by painters performing solvent
wipe-down outside the shop's ventilated booth or prep station.
Q Respirators are not required: All solvent wipe-down tasks are performed in the ventilated spray
booth or prep station with the exhaust fan operating.
Q Respirators are not required: Personal breathing zone monitoring indicates that employee exposure
levels are below the OSHA permissible exposure limits for workers performing solvent wipe down
tasks. Employee exposure monitoring was conducted on the following date(s) .
The results are available at the following location: .
Q Other:
The following employees perform solvent wipe-down tasks (list each employee's name and the amount of time
they spend on this task in a typical day):
A-2
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Hazard Evaluation For: Paint Mixing
Activities: Painters usually mix three types of coatings (primers, basecoats, and clearcoats) for every auto
refinishing job. Hardeners and paint thinners are sometimes also added to the mixtures.
Hazards: Coatings and other chemicals used for paint mixing are comprised of the following hazardous substances:
Primers (barium sulfate; titanium dioxide; methyl isobutyl ketone, xylene, toluene, ethylbenzene, butyl
acetate)
Basecoats. various colors (titanium dioxide, pigments, methyl isobutyl ketone, ethyl acetate, butyl acetate,
toluene, ethylbenzene, xylene, lead and chromium)
Clearcoat (toluene, xylene, methyl ethyl ketone, ethyl acetate, butyl acetate)
Hardener (80% hexamethylene diisocyanate polymer and 20% of butyl acetate)
Paint thinner (mineral spirits)
Other (see product MSDSs):
Inhaling vapors from paints and solvents may affect the nervous system, causing headaches, dizziness and
lightheadedness. According to the MSDSs, all clearcoat formulations and some primer formulations contain
isocyanates (isocyanates are a major component of the hardeners added to these formulations). See
http://www.cdc.gov/niosh/asthma.html for NIOSH Alert "Preventing Asthma and Death from Diisocyanate
Exposure."
Controls: The following controls and procedures are used to minimize health hazards associated with paint mixing
activities (check all that apply):
Q Painters perform mixing in the mixing room to minimize exposure to others in the rest of the
facility.
Q To help control the accumulation of vapors in the mixing room, the facility has installed the
following type of ventilation system: .
Q To help prevent the release of solvent vapors in the mixing room, painters are instructed to keep all
containers tightly sealed when not in use.
Q Other: (e.g., a local exhaust ventilation hood).
Respiratory Protection:
Q Half-facepiece APRs with organic vapor cartridges must be worn by painters performing paint
mixing.
Q Respirators are not required: Personal breathing zone monitoring indicates that employee exposure
levels are below the OSHA permissible exposure limits for workers performing paint mixing tasks.
Employee exposure monitoring was conducted on the following date(s) . The
results are available at the following location: .
Q Other:
The following employees perform paint mixing tasks (list each employee's name and the amount of time they
spend on this task in a typical day):
A-3
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Hazard Evaluation For: Spray Painting _
Activities: Painters apply three basic types of coatings (primers, basecoats, and clearcoats) using a paint spray gun.
Hazards: Coatings used for spray painting are comprised of the following hazardous substances:
Primers (barium sulfate; titanium dioxide; methyl isobutyl ketone, xylene, toluene, ethylbenzene, butyl
acetate)
Basecoats. various colors (titanium dioxide, pigments, methyl isobutyl ketone, ethyl acetate, butyl acetate,
toluene, ethylbenzene, xylene, lead and chromium)
Clearcoat (toluene, xylene, methyl ethyl ketone, ethyl acetate, butyl acetate)
Hardener (80% hexamethylene diisocyanate polymer and 20% of butyl acetate)
Other (see MSDSs product): _
Spray painting has the greatest potential for elevated worker exposures to the hazardous ingredients in paints. The
paint droplets contain all of the components of the paint, including several types of organic solvents and
isocyanates. Paint mists can carry all these components into the lungs. Isocyanates present serious health risks,
including asthma, allergic lung and skin reactions, and chronic lung disease. See
http://www.cdc.gov/niosh/asthma.html for NIOSH Alert "Preventing Asthma and Death from Diisocyanate
Exposure."
