UNIVERSITY OF LOUISVILLE
RESPIRATORY PROTECTION
UNIT SPECIFIC PLAN
Each department, unit or group covered under the OSHA Respiratory Protection
Standard, 29 CFR 1910.134, and the UofL Respiratory Protection Program must develop
a unit-specific plan for the respiratory hazards encountered in that work area.
A completed plan is required for all departments with employees who are required to use
or voluntarily wear respirators during work, for both routine tasks and emergencies.
Individual plans must establish policies and procedures SPECIFICALLY addressing
hazard assessment, respirator selection and use, medical evaluation and qualification, fit
testing, training and recordkeeping for their respective units.
This template is provided as a guide for the development of the required written plan.
Individual departments and supervisors can use this template to design a Respiratory
Protection Plan customized for their workplace by inserting the appropriate information
as indicated in this document.
A copy of the UofL Respiratory Protection Program Must be included with the
Unit-Specific Plan
If you have questions or require assistance with completing or implementing this
plan, please contact the University of Louisville, Department of Environment Health
and Safety, Industrial Hygiene Section.
Respiratory Protection Program Administrator: 852-2961
University of Louisville
Department of Environmental Health & Safety
Modified on October 25, 2007
http://louisville.edu/dehs/ohs/respiratory-protection
UNIVERSITY OF LOUISVILLE
UNIT SPECIFIC
RESPIRATORY PROTECTION PLAN
Table of Contents
Identification and Responsibility ..................................................................................... 3
Written Unit-Specific Plan ............................................................................................... 3
Hazard Assessment ........................................................................................................... 3
Medical Evaluation and Certification ............................................................................. 4
Education and Training ................................................................................................... 5
Fit Testing .......................................................................................................................... 6
Respirator Selection .......................................................................................................... 7
Respirator Inspection, Cleaning, Storage, and Maintenance ....................................... 8
Documentation and Recordkeeping ................................................................................ 9
Program Evaluation........................................................................................................ 10
Supporting Documents ................................................................................................... 10
University of Louisville
Department of Environmental Health & Safety
Modified on October 25, 2007
http://louisville.edu/dehs/ohs/respiratory-protection
UNIVERSITY OF LOUISVILLE
UNIT SPECIFIC
RESPIRATORY PROTECTION PLAN
This document is a summary of the main requirements of the UofL Respiratory
Protection Program as it applies to this unit. It identifies the individuals responsible for
implementing these requirements and sets the specific procedures used to ensure
compliance with the UofL policy and OSHA Standards. This document is used in
conjunction with the UofL Respiratory Protection Program, which explains these
requirements in detail. Therefore, a copy of the Respiratory Protection Program must be
accessible and maintained with this plan.
Identification and Responsibility
In accordance with the OSHA Respiratory Protection Standard, 1910.134, and the UofL
Respiratory Protection Program, the following plan has been developed for the following
unit:
Dept, School, or Unit
Location: Campus, Bldg, Rm. #
Responsible Supervisor, PI, Manager or PD
Job Title or Position
Preparation Date
The Responsible Supervisor, (supervisor) as defined in the UofL Respiratory Protection
Program is ultimately accountable and responsible for ensuring that the Unit-Specific
Respiratory Protection Plan is complete and implemented as described, and that it is
understood and followed by the employees under their charge.
Written Unit-Specific Plan
Unit-Specific Respiratory Protection Plan and UofL Respiratory Protection Program
are accessible to employees in the following location(s):
While the supervisor is responsible for implementing each of the elements described
within the written Respiratory Protection Plan, it is permissible to delegate some tasks to
other capable employees, provided the roles are clearly documented and understood.
Hazard Assessment
University of Louisville
Department of Environmental Health & Safety
Modified on October 25, 2007
http://louisville.edu/dehs/ohs/respiratory-protection
When an overexposure to an airborne contaminant is suspected, either during routine
operations or during a foreseeable emergency, it is important that a thorough hazard
evaluation be conducted. The DEHS Respirator Protection Program Administrator must
be notified of any workplace conditions where airborne contaminants may be present and
potential worker exposure may exist. DEHS must also be notified for a re-assessment
when there are changes in workplace conditions or operations that may affect employee
exposure. Initial and periodic workplace assessments must be conducted by the
responsible supervisor, or designee, to ensure DEHS is contacted for hazard assessments
in a timely manner.
