Overview

• Appointing a Respirator Program Manager
• Writing a Site Specific Respirator Program
• Selecting the Right Respirator for the Task

• Medical Training
• Training
• Fit Testing
• Ordering Respirators and Supplies

• Managing Respirator Use
• Maintaining Respirators

Section 4: Records & Evaluations

• Recordkeeping
• Evaluating the Site Specific Program

Overview

This guide outlines the steps for planning and managing a respirator protection program for workers exposed to lead dust or fume during construction activities. It covers all the components of a respirator program as required by OSHA. The guide will be helpful to anyone with respirator program responsibilities; it can be used in its entirety or by section.

Why do you need a respirator protection program?

• It is required by OSHA whenever respirators are used.
  
• Respirators must be used when engineering and work practice controls fail to reduce lead exposure below the Permissible Exposure Limit (PEL).

— This Guide will elaborate on these tasks —

• Appointing a respirator program manager
• Writing a site specific respirator program
  
• Selecting the right respirator for each lead generating task
  

Approving a Respirator Program Manager (RPM)

• Appointed by higher management
  
  • Position can be assigned to a site safety officer, project engineer, or other competent construction manager
  
  
• RPM must be qualified by training and/or experience with the respirators used at the site
  
  • Arrange respirator training if needed (see Resource List).
  
  
• A qualified worker can be assigned day-to-day program tasks such as:
  • fit testing
    
  • training
    
  • maintenance/cleaning
    
  • assisting in program evaluation

Writing a site specific respirator program

• Program can be written by RPM, company safety officer or IH consultant
  
• The Program can be adapted from:
  
  • company-wide program
    
  • previous project
    
  • OSHA model program
    
  • commercially available program
  
  
• The Program must address the following items:
  
  • respirator selection
    
  • medical evaluation
    
  • use of respirators
    
  • training
    
  • fit testing
    
  • maintenance
    
  • record keeping
    
  • evaluation
• The Program must be site specific. It must address the use of respiratory protection under the conditions present at the site.
  
  • The site-specific program is an open-ended document that is updated as respirator needs change at the site.
    
  • The Sample Program in Section 5 represents the program updated after exposure monitoring and respirator selection have been completed. You can adapt this sample program to your site’s conditions and needs.

Selecting the right respirator for the task

OSHA Presumed Exposure Level for Selected Tasks

• Less than 500 mcg/m³
  • Manual demolition
    
  • Power tool cleaning with dust collection systems
    
  • Dry manual sanding
    
  • Dry manual scraping
    
    
• Between 500 and 2,500 mcg/m³
  • Movement and removal of the abrasive blasting enclosure
    
  • Rivet busting
    
  • Power tool cleaning without dust collection systems
    
  • Cleanup of dry expendable abrasive blasting jobs
    
  • Lead burning
    
  • Using lead-containing mortar
    
    
• > 2,500 mcg/m³
  • Abrasive blasting
    
  • Welding
    
  • Oxy-acetylene torch cutting

• Use the Respirator Selection Flow Chart below to select the correct respirator for each activity. An example of a completed worksheet follows on the next page.
  
• Complete the blank Worksheet in Section 5 (D-35).

Respirator Selection Flow

Step 1: List all activities that generate lead dust or fume. Seek input from job foremen, stewards, and workers. Step 2: Identify workers and supervisors who do these activities or may be working nearby. Step 3: List air monitoring results as an 8-hour Time Weighted Average (TWA). See Guide for Managing Exposure Assessment for Lead. Step 4: Compare the air monitoring results with the Maximum Use Concentrations (MUC) in Table 1 (D-6). Step 5: Select a respirator with a MUC greater than the monitoring result. Step 6: Include respirator selection worksheet in your site specific respirator program.

* N/R/P-100 designation indicates resistance to oil. N=not oil resistant/ R=oil resistant / P=oil proof.
# Must be quantitatively fit tested.

Mobilizing at the Worksite

Once the initial planning has been completed, it is time to mobilize people and equipment. Mobilization requires additional planning, coordination and paperwork.

Before a worker can use a respirator on-site the following activities must be completed:

• Medical evaluation
  
• Training
  
• Fit testing
  
• Ordering respirators and supplies

• Medical evaluation is done by a physician or licensed health care professional (referred to as the PLHCP), who is responsible for:
  
  
• Reviewing the OSHA Respirator Medical Evaluation Questionnaire (MEQ)
  
• Making a medical determination of fitness to wear a respirator
  
• Recommending any follow-up evaluation
  
• Communicating result to employer/workers

• Find a PLHCP to provide medical evaluations for respirator users.
  • Use Infosheet 1: Information to Gather when Hiring a Medical Service (D-37).
    
    
• Provide the PHLCP with a copy of the company respirator program and a completed Job/Task Information Form.

Administering the medical evaluation

Medical evaluations can be administered in one of three ways:

The MEQ is completed on-site and reviewed off site by the PLHCP. See flow chart below: Preparing MEQs On-Site.

