Respirator Medical Evaluation Questionnaire

Welcome! Because you may be wearing a respirator as a part of your job, the Occupational Safety & Health Administration (OSHA)

requires that you complete a respirator medical questionnaire. This first section answers some questions that you may have about this

process. You will then be ask to answer a series of health questions. Your answer will be treated on a confidential manner and will

not be available or released to your employer without your permission. It will take approximately 20 minutes to fill out the questionnaire.

Why do I have to fill out the questionnaire?  It is required by

as part of a respirator program established by your employer.

Is the information I provide secure?

The information you provide to us in this questionnaire is provided through a secure website using SSL (secure sockets layers) technology.

All data is stored behind a firewall on a secured server. The only individuals with access to this information are the independent physicians

and other license health care providers involved in the review of the questionnaires.