OSHA 29 CFR 1910.134 - Respiratory Protection

SCOPE AND APPLICATIONThe purpose of this respiratory protection program is to provide the safest working environment for our employees. In the control of occupational diseases caused by breathing air contaminants, the primary objective is to prevent atmospheric contamination by engineering control measures. When effective engineering controls are not feasible, or while they are being instituted, our employees will use appropriate respiratory protection.

Our respirator protection program contains the following elements:

• Assignment of Responsibilities

• Workplace Hazard Analysis

• Respirator Selection

• Medical Surveillance

• Fit Testing

• Respirator Use

• Cleaning and Maintenance

• Cartridge Change Schedule

• Defective Respirators

• Voluntary Respirator Use

• Emergency Respirator Use

• Respirators for IDLH Atmospheres

• Training

• Program Evaluation

• Recordkeeping

ASSIGNMENT OF RESPONSIBILITIESManagement: Though management has the ultimate responsibility for the implementation, maintenance and the success of this respiratory protection program, the responsibilities are delegated to a named and documented Program Administrator, supervisors, and the respirator users themselves

Management will:

• Assign a program administrator, who is qualified by training to serve in that role

• Ensure each suspected airborne hazard is properly evaluated

• Provide the necessary respiratory equipment

• Ensure adherence to medical clearance procedures

• Ensure proper employee safety training

• Establish and enforce safe operating rules and procedures

OSHA 29 CFR 1910.134 - Respiratory Protection

The Program Administrator for our Respiratory Protection Program is:

The Program Administrator is responsible for the administration of this program and has full authority to make necessary decisions to ensure its success.

In addition, the Program Administrator is responsible for:

• Identifying work areas, processes or tasks that require workers to wear respirators, and evaluating hazards

• Selection of respiratory protection options

• Monitoring respirator use to ensure that respirators are used in accordance with their certifications

• Arranging for and/or conducting training

• Arranging for and/or conducting quantitative/qualitative fit testing

• Ensuring proper storage and maintenance of respiratory protection equipment

• Administering the medical surveillance program

• Maintaining records required by the program

• Annually evaluating the program

• Updating the written program, as needed

Supervisors are responsible for ensuring that the respiratory protection program is implemented in their work areas. In addition to being knowledgeable about the program requirements for their own protection, supervisors will also ensure that the program is understood and followed by the employees under their charge. Supervisors will complete the Respirator Request Form, see Appendix A, for each employee who is assigned a respirator.

Additional duties of the supervisor include:

• Identify employees who may require a respirator and submit a Respirator Request Form

• Ensure that employees under their supervision (including new hires) have received appropriate training, fit testing, and annual medical evaluation

• Ensure the availability of appropriate respirators and accessories

• Be aware of tasks requiring the use of respiratory protection

• Enforce the proper use of respiratory protection

• Ensure that respirators are properly cleaned, maintained, and stored according to the respiratory protection program

• Develop a respirator cartridge change-out schedule with assistance from the Program Administrator. Provide user training on the change-out schedule

• Ensure that respirators fit well and do not cause discomfort

• Continually monitor work areas and operations to identify respiratory hazards

• Coordinate with the Program Administrator on how to address respiratory hazards or other concerns regarding the program

OSHA 29 CFR 1910.134 - Respiratory Protection

Employees have the responsibility to wear their respirators when and where required and in the manner in which they were trained.

Employees will also:

• Obtain written medical clearance specifically for respirator use prior to initial use, upon a significant change in job task or employee medical condition, or as specified in writing by physician

• Only use the brand and type of respirator for which the user was trained and fit tested

• Conduct either the positive or negative pressure check (depending on which test works best for them) specified in Appendix B-1 of the Respiratory Protection Standard.

• Ensure that their assigned respirator is properly cleaned, maintained, and stored according to the respiratory protection plan and store them in a clean and sanitary location

• Attend respirator training prior to use, annually, and as otherwise deemed necessary by the Program Administrator

• Maintain a facial surface that provides a proper fit with the respirator (e.g., clean-shaven for tight-fitting facepieces)

• Undergo fit-test for each assigned tight-fitting facepiece prior to use whenever a different tight-fitting facepiece is used, and at least annually

• Maintain each assigned respirator in a ready-to-use condition at all times

• Inspect each assigned respirator prior to and after each use, and at least monthly.