• Any positive answer to a question must be followed up by a medical “consultation” or exam. The consultation can be as simple as a phone call from the PLHCP to the worker.
  
• The PLHCP makes a determination of fitness for respirator use or recommends follow-up evaluation.

The MEQ is completed and reviewed on-site under the supervision of the PLHCP.

• Again, any positive response to any question must be followed up by a medical consultation or exam.
  
• The PLHCP makes a medical determination or recommends follow-up evaluation.

• The PLHCP determines the contents of the medical exam. There are no specific medical procedures or tests required by OSHA. (i.e. pulmonary function tests are not required by OSHA but may be ordered by the PLHCP).
  
• The PLHCP does not have to use the OSHA MEQ but must obtain the medical history information contained in it.
  
• The PLHCP makes a medical determination or recommends follow-up evaluation.

Preparing MEQs On-Site

Step 1: Provide each worker being evaluated an MEQ, the form "Employee Instructions For Filling Out Respirator MEQ" (D- 57), and an envelope with their name on it (addressed to the medical service). Step 2: Read out loud the "Employee Instructions for Filling Out Respirator MEQ". Step 3: Have employee provide a contact phone number and time in case the PLHCP needs to speak with them. Step 4: Provide employees with the telephone number of the medical service so they can contact the PLHCP if they have any questions. Step 5: Provide a private area where employees can fill out questionnaires confidentially. Step 6: Ask employees if they need a translator or someone to read the questionnaire to them. Step 7 : Instruct employees to place the completed questionnaire inside the envelope, seal it and return it to you. Step 8 : Deliver the completed questionnaires to the medical service.program.

Plan for special needs or potential problems

Refer to Table 2 below for dealing with common problems that arise in completing the MEQ

Table 2: Troubleshooting

Training

• Establish a training timetable. Conduct respirator training:
  • before workers use a respirator for the first time
    
  • if workplace conditions change
    
  • whenever problems are noted (e.g., workers not wearing respirators when required)
    
  • annually
    
    
• Select person to do the training. This person can be any of the following individuals:
  • the RPM
    
  • a safety officer
    
  • a union trainer
    
  • a knowledgeable foreman, steward, or worker
    
  • an IH consultant
  
  
• Select a quiet, comfortable area in which to conduct the training.
  
• Prior to training, review the training materials to ensure that they:
  • are site specific - dealing with the conditions at the site
    
  • include a review of respirator use
    
  • are understandable to all workers – language and words that they know
    
    
• Refer to Checklist 1: Suggested Respirator Training Topics (D-59)
  
• The box below contains suggestions for training activities and discussions

Training Tips

Making sure the respirator fits

Scheduling fit testing:

• After workers have been medically cleared
• Before respirators are worn for the first time
  
• Repeat fit testing:
  • yearly
    
  • whenever workers are assigned a different respirator brand or model
    
  • when the worker has a physical change which might effect fit, like an obvious weight gain or loss
    
  • if the worker, supervisor, RPM, or PLHCP requests it

Select person to do the fit testing:

• Fit testing can be done by any of the following
  • the RPM
    
  • an industrial hygienist or safety professional
    
  • respirator manufacturer representative
    
  • trained worker specialist
    
    
• The person must be familiar with the respirators used at the site and be able to follow the OSHA fit testing instructions.

Choose either a qualitative or quantitative fit test method:

• Qualitative fit testing
  
  • this method relies on a worker’s sense of smell, sense of taste or the irritation of mucus membranes to detect leaks into the facepiece.
    
  • a qualitative fit test kit can be ordered from many respirator manufacturers and safety equipment suppliers (see Resource List).
    
  • Table 3 below summarizes important information on qualitative fit tests.
    
  • refer to the OSHA Respiratory Protection Standard, 1910.134, Appendix A, for detailed instructions on fit testing.
    
  • use the Respirator Fit Test Record in Section 5 (D-61).
  
  
• Quantitative fit testing
  
  • requires special equipment.
    
  • is used for certain type respirators (SCBA/FF) when exposure levels are more than 10 times the PEL. For more information see OSHA’s Small Entity Compliance Guide (see Resource List).
    • consult an industrial hygienist or safety professional if you select this method

Table 3: Qualitative Fit Test Information

*N/R/P-100 designation indicate resistance to oil.
N=not oil resistant/ R= oil resistant / P=oil proof

Ordering Respirators and Supplies

• Order respirators
  
  • one respirator for each worker
  • more than one brand may be necessary to fit all workers
    
  • maintain sufficient stock to replace and repair respirators as needed
    
    
• Order filters
  
  • The right filter for lead exposure is a 100 series (HEPA) filter (N/R/P). This filter can also be used with all fit test agents except banana oil which require organic vapor cartridges.
    
  • Whichever filters or cartridges you use, make sure that they match the facepiece (same manufacturer/model respirator)
    
    

  • See Checklist 2: Respirator Supplies

Day-to-Day Practices

This section includes guidance on:

Managing respirator use
Maintaining respirators

• Post Infosheet 2: Respirator Use Practices (D-65) in the office, the shanty and at the supply station.
  