Controls: The following controls and procedures are used to minimize health hazards associated with spray painting
activities (check all that apply):
Q Shop is equipped with a ventilated spray booth. List type and number of spray booths (e.g.,
downdraft, semi-downdraft, crossdraft): _ .
Q Shop is equipped with a ventilated prep station for priming and small touch-up applications. List type
and number of prep stations (e.g., downdraft, semi-downdraft, crossdraft): _ .
Q IT IS AGAINST SHOP POLICY TO PERFORM SPRAY PAINTING OUTSIDE OF THE BOOTH OR PREP STATION.
Q Painters properly maintain the spray booth and prep station (e.g., change filters on a regular basis) to
ensure the ventilation systems operate effectively.
Q Painters use HVLP spray guns for all applications to minimize overspray. (See NIOSH publication,
"Control of Paint Overspray in Autobody Repair Shops," http://www.cdc.gov/niosh/paintovr.html.)
Q Other: _ .
Respiratory Protection:
A hooded, supplied-air respirator (SAR), used in the continuous flow mode, must be worn by all
employees performing spray painting.
A full face-piece powered air-purifying respirator (PAPR) with a protection factor of at least 25 must
be worn be all employees performing spray painting.
Other (note, since this task requires eye protection and a higher level of protection, half -mask
respirators are not acceptable): _ .
The following employees perform spray painting tasks (list each employee's name and the amount of time they
spend on this task in a typical day):
A-4
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Hazard Evaluation For: Spray Gun Cleaning
Activities:
(Describe the gun cleaning procedures used in the shop.)
Hazards: Methyl ethyl ketone (MEK), a major component of gun cleaning solvent, evaporates quickly and its vapors
may be harmful to painters if inhaled. According to the MSDS, MEK may cause headaches, nausea, vomiting,
dizziness, drowsiness, irritation of the respiratory tract, and loss of consciousness when inhaled. The following link
allows a search on various MSDSs: http://siri.uvm.edu/msds/. Refer to your product MSDS for additional hazardous
materials present in your gun cleaning solution.
In addition to gun cleaning solvent, components of residual paint may also pose hazards.
Controls: The shop has the following controls and procedures in place to minimize hazards associated with spray
gun cleaning (check all that apply):
Q Shop equipped with an automatic gun cleaner that minimizes the need for manual gun cleaning. List
type of gun cleaner used (e.g., enclosed basin, parts washing sink):
Q Gun cleaner equipped with an exhaust ventilation system to remove vapors from the work area (e.g.,
ventilated parts washing sink).
Q Gun cleaner located near other source of exhaust ventilation. Describe ventilation:
Q Ventilated work station provided for manual gun cleaning tasks.
Q Spray gun cleaning takes place in the mixing room to minimize exposure to others in the rest of the
facility.
Q Other:
Respiratory Protection:
Q Half-facepiece APRs with organic vapor cartridges must be worn during the gun cleaning process since
a certain amount of manual cleaning is necessary and workers may be exposed to solvent vapors during
this process. For example, to extend the service life of the cleaning solvent in the automatic gun
cleaner, painters may manually pre-rinse the gun cup to remove gross contamination before placing the
gun and cup in the automatic cleaner. Painters may also be exposed to solvents when opening and
closing the gun cleaner, when positioning the guns and gun cups in the cleaner, and when retrieving
guns and gun cups that are still wet with solvent.
Q Respirators are not required: Personal breathing zone monitoring indicates that employee exposure
levels are below the OSHA permissible exposure limits for workers performing gun cleaning tasks.
Employee exposure monitoring was conducted on the following date(s): .
The results are available at the following location: .
Q Other:
The following employees perform spray gun cleaning tasks (list each employee's name and the amount of time
they spend on this task in a typical day):
A-5
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Hazard Evaluation For: Spray Booth Maintenance
Activities: The automotive spray booth filters must be replaced periodically. Employees change the filters
according to the following schedule or conditions: . For
this task the ventilation system must be turned off while workers open the units and replace old filters with new ones.
