RESPIRATOR PROGRAM
PURPOSE
Policy Statement:
In our continuing pursuit of a safe and healthful workplace, our company has developed and instituted a
Respiratory Protection Program to be followed by employees required to wear respiratory protection to
enhance the safety of the work environment.
KEY ELEMENTS
An effective respirator program should include the following:

Written standard operating procedures

Program evaluation

Selection

Training

Fit testing

Inspection, cleaning, maintenance, and storage

Medical examinations

Work area surveillance

Air quality standards

Approved respirators
SUMMARY OF PROGRAM
Any respirator program should stress thorough training of all participants; especially the users who need
to wear the respirators. Employers must be aware that the equipment does not eliminate the hazard. If
the equipment fails, overexposure will occur. To reduce the possibility of failure, equipment must fit
properly and be maintained in a clean and serviceable condition.
Employers and employees must understand the equipment’s purpose and its limitations. The equipment
must not be altered or removed from the wearer even for a short time, despite the fact that the wearer
may find it uncomfortable.
REFERENCES
Title 29, Code of Federal Regulations, Part 1910.134.
American National Standards Institute (ANSI), Z88.2-1980.
POLICY STATEMENT
In our ongoing pursuit of a safe and healthful work place, this company has developed a Respirator
Protection Program to be followed by all employees required to wear respiratory protection to enhance
the safety of their work environment.
ADMINISTRATIVE RESPONSIBILITY
The ultimate responsibility for the administration of this policy shall lie with the Safety Manager. The
day-to-day aspects of the policy is the responsibility of department supervision and the employees to
whom respiratory protection is a requirement other assistance can/will be provided as needed.
SELECTION OF RESPIRATORY PROTECTION
The following criteria is used in the final selection of a suitable respirator:
1. Identification of Hazards(s) - The responsible party surveys the work environment to classify
hazard(s) into the following definitions/classes:

Gas/vapor contaminants

Particulate/dust contaminants

Fume contaminants

Mist contaminants

Oxygen deficient atmospheres

Atmospheres immediately dangerous to life and health

Combination of classes
2. Evaluation of the Hazards(s)

Trained and competent personnel take air samples in the work environment to
determine the actual concentration of exposure hazards, which may be present. All
methods used in hazard evaluation are in compliance with OSHA/NIOSH sampling
methodologies.

The resulting concentration is to be compared with current OSHA (PEL) or ACGIH
(TLVs), whichever is lower, to assist in determining the level of protection required.
3. Appropriate Selection and Purchasing

This step is completed by the safety manager and safety committee aided by
information provided by outside experts specifically in occupational health and
industrial hygiene, where required.

Selection shall consider facial irregularities (e.g., scars, facial hair) and the workload of
the employee in comparison any possible resistance/stress placed upon the
employee’s respiratory system by the protective device.

Only appropriately sized respirators shall be assigned to insure proper fit.

Only NIOSH/OSHA approved respirators will be purchased and used.
MEDICAL EVALUATION
1. To insure the examining physician can render a qualified opinion regarding the employee’s
use of respiratory protection, they shall be provided the following information by the Safety
Manager:

Type of respirator to be used.

Task that will be performed.

Length of wear.

The toxic substances involved.

Verbal communications required in the task.
2. Medical examination and testing - Medical examination and testing should place prior to an
employee using respiratory protection:

A medical/occupational history questionnaire (Appendix) shall be completed by the
employee prior to meeting with the physician.

The following medical tests will be completed:
o
Basic physical examination.
o
Pulmonary function tests including FVC and FEV (if indicated).
o
The physician will be responsible for requesting any test (e.g., chest X-ray
EKG) he or she feels necessary to render a qualified opinion.
3. Re-examinations - All employees required or assigned respiratory protection shall be reexamined on an annual basis.
ASSIGNMENT OF RESPIRATORY PROTECTION
Whenever possible, a respiratory protective device shall be assigned to an individual for his or her
exclusive use.
1. Identification - all respiratory protective devices will have a permanent durable identification
marking(s) attached to it that does not interfere with the performance of the device.
2. Permanent assignment - When a respirator is assigned to an employee his or her exclusive
use, records shall be kept indicating the employee specific respirator that was assigned.
3. Temporary emergency assignment shall be done by the Company Safety Manager or
designee.

When a respirator is temporarily assigned to an employee, records shall be kept.
These records will include the employee I.D., respirator I.D., description of operation
or hazard area, and of assignment.

During emergency respirator use, efforts shall be made to collect above information.