• Field supervisors, foremen and workers are responsible for making sure that respirators are used when necessary and that they are maintained and worn correctly.
  • Have a protocol in place for dealing with workers who do not wear respirators when required.
    
    
• Apply the respirator program uniformly and consistently: assure that all supervisory personnel and site visitors wear respirators in areas where they may be exposed to lead.
  
• Discuss problems that arise in the field during management safety meetings and weekly worker toolbox talks.
  
• As part of regular required evaluation, the RPM should make periodic audits of the site and note any problems.

Refer to Table 4 below, Troubleshooting Respirator Problems.

Table 4: Troubleshooting Respirator Problems

Maintaining respirators

On large jobs assign a trained individual to take care of respirators.

• This person (a.k.a. Respirator Technician) is responsible for inspecting, repairing, maintaining supplies, and cleaning respirators.
  
  • Candidates for the job could be a trained apprentice or journeyman.
    
    
• On smaller jobs, workers can do these things for themselves as long as the RPM keeps an adequate stock of respirator supplies and the workers are trained in maintenance procedures recommended by the manufacturer. See Checklist 2: Respirator Supplies , for suggestions. Quantities needed will vary based on size of workforce and duration of project.

This section reviews:

Recordkeeping
Evaluating the site specific program

Recordkeeping

• Records can be kept by RPM or delegated to office staff.
  
• The following records should be maintained
  • respiratory medical clearance
    
  • fit test results
    
  • training rosters
    
    
• Records should be kept in alphabetical order in a file folder or loose-leaf binder together with the site-specific program.
  
• Keep a Record Summary Spreadsheet (D-67) of individual worker records. This can be done electronically or manually and should be maintained with the site-specific program. This summary spreadsheet can be designed to alert you to scheduling needs such as:
  • training
    
  • fit testing
    
  • medical evaluation
    
  • annual follow-ups

Evaluating site-specific program

• The program is evaluated to:
  • ensure that it is working effectively
    
  • identify areas for improvement
    
    
• The components of program evaluation are:
  • reviewing the written guidelines and conducting site audits to assure proper implementation
  • consulting with workers and supervisors about respirator usage
    
    
• Program evaluation is conducted by the RPM with help from the company’s safety person or an IH consultant.
  
• Evaluation frequency is determined by the RPM based on exposure levels and complexity of respirator program.
  
• Conduct the evaluation by walking around the site, observing respirator use, asking questions, and talking to the workers, foremen, and shop stewards.
  
• Ongoing assessment of factors such as respirator fit, selection, proper use under site conditions, and maintenance.
  
• Use the Checklist 3: Evaluation of Site Specific Respirator Program.

Checklists, Sample Forms & Further Information

Sample Site Specific Respiratory Protection Program
Sample Respirator Selection Worksheet
Infosheet 1: Information to Gather When Hiring a Medical Service
Job/Task Information Form for PLHCP
Medical Evaluation Questionnaire (English)
Medical Evaluation Questionnaire (Spanish)
Employee Instructions for Filling Out Respirator MEQ
Checklist 1: Suggested Respirator Training Topics
Respirator Fit Test Record
Checklist 2: Respirator Supplies
Infosheet 2: Respirator Use Practices
Sample Respirator Records Summary
Checklist 3: Evaluation of Site-Specific Respirator Program

Respiratory Protection Program for Lead Sand City Construction Co., Inc.

Gotham City Railway Main Terminal Building Historical Restoration, contract # NCS-7833
January 1, 2000 – June 30, 2001

Purpose

Sand City Construction Co., Inc. has been contracted to complete the Gotham City Railway Main Terminal Building Historical Restoration, contract # NCS-7833.

Sand City Construction has determined that during the course of this project some employees will be exposed to lead dust and fume during routine operations. The purpose of this program is to ensure that Sand City Construction employees are protected from exposure to lead.

Whenever feasible engineering controls, such as substitution, or the use of tools equipped with Local Exhaust Ventilation (LEV) will be used to reduce exposure. When engineering controls cannot be used, or have not successfully reduced the hazard sufficiently, respirators will be employed.

Scope and Application

This program applies to all Sand City Construction employees who are required to wear respirators during normal work operations. Work processes requiring the use of respirators are listed in Section 4.2 Table 1. Work activities covered by this program include the use of: rivet busters, oxyacetylene torches, grinders, and any other tool/task emitting lead dust or fume. Project management will assure that changes in work operations are evaluated for hazardous exposures and proper respirator selection.

Employees participating in the respiratory protection program do so at no cost to themselves. Any expense associated with training, medical evaluations and respiratory protection equipment will be borne by the company.

Voluntary Use

Any employee who voluntarily chooses to wear one of the respirators selected when a respirator is not required will be subject to the provisions of this section.

Sand City Construction will approve requests for voluntary respirator use on a case-by-case basis. Voluntary use of a respirator may be granted if such use will not jeopardize the health or safety of the worker. The Program Administrator will provide all employees who voluntarily choose to wear a respirator a copy of Appendix D of the of the OSHA respirator standard 1910.134 which details the requirements for voluntary use.