Hazards: Some dust is inevitably released during the removal and handling of spent filters. Dust from filters may
irritate the eyes, nose, throat, and/or lungs.
Controls:
(Describe any site-specific controls for this operation.)
Respiratory Protection:
Q Employees must wear half-facepiece APRs with N95 filters while performing this task.
Q Respirators are not required: Personal breathing zone monitoring indicates that employee exposure
levels are below the OSHA permissible exposure limits for the exposures of workers performing this
activity. Employee exposure monitoring was conducted on the following date(s)
The monitoring results are available at the following location:
Q Other:
The following employees perform spray booth maintenance tasks (list each employee's name and the amount of
time they spend on this task in a typical day):
A-6
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[Blank Form]
Hazard Evaluation For:
(Name of Task)
Activities: (List specific activities associated with this task.)
Hazards: (List all respiratory hazards associated with this task. For detailed information on the hazards, refer to
MSDSs for the specific substances in use at the shop.)
Controls: (List any site-specific controls and procedures in place to minimize exposure to the hazards described
in the above section.)
Respiratory Protection: (List required respiratory protection.)
The following employees perform this task (list each employee's name and the amount of time they spend on this
task in a typical day):
A-7
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ATTACHMENT B:
Respirator Medical Evaluation Questionnaire
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Respirator Medical Evaluation Questionnaire
Appendix C to OSHA's Respiratory Protection Standard, 1910.134
Date:
Name: SS#
To the employee:
Can you read (check one)? Yes No
Your employer must allow you to answer this questionnaire during normal working hours, or at a
time and place that is convenient to you. To maintain your confidentiality, your employer or
supervisor must not look at or review your answers, and your employer must tell you how to
deliver or send this questionnaire to the company's occupational health care provider, who will
review it.
PART A. SECTION 1 (Mandatory)
The following information must be provided by every employee who has been selected to use any
type of respirator (please print).
1. Today's date:
2. Your name:
3. Your age (to nearest year):
4. Sex: Male Female
5. Your height: ft. in.
6. Your weight: Ibs
7. Your job title:
8. A telephone number where you can be reached by CORPORATE HEALTH CENTER.
Area code ( ) .
9. The best time to phone you at this number:
10. Has your employer told you how to contact CORPORATE HEALTH CENTER who will review
this questionnaire? Yes No
11. Check the type of respirator you will use (you can check more than one category):
a. N, R, or P disposable respirator (filter-mask, non-cartridge type only).
B-l
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Respirator Medical Evaluation Questionnaire
Appendix C to OSHA's Respiratory Protection Standard, 1910.134
b. Other type (for example, half- or full-facepiece type, powered-air purifying,
supplied air, self-contained breathing apparatus).
12. Have you worn a respirator? Yes No If yes, what type(s):
PART A. SECTION 2 (Mandatory)
Questions 1 through 9 below must be answered by every employee who has been selected to use
any type of respirator (please check "yes" or "no").
YES NO
1. Do you currently smoke tobacco, or have you smoked tobacco
in the last month?
2. Have you ever had any of the following conditions?
a. Seizures (fits)
b. Diabetes (sugar disease)
c. Allergic reactions that interfere with your breathing
d. Claustrophobia (fear of closed-in places)
e. Trouble smelling odors
3. Have you ever had any of the following pulmonary or lung
problems?
a. Asbestosis
b. Asthma
c. Chronic bronchitis
d. Emphysema
e. Pneumonia
f. Tuberculosis
g. Silicosis
h. Pneumothorax (collapsed lung)
i. Lung cancer
j. Broken ribs
k. Any chest injuries or surgeries
1. Any other lung problems that you've been told about
4. Do you currently have any of the following symptoms?
a. Shortness of breath
B-2
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Respirator Medical Evaluation Questionnaire
Appendix C to OSHA's Respiratory Protection Standard, 1910.134
YES NO
b. Shortness of breath when walking fast on level ground
or walking up a slight hill or incline
c. Shortness of breath when walking with other people at
an ordinary pace on level ground
d. Have to stop for breath when walking at your own pace
on level ground
e. Shortness of breath when washing or dressing yourself
f. Shortness of breath that interferes with your job
g. Coughing that produces phlegm (thick sputum)
h. Coughing that wakes you early in the morning
i. Coughing that occurs mostly when you are lying down
j. Coughing up blood in the last month
k. Wheezing
1. Wheezing that interferes with your job
m. Chest pain when you breathe deeply
n. Any other symptoms that you think may be related to
lung problems
Have you ever had any of the following cardiovascular or heart
problems?