Assessment of Bioaerosols: Please contact the Biosafety Officer or call 852-6670 for
information concerning respirator use for biological hazards.
Workplace Review and Hazard Assessment – Responsibility: The following
employee(s) are responsible for conducting initial and periodic review of workplace
conditions and operations for potential worker exposures AND contacting DEHS for a
Hazard Assessment:
Workplace Review and Hazard Assessment – Procedure: The following procedures
are used for conducting the initial and periodic review of workplace conditions and
operations for potential respiratory hazards:
Medical Evaluation and Certification
Employees slated for respirator use, either in required-use or voluntary-use situations,
must receive medical respirator certification before respirator use is permitted. Exception:
Medical Evaluations are not required for Voluntary Use of filtering facepiece respirators
(dust masks).
The medical evaluation for Respirator Qualification is conducted using the Respirator
Medical Evaluation Questionnaire. The employee’s supervisor, or designee, provides
each employee who uses a respirator (except voluntary use of a dust mask) with a copy of
Medical Questionnaire and is responsible for assuring the questionnaire is administered
confidentially during the employee’s normal working hours or at time and place
convenient to the employee and delivered to the physician or clinic.
The responsible supervisor, or designee, must also provide the clinic or physician with
specific information about the employee’s work place conditions. The worksheet,
Worksite Information Regarding Respirator Use is provided to help collect the needed
information.
University of Louisville
Department of Environmental Health & Safety
Modified on October 25, 2007
http://louisville.edu/dehs/ohs/respiratory-protection
Medical Evaluation - Responsibility: The following employee(s) are responsible for
ensuring all employees covered under this section are provided with the Respirator
Medical Evaluation and Questionnaire and Respirator Certification
Medical Evaluation – Procedure: The following procedures are used for providing
employees, at no charge to the employee, with the Medical Evaluation Questionnaire
for Respirators, including any follow-up diagnostic tests or procedures deemed
necessary by the Physician:
.
The following procedures are used for providing physician with employee’s workplace
information, including use of Worksite Information Regarding Respirator Use
.
Medical Certification Records: The following procedures are used for obtaining and
maintaining Medical Certification for Respirator Use
Education and Training
Respiratory Protection Training is mandatory for employees who wear respiratory
protection against hazardous air contaminants and their supervisors.
Training - Responsibility: The following employee(s) are responsible for ensuring all
employees covered under this plan receive all required Respiratory Protection Training
and/or Information
The responsible supervisor, or designee, must assure each employee required to wear a
respirator receives the UofL General Respiratory Protection Training provided by DEHS
prior to initial use of a respirator and annually thereafter, as long as the employee
continues to use respiratory protection.
UofL General Training - Procedure: Describe the methods used to ensure employees
are provided with initial and annual/refresher UofL General Respiratory Protection.
The supervisor or the designee will conduct the unit- specific training focusing on the
specifics of the unit’s respiratory protection plan and the respiratory hazards that
employees may encounter.
University of Louisville
Department of Environmental Health & Safety
Modified on October 25, 2007
http://louisville.edu/dehs/ohs/respiratory-protection
This training will be provided before the employee is assigned to wear a respirator, and
whenever a new hazard is introduced into the work area, or if re-training appears
necessary to ensure safe use of respirators.
Unit Specific Training - Responsibility: The following employee(s) are responsible for
ensuring employees receive the unit-specific Respiratory Protection Training
.
Unit-Specific Training - Procedure: Describe the methods used to ensure employees
are provided with initial and annual/refresher Unit-Specific Training including the
contents of the training.
For employees who choose to wear a respirator but are not required to do so, the
responsible supervisor, or designee, must provide the advisory information: Information
for Employees for Voluntary Use of Respirators.