Voluntary users are subject to the medical evaluation, cleaning, maintenance, inspection and storage elements of this program. Fit testing and training are not required but highly recommended. To date, no workers have requested respirators where not required.

Employees voluntarily wearing filtering facepieces (dust masks) are not subject to the provisions of this program.

Responsibilities
Program Administrator

The Program Administrator is responsible for administering the respiratory protection program.
The responsibilities of the Program Administrator include:

• Identifying work areas, processes and tasks that require respiratory protection.
  
• Selecting respirators.
  
• Monitoring respirator use to ensure they are used correctly.
  
• Arranging for and/or conducting respirator training.
  
• Providing for proper storage and maintenance of respirator equipment in accordance with the
  provisions of this program.
  
• Arranging for and/or conducting fit testing.
  
• Administrating the medical surveillance program.
  
• Keeping records.
  
• Periodically evaluating the program.
  
• Updating the program when required.

The Respirator Program Administrator for Sand City Construction at the Gotham City Railway Main Terminal Building Historical Restoration Project is John Freeman, Telephone number (917) 666-7876.

The Program Administrator may appoint additional personnel to assist him/her in administrating the program. At this site John Franklin is responsible for respirator maintenance.

Supervisors

Supervisors are responsible for ensuring that the respiratory protection program is implemented in their work areas. In addition to being knowledgeable about the program, supervisors must also ensure that the program is understood and followed by the employees they supervise. Duties of the supervisor include:

• Ensuring the availability of appropriate respirators and accessories.
  
• Being aware of tasks requiring the use of respiratory protection.
  
• Enforcing the proper use of respiratory protection when necessary.
  
• Ensuring that respirators are properly cleaned, maintained, and stored according to the respiratory protection plan.
  
• Ensuring that respirators fit well and do not cause discomfort.
  
• Coordinating with the Program Administrator on how to address respiratory hazards or other concerns regarding the program.

Employees

Each employee has the responsibility to wear his or her respirator when and where required and in the manner in which they were trained. Employees must also:

• Care for and maintain their respirators as instructed, and store them in a clean sanitary location.
  
• Inform their supervisor if the respirator no longer fits well, and request a new one that fits properly.
  
• Inform their supervisor or the Program Administrator of any respiratory hazards that they feel are not adequately addressed in the workplace and of any other concerns that they have regarding the program.

Program Elements
Selection Procedures

The Program Administrator has selected respirators for the site based on respiratory hazards that workers are potentially exposed to and in accordance with all OSHA standards.

Workers are given a choice of 3M model 7500 or Survivair 7000 series 1 /2 face air purifying respirator, each available in 3 sizes (small, medium and large). A copy of the manufacturers instructions for using each type respirator is attached to this program.

The Program Administrator has reviewed the hazard evaluation for each operation, process, or work area where airborne contaminants may be present. All work activities that crush, cut, grind, burn or generate dust or fume were evaluated for hazardous exposures. Procedures for respirator selection included:

• Inventory of hazardous substances used or produced at the project site.
  
• Review of work activities to determine where potential exposures to hazardous substances may occur.
  This review was conducted by considering the scope of work, by surveying the workplace, and by talking with employees and supervisors.
  • Initial respirator selection for lead exposed workers will be based on OSHA presumed exposure levels, Lead In Construction; Interim Final Rule, 29 CFR 1926.62

Only respirators approved by the National Institute of Occupational Safety and Health (NIOSH) have been selected for use at this site. All respirators shall be used in accordance with the terms of that certification. All filters, cartridges, and canisters are labeled with the appropriate NIOSH approval label. The label must not be removed or defaced while it is in use.

Respirators selected for use at this site have a maximum use concentration equal to or greater than the air monitoring results for a particular work activity.

Hazard Assessment

The Program Administrator will revise and update the hazard assessment as needed, for example if there is a change in a work process that may potentially affect exposure levels. If an employee feels that respiratory protection is needed during a particular activity, they have been informed that they should notify their supervisor or the Program Administrator. The Program Administrator will evaluate the potential hazard and arrange for outside assistance as needed. If it is determined that respiratory protection is necessary, all other elements of this program will be in effect for those tasks and this program will be updated accordingly.

Table 1: Results of Exposure Assessment and Respirator Selection for Lead Gotham City Railway Main Terminal Building Restoration Project

Medical Evaluation

(a) Employees who are either required to wear a respirator on this job, or who choose to wear one voluntarily, must be medically cleared for respirator use by a physician or licensed health care professional (PLHCP) before being permitted to do so on this job. Any employee refusing the medical evaluation will not be allowed to work in an area requiring respirator use.

(b) The Gotham City Occupational Medicine Clinic has been selected to conduct respirator medical clearance evaluations for Sand City Construction:

Gotham City Occupational Medicine Clinic
55 Sullivan Place, Brooklyn, NY 11225
Telephone number: 718-987-0090

Procedures for the medical evaluation are as follows:

• The medical evaluation is conducted using the questionnaire provided in Appendix C of the OSHA Respiratory Protection Standard. The Program Administrator has to provide a copy of this questionnaire to all employees requiring medical evaluations.
  