• Store written inspection records with the respirator. Inspection requirements are not applicable for single-use respirators

• Wear assigned respirator during activities that have potential for exposure over regulatory limits

• Leave the exposure area in the event of respiratory equipment malfunction, physical or psychological distress, or other unsafe conditions that require relief

• Immediately notify a supervisor of any new or changed workplace hazards, or any significant change in medical condition

• Never perform a job or be present at any location that requires respirator use unless all provisions of this respiratory protection program are observed.

• Immediately notify the Program Administrator of any problem or question about an assigned respirator or its use

WORKPLACE HAZARD ANALYSISWe will conduct a hazard evaluation for each operation, process, or work area where there is a potential presence of airborne contaminants while conducting routine operations or during an emergency.

The hazard evaluation will include:

1) Identification and development of a list of hazardous substances used in the workplace, by department, or work process.

2) Review of work processes to determine where potential exposures to hazardous substances may occur. Conduct the review by surveying the workplace, processes, reviewing records, and talking with employees and supervisors.

3) Conduct exposure monitoring, which is usually conducted by a third party, to quantify potential hazardous exposures. Post the monitoring results.

4) If air monitoring indicates the need for employee use of respirators, the results of the monitoring will be included in our written respiratory protection program.

OSHA 29 CFR 1910.134 - Respiratory Protection

RESPIRATOR SELECTION• All respirators and cartridges are NIOSH certified.

• Industrial hygiene surveys are conducted to determine respiratory protection requirements.

• Cartridges are selected according to the hazards identified in the workplace. A list of approved cartridges and change schedules is provided in Appendix E.

• Cartridge change schedules are developed by management based on exposure monitoring, chemical data, and cartridge specifications.

• OSHA’s Assigned Protection Factors (APF) are used to select respirators that meet or exceed the required level of employee protection. OSHA’s published APFs are listed in the table on the next page.

Type of Respirator1, 2 Quarter Mask Half Mask Full

FacepieceHelmet/Hood

Loose-fitting Facepiece

1. Air-Purifying Respirator 5 310 50 ........................ ........................

2. Powered Air-Purifying Respirator (PAPR) ........................ 50 1,000 425/1,000 25

3. Supplied Air-Respirator (SAR) or Airline Respirator• Demand mode• Continuous flow mode• Pressure-demand or other positive-pressure

mode

........................

........................

........................

105050

501,0001,000

........................ 425/1,000........................

........................25........................

3. Self-Contained Breathing Apparatus (SCBA)• Demand mode• Pressure-demand or other positive-pressure

mode (e.g., open/closed circuit)

........................

........................10........................

5010,000

5010,000

........................

........................

ASSIGNED PROTECTION FACTORS5

Notes to Eye and Face Protection Selection Chart:1 We may select respirators assigned for use in higher workplace concentrations of a hazardous substance for use at lower concentrations of that substance, or when required respirator use is independent of concentration.

2 The assigned protection factors in this table are only effective when used as part of this effective respirator program.

3 This APF category includes filtering facepieces, and half masks with elastomeric facepieces.

4 We must have evidence from the respirator manufacturer that testing of these respirators demonstrates performance at a level of protection of 1,000 or greater to receive an APF of 1,000. This level of performance is demonstrated by performing a WPF or SWPF study or equivalent testing. Absent such testing, all other PAPRs and SARs with helmets/hoods are treated as loose-fitting facepiece respirators, and will receive an APF of 25.

5 These APFs do not apply to respirators used solely for escape.

OSHA 29 CFR 1910.134 - Respiratory Protection

MEDICAL SURVEILLANCEEmployees covered under the respiratory protection program are required to participate in the medical surveillance program. A respirator medical evaluation questionnaire meeting the requirements of Appendix E to §1910.134 is included in this program as Appendix B.

Employees who are either required to wear respirators, or who choose to wear certain respirators voluntarily, must pass a medical exam before the employee is permitted to wear a respirator on the job.

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 is not allowed to work in an area requiring respirator use.

A licensed physician will provide the medical evaluations. Medical evaluation procedures are as follows:

• Conduct the medical evaluation using the questionnaire provided in Appendix B. The Program Administrator will provide a copy of this questionnaire to all employees requiring medical evaluations.

• Provide assistance to employees who are unable to read the questionnaire (by providing help in reading the questionnaire).

• Permit the employees to fill out the questionnaire on company time.

• Grant follow-up medical exams to employees as required by the standard.

• Grant all employees the opportunity to speak with the physician about their medical evaluation.

• The Program Administrator is to provide the licensed physician with a copy of this program, a copy of the Respiratory Protection Standard, the list of hazardous substances by work area, and, for each employee requiring evaluation: their work area or job title, proposed respirator type and weight, length of time required to wear a respirator, expected physical work load (light, moderate, or heavy), potential temperature and humidity extremes, and any additional protective clothing required.