Information for Voluntary Use - Responsibility: The following employee(s) is
responsible for ensuring employees who voluntarily wear a respirator when not required,
are provided with the required information
Information for Voluntary Use - Procedure: Describe the methods used to ensure
employees are provided with information and training appropriate for voluntary use of
respirators, including elastomeric or filtering facepiece (dust mask)
Fit Testing
Fit testing is mandatory for employees required to wear a tight fitting respirator for their
job, including both elastomeric and filtering facepiece respirators. Fit Testing is
conducted by DEHS; please contact the Respiratory Protection Program Administrator to
schedule fit testing.
If the fit testing is not conducted by DEHS, the responsible supervisor, or designee, must
ensure the testing is conducted in accordance with OSHA Quantitative or Qualitative fit
test procedures and must ensure the employee will wear on the job, the exact brand,
model and size of the respirator(s) they were successfully fit tested. Fit Test records must
be forwarded to DEHS prior to the employee’s use of the respirator.
Fit testing is required:
 Before a respirator is provided or used in the work place.
 At least annually
 Whenever an employee switches to a different tight fitting respirator (e.g.
different size, make, model or type)
University of Louisville
Department of Environmental Health & Safety
Modified on October 25, 2007
http://louisville.edu/dehs/ohs/respiratory-protection


When there are changes in the employee’s physical condition that could affect the
respirator fit (e.g. an obvious change in body weight, facial scarring, extensive
dental work, or cosmetic surgery) either reported by the employee, observed by
the employee’s supervisor, PLHCP or the Program Administrator.
When an employee reports that their respirator does not fit properly (e.g. smelling
a contaminant while wearing the respirator with new cartridges, hearing or feeling
air leaking around the facepiece).
Fit testing will not be conducted until DEHS has a copy of the employee’s signed
Medical Qualification for Respirator Use.
Fit Testing - Responsibility: The following employee(s) are responsible for ensuring
employees are provided with fit testing as required.
Fit Testing - Procedure: Describe the methods used to ensure employees are provided
with initial and annual Fit testing. Include procedures to provide DEHS with Medical
Certification documents.
Respirator Selection and Use
The responsible supervisor, or designee, will provide employees the appropriate type(s)
of respirator and filter or cartridge/canister, with guidance as needed from DEHS
Industrial Hygiene section. The respirator must be approved by the Respiratory
Protection Administrator prior to use.
Appropriate respirators will be selected that are NIOSH certified and adequate to protect
the health of the employee and ensure compliance with all other OSHA requirements,
under routine and reasonably foreseeable emergencies. Respiratory protection may also
be provided for substances not regulated by OSHA, but may be of concern due to their
toxicity (i.e. hazardous substances used in research, cytotoxic or other hazardous drugs).
Respirator Selection - Responsibility: The following employee(s) are responsible for
ensuring employees are provided with appropriate respirators and accessories
Respirator Selection - Procedure: Describe the methods used for the following:
How to Identify Potential Respiratory Hazards
When and How to Contact DEHS
University of Louisville
Department of Environmental Health & Safety
Modified on October 25, 2007
http://louisville.edu/dehs/ohs/respiratory-protection
Purchase and Issuance of Respirators - Responsibility: The following individuals are
responsible for providing the appropriate respirators, parts and components for selected
for employees.
Purchase and Issuance of Respirators - Procedure: Describe the methods used to
ensure employees are provided with the approved respirator(s), parts and components,
selected for them initially and thereafter.
Change-Out Schedules For all filters and cartridges/canisters change-out schedules will
be developed by the responsible supervisor or designee.
Respirator Change-Out Schedule - Responsibility: The following employee(s) are
responsible for developing the respirator change-out schedule.
.
Respirator Change-Out Schedule - Procedure: Describe the method used to determine
the cartridge change-out schedule
.
Complete for each process, contaminant or type of respirator, the associated
Cartridge/Canister Change-Out Schedule.
Respirator Cartridge Change-Out Schedule
Task or Process
Specific Air
Contaminant
Respirator &
Cartridge Type
Time of Cartridge
Change
Respirator Inspection, Cleaning, Storage, and Maintenance
All respiratory equipment must be clean, sanitary and in good working order. A checklist
for inspection, cleaning and sanitizing respirators may be useful for employees assigned
to cleaning their own respirator.