• To the extent feasible, the company provides translators and/or readers to assist employees who are unable to read the questionnaire.
  
• All affected employees are given a copy of the medical questionnaire to fill out, along with a stamped envelope addressed to the Gotham City Occupational Medicine Clinic.
  
• Employees are permitted to fill out the questionnaire on company time.
  
• Follow-up medical exams are granted to employees as required by the standard, and/or as deemed necessary by the Gotham City Occupational Medicine Clinic.
  
• All employees are granted the opportunity to speak with the physician about their medical evaluation, if they so request.

The Program Administrator has provided the Gotham City Occupational Medicine Clinic with a copy of this program, a copy of the OSHA Respiratory Protection Standard, and a list of hazardous substances by work area. For each employee requiring a medical evaluation, the Clinic has been provided with the following information:

• Work area or job title.
  
• Proposed respirator type.
  
• Length of time employee will be required to wear a respirator.
  
• Expected physical work load (light, moderate, or heavy).
• Potential temperature and humidity extremes.
  
• Any additional protective clothing required.

Any employee required for medical reasons to wear a powered air purifying respirator (PAPR) will be provided with a powered APR. To date, this has not been necessary.

Any employee who has received clearance and begun to wear a respirator, will be provided with additional medical evaluation under the following circumstances:

• Employee reports signs and/or symptoms related to their ability to use a respirator, such as shortness of breath, dizziness, chest pains, or wheezing.
  
• The Gotham City Occupational Medicine Clinic physician or supervisor informs the Program Administrator that the employee needs to be reevaluated.
  
• 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.

Fit Testing

All employees required to wear a respirator are fit tested:

• Prior to initial use of a tight fitting facepiece respirator.
• Annually.
  
• When there are changes in the employee’s physical condition that could affect respiratory fit (obvious change in body weight, facial scarring, etc).

Employees voluntarily wearing 1 /2-face APRs may be fit tested upon request.

Employees are fit tested with the make, model, and size of respirator that they actually wear. Employees are provided with several models and sizes of respirators so that they may find the best fit.

Fit testing of positive pressure respirators will be conducted in the negative pressure mode.

All fit tests follow the protocol in the OSHA Respiratory Protection Standard 1910.134, Appendix A. All 1 /2-face APRs are qualitatively fit tested. Full-face respirators are quantitatively fit tested when used to a protection factor exceeding 10x the OSHA Permissible Exposure Level for lead. To date, this has not been necessary.

Respirator Use

Employees are trained to use their respirators whenever performing tasks listed in Table 1 or any other tasks specified by the Program Administrator. All use is in accordance with this program and with the training received by workers. A respirator shall not be used in a manner for which it is not certified NIOSH or by its manufacturer.

All employees will conduct user seal checks each time they wear their respirator.
All employees are permitted to leave the work area to go to a clean area to maintain their respirator the following reasons:

• To clean their respirator if the respirator is impeding their ability to work.
  
• To relieve skin irritation.
  
• To change filters/cartridges or to replace parts.
  
• To repair respirator malfunctions.

Employees are informed that they should notify their supervisor before leaving the work area.

Employees are trained that respirators must be worn so that a good facepiece-to-face seal is maintained.

• Employees are not permitted to wear tight-fitting respirators if they have any condition, such as facial scars, facial hair, jewelry, or missing dentures, that prevents them from achieving a good seal.
  
• Employees are not permitted to wear headphones, jewelry, or other articles that may interfere with the facepiece-to-face seal.

Emergency Procedures

At this site there are no work areas or processes identified to date as having foreseeable work related emergencies requiring respiratory protection. Sand City Construction employees are not trained as emergency responders, and are not authorized to act in such a manner.

(a) Respirator Malfunction

For any malfunction (e.g., such as breakthrough, leakage, or a malfunctioning valve), the respirator wearer informs his or her supervisor and then proceeds to the designated clean area to maintain the respirator. The supervisor ensures that the employee receives the needed parts to repair the respirator, or is provided with a new respirator.

Cleaning, Maintenance, Filter Change Out Schedule and Storage

Respirators are inspected for defects, cleaned, disinfected, and maintained on a regular basis by the individual worker or the designated respirator program assistant. At this site John Franklin is responsible for respirator maintenance.

(a) Cleaning

A designated respirator cleaning station is located in the employee locker room. The Program Administrator ensures an adequate supply of appropriate cleaning and disinfecting material at the cleaning station. If supplies are low, employees are informed that they should contact their supervisor, the Program Administrator, or respirator program assistant.

The following procedure is to be used when cleaning and disinfecting respirators:

• Disassemble respirator, remove any filters, canisters, or cartridges.
• Wash the facepiece and parts in a mild detergent with warm water. Do not use organic solvents.
  
• Rinse completely in clean warm water.
  