a. Heart attack
b. Stroke
c. Angina
d. Heart failure
e. Swelling in your legs or feet (not caused by walking)
f. Heart arrhythmia (heart beating irregularly)
g. High blood pressure
h. Any other heart problem that you've been told about
Have you ever had any of the following cardiovascular or heart
symptoms?
a. Frequent pain or tightness in your chest
b. Pain or tightness in your chest during physical activity
c. Pain or tightness in your chest that interferes with your
job
d. In the past two years, have you noticed your heart
skipping or missing a beat?
e. Heartburn or indigestion that is not related to eating
f. Any other symptoms that you think may be related to
heart or circulation problems
B-3
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Respirator Medical Evaluation Questionnaire
Appendix C to OSHA's Respiratory Protection Standard, 1910.134
YES NO
7. Do you currently take medication for any of the following
problems?
a. Breathing or lung problems
b. Heart trouble
c. Blood pressure
d. Seizures (fits)
8. If you've used a respirator, have you ever had any of the
following problems? (If you've never used a respirator, check
the following space and go to Question 9)
a. Eye irritation
b. Skin allergies or rashes
c. Anxiety
d. General weakness or fatigue
e. Any other problem that interferes with your use of a
respirator
9. Would you like to talk to the health care professional who will
review this questionnaire about your answers to this
questionnaire?
Questions 10 to 15 below must be answered by every employee who has been selected to use
either a Full-facepiece Respirator or a Self-contained Breathing Apparatus (SCBA). For
employees who have been selected to use other types of respirators, answering these questions
is voluntary.
YES NO
10. Have you ever lost vision in either eye (temporarily or
permanently)?
11. Do you currently have any of the following vision problems?
a. Wear contact lenses
b. Wear glasses
c. Color blind
d. Any other eye or vision problem
12. Have you ever had an injury to your ears, including a broken
ear drum?
B-4
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Respirator Medical Evaluation Questionnaire
Appendix C to OSHA's Respiratory Protection Standard, 1910.134
YES NO
13. Do you currently have any of the following hearing problems?
a. Difficulty hearing
b. Wear a hearing aid
c. Any other hearing or ear problem
14. Have you ever had a back injury?
15. Do you currently have any of the following musculoskeletal
problems?
a. Weakness in any of your arms, hands, legs, or feet
b. Back pain
c. Difficulty fully moving your arms and legs
d. Pain or stiffness when you lean forward or backward at
the waist
e. Difficulty fully moving your head up or down
f. Difficulty fully moving your head side to side
g. Difficulty bending at your knees
h. Difficulty squatting to the ground
i. Difficulty climbing a flight of stairs or a ladder carrying
more than 25 Ibs.
j. Any other muscle or skeletal problem that interferes
with using a respirator
PARTB
Any of the following questions, and other questions not listed, may be added to the questionnaire
at the discretion of the health care professional who will review the questionnaire.
