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WAC 296-307-60405

Provide medical evaluations.

If you have provided an employee with a medical evaluation addressing respirator use, as required by another chapter, that evaluation will meet the requirements of this section.
You must:
• Follow the medical evaluation process, Steps 1 through 7 in this section, to provide medical evaluations for employees at no cost to them.
Medical Evaluation Process
Step 1: Identify employees who need medical evaluations and determine the frequency of evaluations from Table 7. Include employees who:
• Are required to use respirators
• Voluntarily use respirators that are not filtering-facepiece respirators
You may use a previous employer's medical evaluation for an employee if you can:
• Show the employee's previous work and use conditions were substantially similar to yours
• Obtain a copy of the licensed health care professional's (LHCP's) written recommendation approving the employee's use of the respirator chosen by you.
Step 2: Identify a licensed health care professional (LHCP) to perform your medical evaluations.
If you select a different LHCP, you do not need to have new medical evaluations done.
Step 3: Make sure your LHCP has the following information before the evaluation is completed:
• Information describing the respirators employees may use, including the weight and type.
• How the respirators will be used, including:
– How often the respirator will be used, for example, daily, or once a month
– The duration of respirator use, for example, a minimum of one hour, or up to twelve hours
– The employee's expected physical work effort
– Additional personal protective clothing and equipment to be worn
– Temperature and humidity extremes expected during use
• A copy of your written respiratory protection program and this part.
• You may choose to send the questionnaire to the LHCP ahead of time, giving time to review it and add any necessary questions
• The LHCP determines what questions to add to the questionnaire, if any; however, questions in Parts 1-3 may not be deleted or substantially altered.
Step 4: Administer the medical questionnaire in WAC 296-307-61605 to employees, or provide them a medical exam that obtains the same information.
You may use online questionnaires if the questions are the same and requirements of this section are met.
• Administer the examination or questionnaire at no cost to employees:
– During the employee's normal working hours
– At a time and place convenient to the employee
• Maintain employee confidentiality during examination or questionnaire administration:
– Do not view employee's answers on the questionnaire
– Do not act in a manner that may be considered a breach of confidentiality
Providing confidentiality is important for securing successful medical evaluations. It helps make sure the LHCP gets complete and dependable answers on the questionnaire.
• Make sure employees understand the content of the questionnaire.
• Provide the employee with an opportunity to discuss the questionnaire or exam results with the LHCP.
Step 5: Provide follow-up evaluation for employees when:
• The LHCP needs more information to make a final recommendation
• An employee gives any positive response to questions 1-8 in Part 2 or to questions 1-6 in Part 3 of the WISHA medical evaluation questionnaire in WAC 296-307-61605.
Follow-up may include:
• Employee consultation with the LHCP such as a telephone conversation to evaluate positive questionnaire responses
• Medical exams
• Medical tests or other diagnostic procedures.
Step 6: Obtain a written recommendation from the LHCP that contains only the following medical information:
• Whether or not the employee is medically able to use the respirator
• Any limitations of respirator use for the employee
• What future medical evaluations, if any, are needed
• A statement that the employee has been provided a copy of the written recommendation.
Step 7: Provide a powered, air-purifying respirator (PAPR) when the LHCP determines the employee should not wear a negative-pressure air-purifying respirator and is able to wear a PAPR.
See WAC 296-307-602 for requirements regarding selection of air-purifying respirators.
• You may discontinue medical evaluations for an employee when the employee no longer uses a respirator.
• If you have staff conducting your medical evaluations, they may keep completed questionnaires and findings as confidential medical records, if they are maintained separately from other records.
Use Table 7 to determine medical evaluation frequency.
Table 7
Evaluation Frequency
Type of Evaluation:
When required:
Initial medical evaluations
• Before respirators are fit-tested or used in the workplace.
Subsequent medical evaluations
• If any of these occur:
– Your licensed health care professional (LHCP) recommends them; for example, periodic evaluations at specified intervals.
– A respirator program administrator or supervisor informs you that an employee needs reevaluation.
– Medical signs or symptoms (such as breathing difficulties) are:
■ Observed during fit-testing or program evaluation
■ Reported by the employee
– Changes in worksite conditions such as physical work effort, personal protective clothing, or temperature that could substantially increase the employee's physiological stress.
[Statutory Authority: RCW 49.17.010, 49.17.040, 49.17.050, 49.17.060. WSR 05-01-166, § 296-307-60405, filed 12/21/04, effective 4/2/05.]
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