• Wipe the respirator with disinfectant wipes to kill germs.
  
• Air dry in a clean area.
  
• Reassemble the respirator and replace any defective parts.
  
• Place in a clean, dry plastic bag or other airtight container.
  
• Respirators issued for the exclusive use of an employee shall be cleaned as often as necessary.
  
• Atmosphere supplying respirators are to be cleaned and disinfected after each use

(b) Maintenance

Respirators are to be properly maintained at all times in order to ensure that they function properly and adequately protect the employee. Maintenance involves a thorough visual inspection for cleanliness and defects. Worn or deteriorated parts will be replaced prior to use. No components will be replaced or repairs made beyond those recommended by the manufacturer.

The following items will be checked when inspecting respirators:

• Facepiece: cracks, tears, or holes
• Facemask distortion
  
• Cracked or loose lenses/faceshield
  
• Headstraps: breaks or tears, broken buckles
  
• Residue, dirt cracks or tears in valve material
  
• Filters/cartridges, the right one for the hazard, cracked or excessively dirty
  
• Gaskets and housings for cracks or dents

(c) Change Out Schedules

Employees wearing air purifying respirators with 100 series filters are informed that they should change the filter cartridges on their respirators when they are difficult to breathe through, excessively dirty or damaged.

(d) Storage

Respirators are stored in a clean, dry area, and in accordance with the manufacturer’s recommendations. Each employee cleans and inspects his/her own air-purifying respirator in accordance with this program and stores their respirator after drying in a dry plastic bag or rigid container with a tight fitting lid.

(e) Defective Respirators

Respirators that are defective are taken out of service immediately. If, during an inspection, an employee discovers a defect in a respirator, he/she will inform their supervisor. Supervisors give all defective respirators to the Program Administrator or his/her assistant for repair or disposal.

Training
(a) Training Topics:

• OSHA Respiratory Protection Standard Program.
  
• Sand City Construction’s Respiratory Protection Program.
  
• Worker and supervisor responsibilities under the program.
  
• Respiratory hazards encountered at this site and their health effects.
  
• How a respirator works including limitations of selected respirator.
  
• Respirator selection.
  
• Respirator use including inspecting for defects.
  
• Respirator donning and user seal (fit) checks.
  
• Fit testing, explanation of fit test exercises.
  
• Emergency use procedures, if deemed necessary.
  
• Cleaning, maintenance and storage procedures.
  
• When to change filters, where to get new filters and/or replacement parts.
  
• Medical signs and symptoms limiting the effective use of respirators.

Program Evaluation

The Program Administrator or his/her assistant conducts evaluations periodically of the workplace to ensure the effectiveness of the respirator program. The evaluations include consultations with employees and their supervisors, site inspections, air monitoring and a review of records. The Program Administrator corrects any problems identified during these evaluations.

Documentation and Recordkeeping

A written copy of this program and the OSHA standard is kept in the Program Administrator’s Office and is available to all employees who wish to review it. Other records on file include: training rosters and materials, fit test results, and medical clearance certificates. These records will be updated as new employees are trained, or as existing employees receive refresher training, or as new fit tests are conducted.

The Program Administrator also maintains copies of the medical records for all employees covered under the respirator program. The completed medical questionnaire and the physician’s documented findings are confidential and will remain at Gotham City Occupational Medicine Clinic. The company will retain only the physician’s written recommendation regarding each employee’s ability to wear a respirator. Personnel respirator records are summarized in Table 2.

Infosheet 1: Information to Gather When Hiring a Medical Service

Job/Task Information Form for PLHCP

Please provide the following information about respirator users, site working conditions, potential exposures, and respirator selection. Also provide a copy of the company’s current respirator program.

1. Company Name_____________________________ Date__________
Respirator Program Manager_____________________ Phone_____________
Address _______________________________________________________

2. Description of work tasks requiring respirators e.g. torch cutting
_______________________________________________________
_______________________________________________________

3. How often are respirators being worn by employees?

hours per day_____ days per week_____ escape/rescue only_____

4. Potential Exposures: (check all that apply)

_____lead _____asbestos _____silica
_____methylene chloride _____solvents, paints, lacquers _____oxygen deficiency
other(s)______________________________________________________

5. Work Effort:

__ light (sitting, standing) __ moderate (walking, pushing, lifting)
__ heavy (pick and shovel work, heavy lifting)

6. Site Conditions:

___extreme heat or cold ___outdoors
___confined spaces ___elevated work ___other__________
___protective clothing/equipment (other than respirator) Please list:______________________
___________________________________________________________________________

7. Please attach a copy of the company’s respirator program.

8. Please complete the chart below for workers who will be assigned a re spirator (check all that apply).

Notes:
APR - Air purifying respirator
PAPR - Power air purifying respirator
SAR - Supplied air respirator (air line)
SCBA - Self-contained breathing apparatus
1 /2 - Half face respirator
full - Full face respirator
hood/helmet - covers nose, mouth, head and neck and may cover portions of the shoulders and torso

