WAC 296-842-14005   Provide medical evaluations.  


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

     IMPORTANT:

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

     • Using a respirator can create physical risks for an employee each time it is worn. The extent of these risks depends on these factors:

     – Type of respirator;

     – Environmental conditions at the worksite;

     – Physical demands of the work;

     – Use of the protective clothing;

     – Employee's health status.

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


Medical Evaluation Process

     Step 1: Identify employees who need medical evaluations AND determine the frequency of evaluations from Table 7. Include employees who:

     • Are required to use respirators;

     OR

     • Voluntarily use respirators that are not filtering-facepiece respirators.


Note: You may use a previous employer's medical evaluation for an employee if you can:
• Show the employee's previous work and use conditions were substantially similar to yours;
AND
• Obtain a copy of the licensed health care professional's (LHCP's) written recommendation approving the employee's use of the respirator chosen by you.

     Step 2: Identify a licensed health care professional (LHCP) to perform your medical evaluations.


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

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

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

     • How the respirators will be used, including:

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

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

     – The employee's expected physical work effort;

     – Additional personal protective clothing and equipment to be worn;

     – Temperature and humidity extremes expected during use;

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


Note: • You may choose to send the questionnaire to the LHCP ahead of time, giving time to review it and add any necessary questions.
• The LHCP determines what questions to add to the questionnaire, if any; however, questions in Parts 1-3 may not be deleted or substantially altered.

     Step 4: Administer the medical questionnaire in WAC 296-842-22005 to employees, OR provide them a medical exam that obtains the same information.


Note: You may use on-line questionnaires if the questions are the same and requirements of this section are met.

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

     – During the employee's normal working hours;

     OR

     – At a time and place convenient to the employee.

     • Maintain employee confidentiality during examination or questionnaire administration:

     – Do not view employee's answers on the questionnaire;

     – Do not act in a manner that may be considered a breach of confidentiality.


Note: Providing confidentiality is important for securing successful medical evaluations. It helps make sure the LHCP gets complete and dependable answers on the questionnaire.

     • Make sure employees understand the content of the questionnaire.

     • Provide the employee with an opportunity to discuss the questionnaire or exam results with the LHCP.

     Step 5: Provide follow-up evaluation for employees when:

     • The LHCP needs more information to make a final recommendation;

     OR

     • An employee gives any positive response to questions 1-8 in Part 2 OR to questions 1-6 in Part 3 of the DOSH medical evaluation questionnaire in WAC 296-842-22005.


Note: Follow-up may include:
• Employee consultation with the LHCP such as a telephone conversation to evaluate positive questionnaire responses;
• Medical exams;
• Medical tests or other diagnostic procedures.

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

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

     • Any limitations of respirator use for the employee;

     • What future medical evaluations, if any, are needed;

     • A statement that the employee has been provided a copy of the written recommendation.

     Step 7: Provide a powered, air-purifying respirator (PAPR) when the LHCP determines the employee should not wear a negative-pressure air-purifying respirator AND is able to wear a PAPR.


Reference: See WAC 296-842-13005 for requirements regarding selection of air-purifying respirators.
Note: • You may discontinue medical evaluations for an employee when the employee no longer uses a respirator.
• If you have staff conducting your medical evaluations, they may keep completed questionnaires and findings as confidential medical records, if they are maintained separately from other records.

     Use Table 7 to determine medical evaluation frequency.

Table 7

Evaluation Frequency
Type of Evaluation: When required:
Initial medical evaluations • Before respirators are fit-tested or used in the workplace.
Subsequent medical evaluations • If any of these occur:
– Your licensed health care professional (LHCP) recommends them; for example, periodic evaluations at specified intervals.
– A respirator program administrator or supervisor informs you that an employee needs reevaluation.
– Medical signs or symptoms (such as breathing difficulties) are:
▪ Observed during fit testing or program evaluation
OR
▪ Reported by the employee
– Changes in worksite conditions such as physical work effort, personal protective clothing, or temperature that could substantially increase the employee's physiological stress.




[Statutory Authority: RCW 49.17.050 and 29 C.F.R. Subpart Z. 09-19-119, § 296-842-14005, filed 9/22/09, effective 12/1/09. Statutory Authority: RCW 49.17.010, 49.17.040, 49.17.050, 49.17.060. 07-05-072, § 296-842-14005, filed 2/20/07, effective 4/1/07; 03-20-114, § 296-842-14005, filed 10/1/03, effective 1/1/04.]