• Provide any employee required for medical reasons to wear a positive pressure air-purifying respirator with a powered air-purifying respirator.

• Conduct additional medical evaluations after an employee has received clearance and begun to wear his/her respirator under the following circumstances: - The employee reports signs and/or symptoms relating to the ability to use a respirator, such as shortness of breath, dizziness, chest pains,

or wheezing- The physician, supervisor, or Program Administrator informs the company that it is necessary to reevaluate the employee- Information from this program, including observations made during fit testing and program evaluation, indicates a need for reevaluation - A change occurs in workplace conditions that may result in an increased physiological burden on the employee

All examinations and questionnaires are to remain confidential between the employee and the physician.

OSHA 29 CFR 1910.134 - Respiratory Protection

FIT TESTINGThe safe and effective use of respiratory protective equipment requires that the respirator be properly fitted to the employee. Poorly fit respirators fail to provide the expected degree of protection. Additionally, no single model or size of respirator is capable of fitting all people. Several models are needed to determine which provides an acceptable fit.

Fit test employees who are required to wear respirators:

• Prior to being allowed to wear any respirator with a tight fitting face-piece

• Annually

• When there are changes in the employee’s physical condition that could affect respiratory fit (e.g., obvious change in body weight, facial scarring, significant dental changes, etc.)

• Whenever a different respirator facepiece is used

Fit test employees with the make, model, and size of respirator that they will actually wear. Provide employees with several models and sizes of respirators so that they may find an optimal fit. Fit testing of PAPRs is conducted in the negative pressure mode.

An employee cannot wear a face-sealing respirator if there is any facial hair present between the skin and face-mask seal surface that interferes with the seal. Correct any other condition identified during the fit testing that interferes with the sealing surface of the face-piece or interferes with the valve function.

Refer any employee who experiences difficulty breathing or exhibits severe psychological reaction during any phase of fit-testing to the Program Administrator to re-evaluate whether the employee is capable of wearing a respirator.

The Program Administrator will maintain records of fit-tests to assure testing is current. The Program Administrator is responsible for procurement of appropriate respiratory protection. The Program Administrator is responsible for ensuring employees were fit-tested as required by this program, and will ensure that respirators are not issued to or used by any employee who has not met this requirement.

RESPIRATOR USERespirator Inspection:

Prior to daily use of a respirator, the employee will inspect the general condition of the respirator including facepiece, valves, cartridges, and straps. Parts are replaced as necessary. Employees are also required to conduct a monthly documented inspection using the respirator inspection form located in Appendix I.

Before Use Inspection Checklist:

Facepiece:

• Dirt

• Cracks, tears, or holes

• Distortion of facepiece

• Cracked, scratched, or loose fitting lenses

Headstraps:

• Breaks or tears

• Loss of elasticity

• Broken buckles or attachments

OSHA 29 CFR 1910.134 - Respiratory Protection

Inhalation and Exhalation Valves:

• Dust particles, dirt, or detergent residue on valve and valve seat

• Cracks, tears, or distortion in valve material

• Missing or defective valve covers

Filter Elements:

• Proper filter for the hazard

• Approval designation

• Missing or worn gaskets

• Worn threads on filter and facepiece

• Cracks or dents in filter housing

• Deterioration of canister harness

• Service life indicator, or end of service date

Seal Check:

• Perform a user seal check each time a respirator is donned (when using a disposable respirator, follow manufacturers directions to assure a proper seal).

• Positive Pressure Check – Block the openings of the exhalation valve guard and exhale slightly. If the facepiece bulges slightly, an effective seal was obtained.

• Negative Pressure Check – Place palms over the openings in the cartridges or remove the cartridges and place palms over the inhalation connectors. Inhale and hold your breath for 5 seconds. If the facepiece collapses slightly and no air leaks between the facepiece and your face are detected, an effective fit was obtained. If air leaks are detected, reposition the facepiece on your face and repeat the procedure until an effective seal is obtained.

Do not use respirators if facial hair may interfere with a proper seal. In addition, ensure that the use of goggles, safety glasses, or prescription lenses does not interfere with obtaining a proper seal.

Leave respiratory protection areas if vapor or gas breakthrough occurs or if a change in breathing resistance occurs. Inspect the respirator to determine the cause and necessary parts and/or cartridges replaced.

Clean and disinfect respirators according to the schedule provided in Appendix D.