OSHA Respirator Medical Evaluation Questionnaire

To the employee: Can you read English (check one): ___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) 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. Last name:________________ First name:______________
3. Age (to nearest year):______________
4. Sex (check one): ___Male ___Female
5. Height: ___ft. ___in.
6. Weight: _____lbs.
7. Job title:____________________
8. A phone number where you can be reached by the health care professional who reviews this
questionnaire (include area code): (_______)____________________
9. The best time to reach you at this number__________
10. Has your employer told you how to contact the health care professional who will review this
questionnaire (check one): ___Yes ___No
11. Check the type of respirator you will use (you can check more than one category):
a_____. Disposable respirator N, R, or P (filter-mask, non-cartridge type only).
b._____ Other (for example, half or full-facepiece, powered-air purifying, supplied-air, self-contained breathing apparatus).
12. Have you ever worn a respirator in the past: ___Yes ___No
If "yes," what type(s): __________________________________________
__________________________________________________________ __________________________________________________________

Part A. Section 2. (Mandatory) Questions 1 through 9 below must be answered by every employee who has been selected to use any type of respirator (please circle "yes" or "no").

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.

Cuestionario de Evaluación Médica Obligado por OSHA
(Administración de Seguridad y Salud Ocupacional)
Parte 29 CFR 1910.134 Obligatorio para la protección del sistema respiratorio

Marque con un círculo para indicar sus respuestas a cada pregunta

Para el empleado: ¿Puede usted leer? (circule uno) Sí No

Su empleador debe dejarlo responder estas preguntas durante horas de trabajo o en el momento y lugar que sea conveniente para usted. Para mantener este cuestionario confidencial, su empleador o supervisor no debe ver ni revisar sus respuestas. Su empleador debe informarle a quién dar o cómo enviar este cuestionario al profesional de salud que lo va a revisar.

Parte A. Sección 1. (Obligatorio). La siguiente información debe ser provista por cada empleado que ha sido seleccionado para usar cualquier tipo de respirador (escriba claro por favor).

1. Fecha: _______________________________________________________________________

2. Nombre: _____________________________________________________________________

3. Edad:________________________________________________________________________

4. Sexo (circule uno) Masculino o Femenino

5. Altura: __________ pies________pulgadas

6. Peso:____________libras

7. Su ocupación, título o tipo de trabajo:_______________________________________________

8. Número de teléfono donde le puede llamar un profesional de salud con licencia que revisará este cuestionario (incluya el área):______________________________________________________

9. Indique la hora más conveniente para llamarle a este número:____________________________

10. ¿Le ha informado su empleador cómo comunicarse con el profesional de salud con licencia que va a revisar este cuestionario (circule una respuesta)? Sí No

11. Anote el tipo de equipo respiratorio que va a utilizar (puede anotar más de una categoría)
a.____________Respirador desechable de clase N, R o P (por ejemplo: respirador de filtro mecánico, respirador sin cartucho).

b.___________Otros tipos (respirador de media cara o cara completa, purificador de aire accionado por un motor, máscara con manguera con soplador (PAPR), máscara con manguera sin soplador (SAPR), aparato personal de auto-respiración (SCBA)

12. ¿Ha usado algún tipo de respirador? Sí No

Si ha usado equipo protector respiratorio, qué tipo(s) ha utilizado:
_________________________________________________________________

_________________________________________________________________

Parte A. Sección 2. (Obligatorio): Las preguntas del 1 al 9 deben ser contestadas por cada empleado que fue seleccionado para usar cualquier tipo de respirador. Marque con un círculo para indicar sus respuestas.

Parte B. Las siguientes preguntas pueden ser agregadas al cuestionario a discreción del profesional de salud con licencia del estado.

EMPLOYEE INSTRUCTIONS FOR FILLING OUT RESPIRATOR
MEDICAL EVALUATION QUESTIONNAIRE (MEQ)

Attached is a medical evaluation questionnaire for you to fill out. The OSHA standard requires that any employee who wears a respirator must be medically evaluated to ensure the safety and health of the employee. Your answers to this questionnaire will be kept confidential. Your employer does not have the right to view your answers.

A physician or licensed health care professional (PLHCP) will review the questionnaire. If you have any questions about the questionnaire or concerns about respirator use and your health, you can call the PLHCP ___________________ at (_______) -- (___________________)

If the PLHCP has any questions for you, s/he must be able to contact you. It is important that you include your home phone number and a time that you can be reached at home.

If you answer “yes” to any of the questions, please include any comments you might think important in helping the doctor evaluate your answers. (For example, if you have ever had pneumonia, note how long ago, or if you have high blood pressure, note if you are seeing a physician or taking medication to control it.) You can make notes near the question or on the back of the last page of this questionnaire.

The PLHCP may determine that a physical examination is necessary in order to better assess your ability to use a respirator. If so, your employer is required to provide you with a confidential medical examination at no cost to you.

The PLHCP will send a letter to you and your employer indicating if you are cleared for respirator use.

Thank you for your cooperation.