Only the respirator manufacturer’s NIOSH Certified parts, designed for that respirator,
may be used. No components may be replaced or repairs made beyond those
recommended by the manufacturer. Only those people who are appropriately trained to
perform respirator repair and maintenance may do so. Under no circumstance may an
employee use a defective respirator.
University of Louisville
Department of Environmental Health & Safety
Modified on October 25, 2007
http://louisville.edu/dehs/ohs/respiratory-protection
Respirator Cleaning, storage and maintenance - Responsibility: The following
employee(s) are responsible for ensuring respirators are appropriately inspected, cleaned,
stored and maintained.
.
Respirator Cleaning and Storage
Description/Location of
Respirator Cleaning Station
Cleaner and
Disinfectant used
Location of
Respirator Storage
Cleaning Schedule
.
Respirator Repair and Maintenance: Describe the methods used to provide repair,
parts, and service and maintenance for respirators.
The responsible supervisor or designee must certify in writing that monthly inspection
of respirators maintained for emergency use.
Care of Respirators for Emergency Use: Describe the special procedures for monthly
inspection
Documentation and Recordkeeping
Written information regarding the medical evaluations, medical opinions related to the
worker’s ability to wear a respirator, fit testing, inspection of emergency use respirators
and the overall respiratory protection program must be maintained. The information is
necessary to facilitate employee involvement, to assist in auditing the program, and
provide a record for compliance determination. The documents must be available
Respiratory Protection Program: The responsible supervisor who has an employee
included in the Respiratory Protection Program must have a copy of this document
readily available to employees and for inspection by OSHA representatives.
Unit Specific Respiratory Plan: This Plan must be specific to the work place conditions,
as well be must be maintained and updated whenever there are changes in workplace
conditions or operations that may affect employee exposure. This document must be
readily available to employees and for inspection by DEHS or OSHA representatives.
University of Louisville
Department of Environmental Health & Safety
Modified on October 25, 2007
http://louisville.edu/dehs/ohs/respiratory-protection
Medical Evaluation: These records will be maintained by the Health Services Office (or
other health care provider) for the duration of the employee’s employment with UofL
plus 30 years.
The Physician’s Certification for Respirator Use: This form states whether the
employee may or may not wear a respirator. Responsible supervisors must obtain a copy,
and forward a copy to the Program Administrator prior to respirator training and fit
testing. The document must be available for inspection by DEHS or OSHA
representatives.
Fit Test and Training Records: Records of General and Unit Specific
Respiratory Protection Training and Fit Testing will be maintained by supervisor
or designee and be readily available for inspection by DEHS or OSHA
representatives.
Recordkeeping - Responsibility: The following employee(s) are responsible for
ensuring all records are established and maintained according to the UofL Respiratory
Protection Program
.
Recordkeeping - Procedure: The required records are kept in the following locations
UofL Respiratory Protection Program:
Unit Specific Respiratory Protection Plan:
Physician’s Certification for Respirator Use:
Fit Test and Training Records:
Program Evaluation
The responsible supervisor must ensure the on-going assessment of their work areas, and
review and update this written Respiratory Protection Plan as necessary to ensure the plan
is effectively implemented. Supervisors must notify DEHS whenever workplace
conditions may exist or change that may affect employee exposure to respiratory hazards.
Supporting Documents
UofL Respiratory Protection Program
University of Louisville
Department of Environmental Health & Safety
Modified on October 25, 2007
http://louisville.edu/dehs/ohs/respiratory-protection
The OSHA Respiratory Protection Standard 29 CFR 1910.34
Respirator Medical Evaluation Questionnaire
Worksite Information Regarding Respirator Use (supervisor prepares for MD)
Respirator Selection and Use Worksheet
Information for Employees for Voluntary Use of Respirators
Cleaning and Sanitizing Your Respirator
OSHA Information for Cartridge Change-Out Schedule
University of Louisville
Department of Environmental Health & Safety
Modified on October 25, 2007
http://louisville.edu/dehs/ohs/respiratory-protection