Store respirators in a plastic bag to protect them from damage, contamination, and dust. Store respirators to prevent exposure to sunlight, extreme temperatures, excessive moisture, and damaging chemicals. Store respirators flat to prevent deformation of the facepiece.

OSHA 29 CFR 1910.134 - Respiratory Protection

CLEANING AND MAINTENANCE Respirator Disassembly

• Remove filters and/or cartridges from face piece.

• Inspect head straps and clips for abuse. Check all elastomer and rubber parts for pliability and signs of deterioration.

• Unscrew and remove exhalation valve guard, valve and seat.

• Remove the threaded plastic flange which holds the exhalation valve seat from the inside of the oral/nasal cup.

• Remove oral/nasal cup assembly by pulling it from the mask.

• Unscrew the nut retaining the speaker diaphragm and remove the diaphragm and O-ring. Inspect the O-ring for damage, replace if necessary.

• Remove the speaker adapter and gasket from the face piece by unscrewing the nut on the outside. Inspect the gasket for damage and replace if necessary.

• Remove the cartridge connectors and their grommets from the face piece.

• Inspect grommet for damage and replace if necessary.

Respirator Cleaning

• Wash the face piece and accessories in warm soapy water. Gently scrub with a soft bristle brush.

NOTE: Use warm water (110°F - 125°F). Rinse parts thoroughly in clean water.

• Air dry in a clean place or wipe dry with a lintless cloth.

Reassembly

• Visually inspect the exhalation valve for damage. If physical abuse is evident, replace.

• Check oral/nasal cup and its inhalation valves for distortion and completeness.

• Reassemble the face piece by reversing the disassembly steps. Make sure all O-rings and gaskets are in place.

Sanitizing

• Immerse the respirator body for two minutes in a 50 ppm chlorine solution (about 2 ml bleach to 1 liter of water).

• Rinse thoroughly in clean water and dry.

NOTE: Use care to ensure the respirator is thoroughly rinsed after cleaning and sanitizing to prevent dermatitis.

Storage

After inspection, cleaning and necessary repair, store respirators in an area to protect against dust, sunlight, heat, extreme cold, excessive moisture or damaging chemicals. See discussion above regarding storage.

OSHA 29 CFR 1910.134 - Respiratory Protection

CARTRIDGE CHANGE SCHEDULEA cartridge’s useful service life is how long it provides adequate protection from harmful chemicals in the air. The service life of a cartridge depends upon many variables including environmental (heat and humidity) conditions, employee breathing rate, frequency of use by employee (e.g., continuously or intermittently), cartridge filtering capacity, the number and concentration of the contaminants in the air, etc.

Develop a respirator cartridge change out schedule for cartridges or canisters used with air purifying respirators that do not have an End of Service Life Indicator (ESLI). The purpose of this is to prevent contaminants from breaking through the respirator’s sorbent cartridge(s), and thereby over-exposing employees.

1) Employees wearing APRs or PAPRs with P100 filters for protection against wood dust and other particulates will change the cartridges on their respirators when they first begin to experience difficulty breathing (i.e., resistance) while wearing their masks.

2) Employees wearing APRs with organic vapor cartridges will change the cartridges on their respirators in accordance with the manufacturer’s recommendation or through information obtained from either for the following:

Manufacturer - 3M has an interactive “Cartridge Service Life” program which is available for free at:

www.mmm.com/market/safety/ohes2/index.html

This program will estimate cartridge service life for 3M products against many contaminants. The program does not evaluate the service life against mixtures (multiple contaminants).

OSHA – OSHA provides a Math Model “eTool” in their “Respiratory Protection Advisor – Respirator Change Schedules,” which estimates cartridge service life. The Math Model is available for free at:

www.osha.gov/SLTC/etools/respiratory/change_schedule.html

DEFECTIVE RESPIRATORS1. Take respirators that are defective or have defective parts out of service immediately. If, during an inspection, an employee discovers a defect

in a respirator, bring the defect to the attention of the Program Administrator or other responsible party who will decide whether to:

• Temporarily take the respirator out of service until it is repaired.

• Perform a simple fix on the spot such as replacing a headstrap.

• Dispose of the respirator due to an irreparable problem or defect.

2. When a respirator is taken out of service for an extended period of time, tag the respirator out of service, and give the employee a replacement of similar make, model, and size. Keep all tagged out respirators in the storage cabinet inside the Program Administrator’s office.

