Respiratory Medical Questionnaire


The University has the responsibility of ensuring that employees are medically fit and able to tolerate the physical and psychological stress imposed by respirator use, as well as the physical stress originating from job and workplace conditions. Employees will not be allowed to wear respirators (except filtering face pieces – dust masks) until a licensed health care professional (LHCP) has determined that they are medically able to do so.

Under the University’s Respiratory Protection Program, each employee who is required to wear a respirator is mandated by regulation (Federal OSHA CFR 1910.134(c)(1)(ii) and WA State WAC 296-62-07715) to fill out and submit a Medical Questionnaire to either the KVH workplace health or to your primary health care provider prior to being issued a respirator. Any employee refusing the medical evaluation cannot use a respirator.

It is also mandatory that every wearer of a respirator shall attend respiratory protection awareness training and be fit-tested on the selected respirator.

Fill out the Medical Questionnaire.

For questions, contact or e-mail EH&S at (509)-963-2255 or EHS@cwu.edu

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