INSTRUCCIONES PARA LLENAR EL CUESTIONARIO DE EVALUACIÓN MÉDICA
DE EMPLEADOS QUE USAN RESPIRADORES

Adjunto encontrará un cuestionario de evaluación médica para que lo llene. La norma de OSHA exige que cualquier empleado que vaya a utilizar un respirador, pase por una valoración médica para asegurar su salud y su seguridad. Las respuestas que dé en el cuestionario son confidenciales. Su empleador no tiene derecho de ver sus respuestas.

Un médico o un profesional médico autorizado (en inglés PLHCP) va a revisar el cuestionario. Si tiene alguna pregunta sobre el cuestionario o alguna inquietud sobre el uso del respirador y su salud, puede llamar al PLHCP
___________________________________ al teléfono (_____) - ____________________.

Si el PLHCP tiene alguna pregunta para usted, debe poder contactarlo. Es muy importante que incluya su número de teléfono y una hora a la que se le pueda llamar a su casa.

Si responde que “sí” a cualquiera de las preguntas, le agradeceríamos que nos dijera cualquier cosa que considere importante para ayudarle al médico a evaluar sus respuestas. (Por ejemplo, si le ha dado neumonía, diga hace cuánto tiempo le dió, o si tiene presión alta, diga si su médico se la está tratando o si está tomando medicamentos para la presión). Puede escribir notas cerca de la pregunta o en la parte de atrás de la última página de este cuestionario.

Es posible que el PLHCP determine que es necesario que usted se haga un examen físico para poder valorar mejor si usted puede usar un respirador. De ser así, su empleador deberá proporcionarle un examen médico confidencial sin costo para usted.

Si el PLHCP considera que usted está en capacidad de utilizar el respirador, le enviará una carta a usted y a su empleador para notificarle.

Muchas gracias por su cooperación.

Checklist 1: Suggested Respirator Training Topics

Topic
General requirements of OSHA Respiratory Protection Standard
Company respirator program; supervisor and worker responsibilities
Lead hazards on site; specify tools and tasks *
Health effects of lead exposure *
Respirator selection (why respirators are necessary), which respirators are required for each task
Limitation and capabilities of selected respirator type
How the respirator works, including type of filter, how to put it on, and how to inspect it for defects; sealing surfaces, valves, straps, cartridges and filters
Positive and negative pressure seal checks
Review fit testing and brief explanation of exercises
Cleaning, storage, maintenance, procedures and supplies
Emergency procedures: what to do if respirator fails, leaks, or causes skin irritation
How to maintain a good fit - facial hair policies, eyeglasses or any other personal protective equipment
When to change filters and where to get new filters and parts
Medical signs or symptoms that may effect respirator use; shortness of breath, dizziness

Respirator Fit Test Record

Employee Information

Name: __________________________________ Date of Birth: ___________________

Home Address: ________________________________________________________

Employer Information

Name: __________________________________ Site:: ___________________

Address: ________________________________________________________

Fit Test Information
Test Date: _____

Test method:(circle) Qualitative/Quantitative

Test givers name: __________________

1. Respirator: Brand: _______ Model # : _______ Size: ________
2. Respirator: Brand: _______ Model # : _______ Size: ________

Sensitivity check: how many sprays (10) (20) (30)

Preliminary Procedures
Clean shaven
Positive/Negative face seal check

Fit Test Exercises (one miute each)
Normal breathing
Deep breathing
Turn head side to side
Moving head up and down
Talking
Jogging in place
Normal breathing

Checklist 2: Respirator Supplies

Item
Spare respirator facepieces in various sizes (small, medium, large)
Replacement 100 series (HEPA) filters (N/R/P)*: keep 2-4 week supply on hand
Spare parts: valves, valve covers, straps
Cleaning and sanitizing solutions, mild soaps, diluted disinfectant
Respirator cleaning wipes for use in the field
Respirator storage containers: heavy duty, ziplock bags or rigid plastic containers

Infosheet 2: Respirator Use Practices

Display this sheet where workers can easily see it.

SAMPLE RESPIRATOR RECORDS SUMMARY

Checklist 3: Evaluation of Site-Specific Respirator Program

Item
Have any new lead tasks been added to project? Have exposures been evaluated?
Are new employees receiving medical evaluation/fit testing /training in a timely manner?
Selection	Have respirators been selected for these new tasks?
	Ask workers if respirators:
	are comfortable
	are compatible with other personal protective equipment
	Interfere with vision or communication
Medical Clearance	Have all wearers been medically cleared to use respirators?
	Have arrangements been made to complete outstanding evaluations?
Training	Have all wearers been trained in respirator use in the past year?
	Have arrangements been made to complete outstanding training?
	Is training site specific?
Fit Testing	Have all wearers been fit tested in the past year?
	Have plans been made to complete outstanding fit tests?
Respirator Use	Are workers using their respirators when needed?
	Are they wearing them correctly?
Storage & Maintenance	Are respirators being properly cleaned, stored and maintained?
	Are cleaning supplies available?
	Are convenient and clean storage facilities available?
Does the written program reflect changes to the program?

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