OSHA 29 CFR 1910.134 - Respiratory Protection

VOLUNTARY RESPIRATOR USEEmployees may voluntarily use respiratory protection when not required for job duties only when it is determined that the respirator itself does not present a hazard.

Employees voluntarily using respirators will comply with Appendix F of this program.

Medically approve those employees voluntarily using respiratory protection to wear the respirator (Exception: Not required for filtering face pieces). Maintain respirators in accordance with all aspects of this policy

EMERGENCY RESPIRATOR USEThe Program Administrator will develop specific procedures related to emergency respirator use. Supplemental procedures for emergency respirator use are included as Appendix G.

RESPIRATORS FOR IDLH ATMOSPHERESThe Program Administrator will develop specific procedures related to Immediately Dangerous to Life and Health (IDLH) use. Supplemental procedures for IDLH respirator use are included as Appendix H.

TRAININGTrain all employees participating in our respiratory protection program initially annually, and when the following situations occur:

• Changes in the workplace of the type that would render previous training obsolete

• Inadequacies in the employee’s knowledge or skill demonstrate retraining is necessary

• Other situations that arise indicating retraining is necessary.

Topics included in the training program will consist of, but are not limited to:

• Why the respirator is necessary and how improper fit, usage, or maintenance can compromise the protective effect of the respirator

• What are the limitations and capabilities of the respirator

• How to use the respirator effectively in emergency situations, including situations in which the respirator malfunctions

• How to inspect, put on and remove, use, and check the seals of the respirator

• What the procedures are for maintenance and storage of the respirator

• How to recognize medical signs and symptoms that may limit or prevent the effective use of respirators

PROGRAM EVALUATIONThe Program Administrator will evaluate the respiratory protection program to ensure that the provisions of the policy are effective. Interview employees periodically to assess program effectiveness and proper respirator usage. Factors may include respirator fit, proper respirator usage, appropriate respirator selections, and respirator maintenance and storage.

OSHA 29 CFR 1910.134 - Respiratory Protection

RECORDKEEPINGThe Program Administrator will maintain records of all medical evaluations, fit testing, training and all other elements of the respirator protection program, as well as a copy of this respiratory protection program.

Retain and make available records of medical evaluations required by OSHA in accordance with 29 CFR 1910.1020.

Qualitative and quantitative fit tests records will include:

• The name or identification of the employee tested;

• Type of fit test performed;

• Specific make, model, style, and size of respirator tested;

• Date of test; and

• The pass/fail results for QLFTs or the fit factor and strip chart recording or other recording of the test results for QNFTs.

Retain fit test records for respirator users until the next fit test is administered.

First Name: Last Name:

Position/Task Name: Dept/Unit/Shop:

Describe the Hazards/Agents Products:

Are current MSDS available? Yes No (Current MSDS are necessary for hazard assessment and respirator selection.)

Describe the Activities/Processes:

Frequency of Activity/Process: Rarely Occasionally Frequently Task Specific Please explain:

Contaminant Forms: (Check all that apply) Particulate Vapor Gas Fume

Current Engineering Controls: (Check all that apply) None Substitution by less toxic material Isolation or enclosure of operation or process General ventilation dilution Local Exhaust: Hood, vented duct or other ventilation apparatus Tools or equipment designed to minimize exposure Other Explain:

Current Administrative Controls: (Check all that apply) Employee Training SOP (Specify) Other Explain: ___________________________

PPE/Other Equipment: (Check all that apply) None Gloves Hard Hat Face Shield Safety Goggles Lab Coat Coveralls Other

Special Uses: (Check all that apply) None Riot Control Rescuel Biological Use Chemical Spill Clean-up Pesticide Application Escape Only (Specify) Confined Space Entry Other

Physical Demands of Work: (Check all that apply) Constant Intermittent Light (i.e. Standing) Moderate (i.e. Walking) Heavy (i.e. Digging) High Temperatures Low Temperatures Other

EMPLOYEE INFORMATION

WORK INFORMATION

APPENDIx A - Respirator Request Form

APPENDIx B – Medical Surveillance 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 Can you read and check off: 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 health care professional who will review it.

Part A – Section 1 (Mandatory)Every employee must provide the following information if they were 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: lbs.

7. Your job title:

8. Provide a phone number where the health care professional who reviews this questionnaire can reach you (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: Yes No

11. Check the type of respirator you will use (you can check more than one category):

N, R, or P disposable respirator (filter-mask, non- cartridge type only).

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)Every employee who was selected to use any type of respirator must answer Questions 1 through 9 (please check “yes” or “no”).

