OSHA Respirator Medical Evaluation Questionnaire - Medical Evaluation and Questionnaire Requirements - OSHA Infossheet

Sep 19, 2026

OSHA Infossheet provides instructions and requirements for respirator medical evaluations and the mandatory medical questionnaire used under the Respiratory Protection standard. It explains the employer’s duty to designate a physician or other licensed health care professional (PLHCP) to collect required information from Appendix C, administer the questionnaire and examinations confidentially during working hours, and provide follow-up examinations when specific responses or findings occur. It includes an excerpted questionnaire section for employees, including required personal details and health questions covering smoking, respiratory, cardiovascular, and pulmonary symptoms.

LanguageEnglish

CategoryForms

FormatPDF

Pages5

Reading Time2 min

AccessFree to download

Medical Evaluation and Questionnaire Requirements

Employer and PLHCP responsibilities

Confidential administration and follow-up examinations

Excerpt from Appendix C of 29 CFR 1910.134

To the employer and to the employee

Part A Section 1 (Mandatory) employee information

Part A Section 2 (Mandatory) health questions (1-9)

OSHA INFOSHEET | | | | | --- | --- | --- | | Respirator Medical Evaluation Questionnaire
Respirators must be used in workplaces in which employees are exposed to hazardous airborne contaminants. When respiratory protection is required employers must have a respirator protection program as specifed in OSHA’s Respiratory Protection standard (29 CFR 1910.134). Before wearing a respirator, workers must frst be medically evaluated using the mandatory medical questionnaire or an equivalent method. To facilitate these medical evaluations, this INFOSHEET includes the mandatory medical questionnaire to be used for these evaluations. | | | | Medical Evaluation and Questionnaire Requirements
The requirements of the medical evaluation and for using the questionnaire are provided below:
The employer must identify a physician or other licensed health care professional (PLHCP) to perform all medical evaluations using the medical questionnaire in Appendix C of the Respiratory Protection standard or a medical examination that obtains the same information.(See Paragraph (e)(2)(i).)
The medical evaluation must obtain the information requested in Sections 1 and 2, Part A of Appendix C. The questions in Part B of Appendix C may be added at the discretion of the health care professional. (See Paragraph (e)(2)(ii).) | •
• | The employer must ensure that a followup medical examination is provided for any employee who gives a positive response to any question among questions 1 through 8 in Part A Section 2, of Appendix C, or whose initial medical examination demonstrates the need fora follow-up medical examination. The employer must provide the employee with an opportunity to discuss the questionnaire and examination results with the PLHCP. (See Paragraph (e)(3)(i).) The medical questionnaire and examinations must be administered confdentially during the employee’s normal working hours or at a time and place convenient to the employee and in a manner that ensures that he or she understandsits content. The employer must not review the employee’s responses, and the questionnaire must be provided directly to the PLHCP. (See Paragraph (e)(4)(i).) | | Excerpt from Appendix C of 29 CFR 1910.134:
OSHA Respirator Medical Evaluation Questionnaire | | | To the employer: Answers to questions in Section 1, and to question 9 in Section 2 of Part A, do not require a medical examination. To the employee: 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 confdentiality, 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 health care professional who will review it. Once flled out, this form must be given to the PLHCP. This form should not be submitted to OSHA. 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 (circle one): Male/Female 5. Your height: [ft. in](ft. in). 6. Your weight: lbs. 7. Your job title: 8. A phone number where you can be reached by the health care professional who reviews this questionnaire (include the Area Code): 9. The best time to phone you at this number: 10. Has your employer told you how to contact the health care professional who will review this questionnaire (circle one): 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 Other type (for example, half-or full-facepiece type, powered-air purifying, supplied-air, self-contained breathing apparatus) . 12. Have you worn a respirator (circle one): Yes/No If “yes,” what type(s): Part A. Section 2. (Mandatory) Questions 1 through 9 be

FAQs

What is the purpose of the respirator medical evaluation questionnaire?

The questionnaire is used to medically evaluate workers before they wear a respirator when respirator use is required. It includes the mandatory questions provided in the OSHA Respirator Medical Evaluation Questionnaire (Appendix C).

Who performs the medical evaluations using the questionnaire?

The employer must identify a physician or other licensed health care professional (PLHCP) to perform the medical evaluations using the medical questionnaire in Appendix C or an equivalent method that gathers the same information.

When must the employer provide a follow-up medical examination?

A follow-up examination must be provided for any employee who gives a positive response to specified questions in Part A, Section 2, or whose initial medical examination shows a need for follow-up. The employee must also be given an opportunity to discuss results with the PLHCP.

Sep 19, 2026

Upload by Margaret