Employees assigned respiratory protection on an emergency or temporary basis will
be required to perform an inspection and testing prior to donning in conformance
with Sections VI and VII of this policy.
TRAINING AND EDUCATION
1. Prior to the assignment of a respiratory protection device, those employees being considered
shall receive training, which includes the following:

Explanation of the company’s respirator policy.

The responsibility of the policy administrator (Safety Manager).

The employee’s responsibility.

Explanation of the respiratory hazards posed by the operation-regulated areas.

Explanation of current administrative and engineering control in conjunction with
respiratory protection.

Explanation of the selection process.

The functions, capabilities, and limitations of the selected equipment.

Demonstrations on the donning, fit testing, and proper wearing of the respirator.

Respiratory maintenance, cleaning, and storage.

The federal and state government’s regulatory requirements.

Emergency situations.
2. As part of the training, the employee will have the opportunity to handle the selected
respirator, have it fitted properly, test the face piece to insure fit and wear it in “normal” air
FIT TESTING
1. The policy administrator will choose the most appropriate mean(s) for testing for each
employee and type of respiratory protection assigned.
2. A positive and negative fit test shall be conducted for each negative cartridge-type respirator
prior to donning.
CLEANING AND DISINFECTING
All respirators shall be cleaned and disinfected per the manufacturer requirements as follows:
1. Permanently assigned respirators - Those respirators assigned to an employee for his or her
exclusive use shall be cleaned and disinfected as needed, but no less than weekly.
2. Temporary or emergency assigned respirators - Those respirators assigned on an emergency
or temporary basis shall be cleaned and disinfected each use and prior to each reassignment
to another employee.
INSPECTION AND REPAIRS
1. Inspection

All respirators used under permanent or temporary assignment must be inspected
prior to each donning by the assigned employee. The employee shall be responsible
for inspection of the following:
o
Straps, cartridges
o
Face seal
o
Exhaust and inlet valves
o
Air hose connections or blower
o
Batteries
o
Lens
If repairs are needed, these should be completed in accordance with paragraph 2.

Emergency assigned respirators (if any) shall be inspected at least monthly. The
policy administrator may require more frequent inspections. All points required by
the manufacturer and paragraph A1 will be included in the emergency respirator in
process.
2. Repairs

The Safety Manager will designate an individual that has been appropriately trained to
properly repair or service the respirators policy. If respirators must be removed from
service or cannot be repaired, an interim respirator shall be temporarily assigned.
STORAGE
All respirators shall be stored in a clean, contaminant-free environment. The respirator/face piece shall
be placed in a plastic bag to ensure that contaminants will not get into or onto the face piece or the
respirator. Whenever possible, all safety equipment should be stored in a secured area.
PROGRAM EVALUATION
On an annual basis, the program administrator and appropriate department supervisors shall review all
points of the program with the affected personnel to ensure effectiveness and workability. Furthermore,
all program points shall be reviewed in comparison to current state and federal regulations to ensure
proper compliance.
QUALITATIVE FIT TEST
Qualitative fit tests involve a test subject’s responding to a chemical exposure outside the respirator face
piece. Three of the most popular methods are:

An irritant smoke test.

An odorous vapor test (isoamyl acetate-banana oil).