1. Do you currently smoke tobacco, or have you smoked tobacco in the last month? . . . . . . . . . . . Yes No

2. Have you ever had any of the following conditions? Seizures (fits) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Diabetes (sugar disease) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Allergic reactions that interfere with your breathing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Claustrophobia (fear of closed-in places) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Trouble smelling odors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

APPENDIx B – Medical Surveillance Questionnaire

3. Have you ever had any of the following pulmonary or lung problems?Asbestosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Chronic bronchitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Emphysema . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Pneumonia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Tuberculosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Silicosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Pneumothorax (collapsed lung) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Lung cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Broken ribs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Any chest injuries or surgeries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Any other lung problem that you’ve been told about . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

4. Do you currently have any of the following symptoms of pulmonary or lung illness?Shortness of breath . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Shortness of breath when walking fast on level ground or walking up a slight hill or incline . . . . . . Yes No Shortness of breath when walking with other people at an ordinary pace on level ground . . . . . . . . . Yes No Have to stop for breath when walking at your own pace on level ground . . . . . . . . . . . . . . . . . . . . . . Yes No Shortness of breath when washing or dressing yourself . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Shortness of breath that interferes with your job . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Coughing that produces phlegm (thick sputum) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Coughing that wakes you early in the morning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Coughing that occurs mostly when you are lying down . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Coughing up blood in the last month . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Wheezing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Wheezing that interferes with your job . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Chest pain when you breathe deeply . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Any other symptoms that you think may be related to lung problems . . . . . . . . . . . . . . . . . . . . . . . . Yes No

5. Have you ever had any of the following cardiovascular or heart problems?Heart attack . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Stroke . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Angina . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Heart failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Swelling in your legs or feet (not caused by walking) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Heart arrhythmia (heart beating irregularly) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No High blood pressure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Any other heart problem that you were told about . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

6. Have you ever had any of the following cardiovascular or heart symptoms?Frequent pain or tightness in your chest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Pain or tightness in your chest during physical activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Pain or tightness in your chest that interferes with your job . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No In the past two years, have you noticed your heart skipping or missing a beat . . . . . . . . . . . . . . . . . Yes No Heartburn or indigestion that is not related to eating . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Any other symptoms that you think are related to heart or circulation problems . . . . . . . . . . . . . . . . Yes No

APPENDIx B – Medical Surveillance Questionnaire

7. Do you currently take medication for any of the following problems?Breathing or lung problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Heart trouble . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Blood pressure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Seizures (fits) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

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) Eye irritation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Skin allergies or rashes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Anxiety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No General weakness or fatigue) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Any other problem that interferes with your use of a respirator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

9. Would you like to talk to the health care professional who will review this questionnaire about your answers to this questionnaire? Yes No

Every employee must answer Questions 10 to 15 who was selected to use either a full-facepiece respirator or a self-contained breathing apparatus (SCBA). For employees who were selected to use other types of respirators, answering these questions is voluntary.

10. Have you ever lost vision in either eye (temporarily or permanently)? Yes No

11. Do you currently have any of the following vision problems?Wear contact lenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Wear glasses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Color blind . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Any other eye or vision problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

12. Have you ever had an injury to your ears, including a broken ear drum? Yes No

13. Do you currently have any of the following hearing problems?Difficulty hearing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Wear a hearing aid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Any other hearing or ear problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

14. Have you ever had a back injury? Yes No

15. Do you currently have any of the following musculoskeletal problems?Weakness in any of your arms, hands, legs, or feet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Back pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Difficulty fully moving your arms and legs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Pain or stiffness when you lean forward or backward at the waist . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Difficulty fully moving your head up or down . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Difficulty fully moving your head side to side . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Difficulty bending at your knees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Difficulty squatting to the ground . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Climbing a flight of stairs or a ladder carrying more than 25 lbs . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Any other muscle or skeletal problem that interferes with using a respirator . . . . . . . . . . . . . . . . . . Yes No

APPENDIx B – Medical Surveillance Questionnaire

Part B

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:

3. Have you ever worked with any of the materials, or under any of the conditions, listed below? Asbestos . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Silica (e.g., in sandblasting) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Tungsten/cobalt (e.g., grinding or welding this material) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Beryllium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Aluminum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Coal (for example, mining) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Iron . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Tin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Dusty environments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Any other hazardous exposures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

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. Were you 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

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:

APPENDIx B – Medical Surveillance Questionnaire

10. Will you use any of the following items with your respirator(s)?HEPA Filters:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Canisters (for example, gas masks): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Cartridges: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

11. How often are you expected to use the respirator(s)?Escape only (no rescue): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Emergency rescue only: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Less than 5 hours per week: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Less than 2 hours per day: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No 2 to 4 hours per day: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Over 4 hours per day: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

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 lbs.) 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 lbs.) 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 lbs.) on a level surface.