1. In your present job, are you working at high altitudes (over 5,000 feet) or in a place that
has lower than normal amounts of oxygen: Yes No
If "yes," do you have feelings of dizziness, shortness of breath, pounding in your chest, or
other symptoms when you're working under these conditions: Yes No
2. At work or at home, have you ever been exposed to hazardous solvents, hazardous
airborne chemicals (e.g., gases, fumes, or dust), or have you come into skin contact with
hazardous chemicals: Yes No
If "yes," name the chemicals if you know them:
B-5
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Respirator Medical Evaluation Questionnaire
Appendix C to OSHA's Respiratory Protection Standard, 1910.134
YES NO
3. Have you ever worked with any of the materials, or under any of
the conditions, listed below (please check "yes" or "no"):
a. Asbestos
b. Silica (e.g., in sandblasting)
c. Tungsten/cobalt (e.g., grinding or welding this material)
d. Beryllium
e. Aluminum
f. Coal (for example, mining)
g. Iron
h. Tin
I. Dusty environments
j. Any other hazardous exposures
If "yes," describe these exposures:
4. List any second jobs or side businesses you have:
5. List your previous occupations:
6. List your current and previous hobbies:
7. Have you been in the military services? Yes No_
If "yes," were you exposed to biological or chemical agents (either in training or combat):
Yes No
8. Have you ever worked on a HAZMAT team? Yes No_
B-6
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Respirator Medical Evaluation Questionnaire
Appendix C to OSHA's Respiratory Protection Standard, 1910.134
9. Other than medications for breathing and lung problems, heart trouble, blood pressure,
and seizures mentioned earlier in this questionnaire, are you taking any other medications
for any reason (including over-the-counter medications): Yes No
If "yes," name the medications if you know them:
YES NO
10. Will you be using any of the following items with your
respirator(s) (please check "yes" or "no")?
a. HEPA Filters
b. Canisters (for example, gas masks)
c. Cartridges
11. How often are you expected to use the respirator(s) (please check
"yes" or "no" for all answers that apply to you)?
a. Escape only (no rescue)
b. Emergency rescue only
c. Less than 5 hours per week
d. Less than 2 hours per day
e. 2 to 4 hours per day
f. Over 4 hours per day
12. During the period you are using the respirator(s), is your work effort:
Light (less than 200 kcal per hour): Yes No
If "yes," how long does this period last during the average shift:
hrs. mins.
Examples of a light work effort are sitting while writing, typing, drafting, or performing
light assembly work; or standing while operating a drill press (1-3 Ibs.) or controlling
machines.
Moderate (200 to 350 kcal per hour): Yes No
If "yes," how long does this period last during the average shift:
hrs. mins.
Examples of moderate work effort are sitting while nailing or filing; driving a truck or
bus in urban traffic; standing while drilling, nailing, performing assembly work, or
transferring a moderate load (about 35 Ibs.) at trunk level; walking on a level surface
about 2 mph or down a 5-degree grade about 3 mph; or pushing a wheelbarrow with a
heavy load (about 100 Ibs.) on a level surface.
B-7
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Respirator Medical Evaluation Questionnaire
Appendix C to OSHA's Respiratory Protection Standard, 1910.134
Heavy (above 350 kcal per hour): Yes No
If "yes," how long does this period last during the average shift:
hrs. mins.
Examples of heavy work are lifting a heavy load (about 50 Ibs.) from the floor to your
waist or shoulder; working on a loading dock; shoveling; standing while bricklaying or
chipping castings; walking up an 8-degree grade about 2 mph; climbing stairs with a
heavy load (about 50 Ibs.).
13. Will you be wearing protective clothing and/or equipment (other than the respirator)
when you're using your respirator: Yes No
If "yes," describe this protective clothing and/or equipment:
14. Will you be working under hot conditions (temperature exceeding 77 deg. F):
Yes No
15. Will you be working under humid conditions: Yes No
16. Describe the work you'll be doing while you're using your respirator(s):
17. Describe any special or hazardous conditions you might encounter when you're using
your respirator(s) (for example, confined spaces, life-threatening gases):
18. Provide the following information, if you know it, for each toxic substance that you'll be
exposed to when you're using your respirator(s):
Name of the first toxic substance:
Estimated maximum exposure level per shift:
Duration of exposure per shift:
Name of the second toxic substance:
Estimated maximum exposure level per shift:
Duration of exposure per shift:
Name of the third toxic substance:
B-8
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Respirator Medical Evaluation Questionnaire
Appendix C to OSHA's Respiratory Protection Standard, 1910.134
Estimated maximum exposure level per shift:
Duration of exposure per shift:
The name of any other toxic substances that you'll be exposed to while using your
respirator:
19. Describe any special responsibilities you will have while using your respirator(s) that may
affect the safety and well-being of others (for example, rescue, security):
B-9
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