A taste test (saccharin solution).
These tests are fast, easily performed, and use inexpensive equipment. Because these tests are based
on the respirator wearer’s subjective response to a test chemical, reproducibility and accuracy may vary.
Qualitative fit testing using isoamyl acetate for chemical cartridge(s) and smoke for high-efficiency
particulate filters shall be conducted at the time fitting and at least annually thereafter. A negative and
positive pressure test conducted prior to qualitative fit testing. A qualified person must conduct the
qualitative fit testing.
All testing must be appropriately documented.
NEGATIVE PRESSURE RESPIRATOR
FIT TESTING AND INSPECTION RECORD
Employee Name: ________________________________________ S.S. #: ________________________
Respirator I.D. # and size of respirator selected: ______________________________________________
Document Date: _________________________
Date and name of person performing last qualitative fit test: ___________
_____________________
Comments: ___________________________________________________________________________
Date of Inspection: _____________________
Positive
Negative
Pressure Test
Pressure Test
Noted Deficiencies
Employee
Initials
MEDICAL QUESTIONNAIRE
Employee Name: _______________________ Date: ___________
S.S. #: __________________ Birth Date: __________ Age: _______
Sex: _____ Height: _____ Weight: ______
Employer: ______________________________
Plant/Dept.: ____________________________
Job Title/Description: ______________________________
Dates at this Job Title: ______________ to ______________
MEDICAL HISTORY
1.
List all hospitalizations and surgeries:
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
2.
List current medicines (including nonprescription drugs)
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
3.
Allergies (drugs, food, chemicals):
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
4.
Are you currently under a physician’s care (if yes, explain)?
Yes ____ No _____
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
5.
Have you ever been told that you have asthma, hay fever, or sinusitis?
Yes _____ No _____
6.
Have you ever been told that you have emphysema, bronchitis, or any other respiratory problems?
Yes _____ No _____
7.
Have you ever been told that you had cancer?
Yes _____ No _____
8.
Have you ever been told that you had high blood pressure?
Yes _____ No _____
9.
Have you ever had a heart attack or heart trouble?
Yes _____ No _____
10. Do you ever have any shortness of breath?
If yes, do you have to rest after climbing several flights of stairs?
Yes _____ No _____
Yes _____ No _____
If yes, if you walk with people your own age, do you walk slower than they do?
Yes _____ No _____
If yes, if you walk slower than a normal pace, do you have to limit the distance you walk?
Yes _____ No _____
If yes, do you have to stop and rest while bathing or dressing?
Yes _____ No _____
11. Do you cough as much as three months out of the year?
Yes _____ No _____
If yes, have you had this cough for more than two years?
Yes _____ No _____
If yes, do you ever cough anything up from the chest?
Yes _____ No _____
12. Do you ever have a feeling of smothering, unable to take a deep breath, or tightness in your chest?
Yes _____ No _____
If yes, do you notice this on any particular day of the week?
Yes _____ No _____
If yes, what day of the week? ___________________
If yes, do you notice this occurs at any particular place?
Yes _____ No _____
If yes, do you notice that this is worse after you have returned to work after being off for several
days?
13. Have you ever noticed any wheezing in your chest?
Yes _____ No _____
Yes _____ No _____
If yes, is this only with colds or other infections?
Yes _____ No _____
Is this caused by exposure to any kind of dust or other material?
Yes _____ No _____
If yes, what kind?
Yes _____ No _____
14. Have you noticed any burning, tearing, or redness of your eyes when you are at work?
Yes _____ No _____
If so, explain circumstances: _______________________________________________________________
____________________________________________________________________________________________
15. Have you noticed any sore or burning throat or itchy or burning nose when you are at work?
Yes _____ No _____
If so, explain circumstances: _______________________________________________________________
____________________________________________________________________________________________
16. Have you noticed any stuffiness or dryness of your nose?
Yes _____ No _____
17. Do you ever have swelling of the eyelids or face?
Yes _____ No _____
18. Do you have frequent headaches that are not relieved by aspirin or Tylenol? Yes _____ No _____
If yes, do they occur at any particular time of the day or week?
Yes _____ No _____
If yes, when do they occur? ___________________________________________
19. Do you tend to have trouble concentrating or remembering?
Yes _____ No _____
20. Do you ever feel dizzy, light-headed, excessively drowsy, or like you have be drugged?
Yes _____ No _____
21. Does your vision ever become blurred?
Yes _____ No _____
22. Do you have numbness or tingling of the hands or feet or other parts of your body?
Yes _____ No _____
23. Have you ever had chronic weakness or fatigue?
Yes _____ No _____
24. Do you ever have itching, dryness, or peeling and scaling of the hands?
Yes _____ No _____
FAMILY/SOCIAL HISTORY
25. Mother: Age ____ Medical History:
_____________________________________________________________________________________________
26. Father: Age ____ Medical History: ____________________________________________________________
_____________________________________________________________________________________________
27. Brothers: How many ____ Medical History: ___________________________________________________
_____________________________________________________________________________________________
28. Sisters: How many ____ Medical History: _____________________________________________________
_____________________________________________________________________________________________
29. Other: _____________________________________________________________________________________