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 lbs.) 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 lbs.).

13. Will you wear 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 work under hot conditions (temperature exceeding 77 deg. F)? Yes No

15. Will you work under humid conditions? Yes No

16. Describe the work you do 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):

APPENDIx B – Medical Surveillance Questionnaire

18. Provide the following information, if you know it, for each toxic substance that you are exposed to when you are 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 first toxic substance: Estimated maximum exposure level per shift: Duration of exposure per shift: The name of any other toxic substances that you are exposed to while using your respirator:

19. Describe any special responsibilities you’ll have while using your respirator(s) that may affect the safety and well-being of others (for example, rescue, security):

APPENDIx C - Fit Test Procedures

OSHA-Accepted Fit Test Protocols Fit Testing Procedures – General Requirements

The employer will conduct fit testing using the following procedures. The requirements in this appendix apply to all OSHA-accepted fit test methods, both QLFT and QNFT.

1. Allow the employee to pick the most acceptable respirator from a sufficient number of respirator models and sizes so that the respirator is acceptable to, and correctly fits, the user.

2. Prior to the selection process, show the employee how to put on a respirator, how it is positioned on the face, how to set strap tension and how to determine an acceptable fit. Provide a mirror to assist the employee in evaluating the fit and positioning of the respirator. This instruction may not constitute the employee’s formal training on respirator use, because it is only a review.

3. Inform the employee that he/she is being asked to select the respirator that provides the most acceptable fit. Each respirator represents a different size and shape, and if fitted and used properly, will provide adequate protection.

4. Instruct each employee to hold each chosen facepiece up to the face and eliminate those that obviously do not give an acceptable fit.

5. The more acceptable facepieces are noted in case the one selected proves unacceptable; the most comfortable mask is donned and worn at least five minutes to assess comfort. Assistance in assessing comfort is given by discussing the points in the following item A.6. If the employee is not familiar with using a particular respirator, direct the employee to don the mask several times and to adjust the straps each time to become adept at setting proper tension on the straps.

6. Assessment of comfort will include a review of the following points with the employee and allowing the employee adequate time to determine the comfort of the respirator:

6. (a) Position of the mask on the nose

6. (b) Room for eye protection

6. (c) Room to talk

6. (d) Position of mask on face and cheeks

7. Use the following criteria to help determine the adequacy of the respirator fit:

6. (a) Chin properly placed;

6. (b) Adequate strap tension, not overly tightened;

6. (c) Fit across nose bridge;

6. (d) Respirator of proper size to span distance from nose to chin;

6. (e) Tendency of respirator to slip;

6. (f) Self-observation in mirror to evaluate fit and respirator position.

8. The employee will conduct a user seal check, either the negative and positive pressure seal checks described in Appendix B-1 of this section or those recommended by the respirator manufacturer which provide equivalent protection to the procedures in Appendix B-1. Before conducting the negative and positive pressure checks, instruct the employee to seat the mask on the face by moving the head from side-to-side and up and down slowly while taking in a few slow deep breaths. Select another facepiece and retest if the employee fails the user seal check tests.

9. Do not conduct the test if there is any hair growth between the skin and the facepiece sealing surface, such as stubble beard growth, beard, mustache or sideburns which cross the respirator sealing surface. Remove or alter any type of apparel which interferes with a satisfactory fit.

10. If an employee exhibits difficulty in breathing during the tests, refer the employee to a physician or other licensed health care professional, as appropriate, to determine whether the employee can wear a respirator while performing her or his duties.

11. If the employee finds the fit of the respirator unacceptable, give the employee the opportunity to select a different respirator and to be retested.

12. Exercise regimen. Give the employee, prior to the commencement of the fit test, a description of the fit test and the employee’s responsibilities during the test procedure. The description of the process will include a description of the test exercises that the employee will perform as part of the test. The employee must wear the respirator for at least 5 minutes before the start of the fit test.

13. Perform the fit test while the employee is wearing any applicable safety equipment that is worn during actual respirator use which could interfere with respirator fit.

14. Test Exercises.

(a) Perform the following test exercises for all fit testing methods prescribed in this appendix, except for the CNP method. A separate fit testing exercise regimen is contained in the CNP protocol. The employee will perform exercises, in the test environment, in the following manner:

(1) Normal breathing. In a normal standing position, without talking, the employee will breathe normally.

