Section 296-842-14005. Provide medical evaluations.

Exemption:	This section does not apply to employees who only use:
	• Filtering-facepiece respirators voluntarily. See WAC 296-842-11005 for voluntary use requirements; or
	• Escape-only respirators that are mouthpiece, loose-fitting, or hooded respirators.

IMPORTANT:

• If an employee has been provided with a medical evaluation addressing respirator use, as required by another chapter, that evaluation will meet the requirements of this section.

• Using a respirator can create physical risks for an employee each time it is worn. The extent of these risks depends on these factors:

– Type of respirator;

– Environmental conditions at the worksite;

– Physical demands of the work;

– Use of the protective clothing;

– Employee's health status.

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;

OR

• Voluntarily use respirators that are not filtering-facepiece respirators.

Note:	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;
	AND
	• 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.

Note:	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 chapter.

Note:	• 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 296-842-22005 to employees, OR provide them a medical exam that obtains the same information.

Note:	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;

OR

– 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.

Note:	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;

OR

• An employee gives any positive response to questions 1-8 in Part 2 OR to questions 1-6 in Part 3 of the DOSH medical evaluation questionnaire in WAC 296-842-22005.

Note:	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.

Reference:	See WAC 296-842-13005 for requirements regarding selection of air-purifying respirators.

Note:	• 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

[Statutory Authority: RCW 49.17.050 and 29 C.F.R. Subpart Z. WSR 09-19-119, § 296-842-14005, filed 9/22/09, effective 12/1/09. Statutory Authority: RCW 49.17.010, 49.17.040, 49.17.050, 49.17.060. WSR 07-05-072, § 296-842-14005, filed 2/20/07, effective 4/1/07; WSR 03-20-114, § 296-842-14005, filed 10/1/03, effective 1/1/04.]

RCW 49.17.050 and 29 C.F.R. Subpart Z. WSR 09-19-119, § 296-842-14005, filed 9/22/09, effective 12/1/09. Statutory Authority: RCW 49.17.010, 49.17.040, 49.17.050, 49.17.060. WSR 07-05-072, § 296-842-14005, filed 2/20/07, effective 4/1/07; WSR 03-20-114, § 296-842-14005, filed 10/1/03, effective 1/1/04.

Rules

296-842-11005,296-842-22005,296-842-22005,296-842-13005,