____________________________________________________________________________________________
30. Married ____ Single ____ Widowed ____ Children ____
31. Cigarettes: ____ Packs a day. How many years? ____
32. Alcohol: How much? _____________________________________
33. Coffee: ____ Cups a day: Decaf? ____
34. Other recreational drugs? _____________________________
35. Do you wear contact lenses?
Yes _____ No _____
36. Do you exercise regularly?
Yes _____ No _____
If yes, explain: _____________________________________________________________________________
____________________________________________________________________________________________
37. Do you have any hobbies or side jobs that require you to be exposed to hazardous compounds,
(such as furniture stripping, pottery, woodworking, ceramics, sandblasting, insulation, auto repair,
or body work)?
Yes _____ No _____
If yes, explain: _____________________________________________________________________________
____________________________________________________________________________________________
38. Other jobs held with this employer (include title/description, dates assigned, chemicals or fumes
exposed to): ________________________________________________________________________________
_____________________________________________________________________________________________
40. Any type of skin rash?
Yes _____ No _____
41. Do any chemicals, fumes, or smoke make you:
Cough?
Yes _____ No _____
Wheeze?
Yes _____ No _____
Become short of breath
Yes _____ No _____
If yes, explain: ______________________________________________________________________________
42. Shift you normally work: _____ to ______
43. In other jobs, have you ever been exposed to:
Wood dust? (Type _________________)
Yes _____ No _____
Nickel?
Yes _____ No _____
Chromium (stainless steel)?
Yes _____ No _____
Silica (foundry, sand blasting)?
Yes _____ No _____
Asbestos?
Yes _____ No _____
Organic solvents? (i.e. trichloroethane)
Yes _____ No _____
Formaldehyde?
Yes _____ No _____
Coal Dust?
Yes _____ No _____
Ammonia?
Yes _____ No _____
Welding Fumes?
Yes _____ No _____
RESPIRATOR INFORMATION FOR PHYSICIAN
Employee Name: ______________________________________ S.S. #: _______________________
Employer: ___________________________________________________________________________
Plant/Dept.: _________________________________________________________________________
Job Title/Description: ________________________________________________________________
_____________________________________________________________________________________
Dates at this Job Title: ______ to ______
Primary Hazardous Compounds for this Job Title: _____________________________________________
_____________________________________________________________________________________________
Type of Respirator to be assigned ____________________________________________________________
For Additional Information Please Contact: __________________________________________
At: _________________________________________________________________________________
Completed By: ___________________________
Title: __________________________________
PHYSICIAN’S APPROVAL FOR RESPIRATOR ASSIGNMENT
Employee Name: ______________________________________ S.S. #: _________________________
Employer: ___________________________________________________________________________
I have reviewed and/or completed the following:
1. Medical/Occupational History Questionnaire
Yes _____ No _____
2. Respirator Information for Physician
Yes _____ No _____
3. Pulmonary Function Test Result
Yes _____ No _____
4. Physical Examination
Yes _____ No _____
Based on the information provided in the above stated forms, tests, and exam, it is my opinion that this
individual is physically and emotionally fit to wear a respirator in an occupational environment.
Yes _____ No _____
Comments: ___________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Physician’s Signature: _______________________________________M.D., D.O.
Print the Following
Physician’s Name: __________________________
Address: _____________________________________________________________________________
Telephone: (____) ____ - ________
NEGATIVE PRESSURE RESPIRATOR FIT TESTING RECORD
Employee Name ______________________________________ S.S. # _________________________
Size and manufacturer of the types of respirators available for selection: __________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Type brand and size of respirator selected __________________________________________________
Fill out the following table after completing the tests for the respirator:
Positive
Negative
Isoamyl
Irritant
Pressure
Pressure
Acetate
Test
Test
Test
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Saccharin
Test
Smoke
Employee
Test
Initial
Place Y (Yes) or N (No) in each column to indicate whether the test was conducted or not. A Pass (+) or
Fail (-) indicates whether the respirator fit is satisfactory.
For example: if a test is conducted and the results are satisfactory, Y+ should be in the record.
NEGATIVE PRESSURE TEST
1. Don the respirator per the manufacturer’s instructions.
2. Seat the mask on the face by moving the head from side-to-side and up and do it slowly
while taking a few slow, deep breaths.
3. Cover the inlet opening of the respirator’s cartridge(s) or filter(s) with the palm of the hand.
4. Inhale gently and hold breath for at least 10 seconds.
5. If the face piece collapses slightly and no inward leakage of air into the respirator has been
properly fitted and the exhalation valve and face piece are not leaking.
POSTIVITE PRESSURE TEST
1. After the negative pressure test has been performed, close the exhalation value. On some
respirators, this requires that the exhalation valve cover be removed following the
manufacturer’s instruction).
2. Exhale gently for at least 10 seconds.
3. The respirator has been properly donned if a slight positive pressure can be obtained inside
the face piece without the detection of any outward leakage of air between the sealing surface of
the face piece and the wearer’s face.
NOTE: A positive and negative pressure fit test should be conducted each time a respirator is donned.