(2) Deep breathing. In a normal standing position, the employee will breathe slowly and deeply, taking caution so as not to hyperventilate.

(3) Turning head side to side. Standing in place, the employee will slowly turn his/her head from side to side between the extreme positions on each side. Hold the head at each extreme momentarily so the employee can inhale at each side.

(4) Moving head up and down. Standing in place, the employee will slowly move his/her head up and down. Instruct the employee to inhale in the up position (i.e., when looking toward the ceiling).

(5) Talking. Request the employee to talk out loud slowly and loud enough so they are heard clearly by the test conductor. The employee can read from a prepared text such as the Rainbow Passage, count backward from 100, or recite a memorized poem or song.

Rainbow Passage

When the sunlight strikes raindrops in the air, they act like a prism and form a rainbow. The rainbow is a division of white light into many beautiful colors. These take the shape of a long round arch, with its path high above, and its two ends apparently beyond the horizon. There is, according to legend, a boiling pot of gold at one end. People look, but no one ever finds it. When a man looks for something beyond reach, his friends say he is looking for the pot of gold at the end of the rainbow.

(6) Grimace. Request the employee to grimace by smiling or frowning. (This applies only to QNFT testing; it is not performed for QLFT)

(7) Bending over. Request the employee to bend at the waist as if he/she were to touch his/her toes. Substitute jogging in place for this exercise in those test environments such as shroud type QNFT or QLFT units that do not permit bending over at the waist.

(8) Normal breathing. Same as exercise (1).

(b) Perform each test exercise for one minute except for the grimace exercise which is performed for 15 seconds. The test conductor will ask the employee about the comfort of the respirator after completion of the protocol. Ask the employee to try another model respirator if it the test model is uncomfortable Do not adjust the respirator once the fit test exercises begin. Any adjustment voids the test, and requires a repeat fit test.

APPENDIx C - Fit Test Procedures

APPENDIx C - Fit Testing Document Form

Employee Name: Date:

Respirator Information

Brand: Style:

Model Number: Size:

User Seal Check: Positive Pressure Pass Fail

Negative Pressure Pass Fail

QUALITATIVE FIT TEST:

Type/Brand:

Expiration Date:

Batch Number or other tracking number mfg.:

Pass Fail

QUANTITATIVE FIT TEST:

Brand/Model:

Serial Number: Calibration Date:

Fit Factor: Pass Fail

APPENDIx D - Voluntary Use of Respirators

Appendix D to Sec. 1910.134 (Mandatory) Information for Employees Using Respirators When Not Required Under the Standard Respirators are an effective method of protection against designated hazards when properly selected and worn. Respirator use is encouraged, even when exposures are below the exposure limit, to provide an additional level of comfort and protection for workers. However, if a respirator is used improperly or not kept clean, the respirator itself can become a hazard to the worker. Sometimes, workers may wear respirators to avoid exposures to hazards, even if the amount of hazardous substance does not exceed the limits set by OSHA standards. If your employer provides respirators for your voluntary use, of if you provide your own respirator, you need to take certain precautions to insure that the respirator itself does not present a hazard.

You should do the following:

1. Read and heed all instructions provided by the manufacturer on use, maintenance, cleaning and care, and warnings regarding the respirators limitations.

2. Choose respirators certified for use to protect against the contaminant of concern. NIOSH, the National Institute for Occupational Safety and Health of the U.S. Department of Health and Human Services, certifies respirators. A label or statement of certification should appear on the respirator or respirator packaging. It will tell you what the respirator is designed for and how much it will protect you.

3. Do not wear your respirator into atmospheres containing contaminants for which your respirator is not designed to protect against. For example, a respirator designed to filter dust particles will not protect you against gases, vapors, or very small solid particles of fumes or smoke.

4. Keep track of your respirator so that you do not mistakenly use someone else’s respirator.

APPENDIx G - Emergency Respiratory Use Procedures

APPENDIx H - IDLH Respirator Use

Type of Respirator: Location:

Respirator Issued to: Type of Hazard:

Face Piece Cracks, tears, or holes Face mask distortion Cracked or loose lenses/face shield

Head Straps Breaks or tears Broken buckles

Valves Residue or dirt Cracks or tears in valve material

Filters/Cartridges Approval designation 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

Rubber/Elastomer Parts Pliability Deterioration

Inspected by: Date:

Action Taken:

APPENDIx I - Respirator Inspection Checklist