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Source: http://www.doksinet Source: http://www.doksinet PEOSH Model Respiratory Protection Program Using N-95, N-99 and N-100 Disposable Particulate Respirators in Emergency Medical Services 24 Source: http://www.doksinet Introduction Use the pages of this Model Program to begin compiling the written program and records required by the PEOSH Respiratory Protection Standard (29 CFR 1910.134) Insert all pages of this program into a binder to create the sections listed in the table of contents on page 27. A cover page is provided 25 Source: http://www.doksinet RESPIRATORY PROTECTION PROGRAM To comply with PEOSH Respiratory Protection Standard (29 CFR 1910.134) Name of EMS Agency Respiratory Protection Program Administrator ( Date implemented )

(Dates revised) 26 Source: http://www.doksinet TABLE OF CONTENTS Section 1: Written Respiratory Protection Program Section 2: N-95 Respirator Product Information Section 3: NIOSH Approval Documentation Section 4: Medical Clearance Forms Section 5: Fit-Test Records Section 6: Copy of Fit-Test Protocol Section 7: Documentation of Initial and Annual Training Section 8: Training Content Section 9: Evaluation of the Program Section 10: PEOSH Respiratory Protection Standard Section 11: Appendices A: Guidance on Airborne Infectious Agents B: PEOSH Respirator Medical Questionnaire C: Guidance on Escape-Only Respirators 27 Source: http://www.doksinet SECTION 1 Written Respiratory Protection Program for using N-95, N-99 and N-100 Disposable Particulate Respirators in Emergency Medical Services Fill in the blank spaces of this written program including the manufacturer’s recommended procedures. The program should be readily available to EMS personnel. The standard

requires evaluations of the workplace as necessary to ensure that the program is effective. PEOSH recommends annual evaluations with revisions to the written program as necessary. This program is available as a WORD document at: http://www.njgov/health/eoh/peoshweb/odispubphtm 28 Source: http://www.doksinet Respiratory Protection Program for Public Sector Emergency Medical Services Agencies (This program applies to N-95, N-99 and N-100 Disposable Particulate Respirators only) EMS Agency: Employer: Address: The purpose of this program is to protect Emergency Medical Services personnel from inhaling hazardous airborne agents during normal work as well as non-routine emergency situations. It was developed to comply with the requirements of the New Jersey Public Employees Occupational

Safety and Health Program’s Respiratory Protection Standard (29 CFR 1910.134) The standard requires that if other means of reducing or eliminating exposure to the airborne hazards are not feasible and public employers provide employees with respirators to protect them from airborne hazards, then a respiratory protection program must be implemented incorporating all of the program components described in the PEOSH Respiratory Protection Standard (29 CFR 1910.134) This program applies to all EMS personnel who are required to wear respirators during emergency medical response operations. Expenses associated with required medical evaluations, fit-tests, training and respiratory protection equipment will be borne by the employer, , as required by the PEOSH Respiratory Protection Standard. Date implemented: Date(s) revised: Responsibility for the

Program will be the Respiratory Protection Program Administrator. Duties are to oversee the development of the respiratory protection program and make sure it is carried out at the workplace. The administrator will also evaluate the program regularly to make sure procedures are followed, respirator use is monitored and respirators continue to provide adequate protection when job conditions change. Responsibilities include: • Become familiar with the PEOSH Respiratory Protection Standard 29 Source: http://www.doksinet • • • • • • • • • • Identify tasks that require respiratory protection Develop the written respiratory protection program Select respirators Arrange for medical clearance / distribute questionnaire Arrange for and/or conduct initial and annual fit-testing Coordinate initial and annual respirator training Monitor respirator use, maintenance, disposal and storage Maintain records required by the program Evaluate

and update the program as needed Monitor PEOSH standards for changes In addition, will assist the Program Administrator in ensuring that the respiratory protection program is implemented, understood, and followed by EMS personnel under their charge. Duties include: • • • • • • • • Ensuring that members under their supervision (including new members) have received: - medical evaluation and clearance to wear a respirator - initial and annual fit-testing - initial and annual training Being aware of tasks requiring the use of respiratory protection Enforcing the proper use of respiratory protection when necessary Ensuring the availability of appropriate respirators and accessories Ensuring that respirators are properly cleaned, maintained, and stored and disposed of according to the respiratory protection plan Observing members for any signs and symptoms that are related to the ability to use a respirator and referring them for a

medical re-evaluation Maintain records required by the program Alerting the Program Administrator if respiratory protection needs to be changed Individual EMS personnel have the responsibility to wear their respirator when and where required and in the manner in which they were trained. They must also: • • • • • • Care for and maintain their respirators as instructed and store them in a clean and sanitary location. Inform the Program Administrator if the respirator no longer fits well and request a new one that fits properly. Inform the Program Administrator of any respiratory hazards that they feel are not adequately addressed and of any other concerns they have regarding the program. Complete the mandatory Respirator Medical Evaluation Questionnaire and any medical evaluation requirements deemed necessary by the evaluating health care professional. Wear respiratory protection devices in conjunction with all requirements of this policy (e.g, no facial hair) Attend annual

respirator training and fit-testing. Identifying Airborne Hazards Requiring Respirator Use The Program Administrator will select respirators to be used based on the hazards to which members are exposed and in accordance with all PEOSH standards. The Program Administrator or , will conduct a hazard evaluation for each operation, process, or work area where airborne contaminants may be present in routine operations or during an emergency. 30 Source: http://www.doksinet The evaluation shall include a reasonable estimate of employee exposures to respiratory hazards and an identification of the contaminant’s chemical state and physical form. The Program Administrator must revise and update the hazard assessment as needed (i.e, any time work process changes may potentially affect exposure or the nature of the hazards change). Chemical Hazard Assessment has reviewed the chemical products used in this agency and those likely to be encountered

in the line of response duties. Based on this review, there are no chemical agents used above the PEOSH Permissible Exposure Levels that would require the use of respirators. In responding to hazardous materials emergencies in the community (PEOSH Standard 29 CFR 1910.120(q)(6)(i)), squad members are trained to Awareness Level and would take no further action beyond notifying the authorities of a release and would transport only decontaminated victims. For chemical / hazardous materials emergencies, EMS personnel should notify the following municipality/county/state emergency agencies for response: Biological Hazards Based on an evaluation of current job tasks which place EMS personnel at risk of exposure to biological hazards the Program Administrator has determined that the airborne infectious agents most likely to be encountered include: tuberculosis,

measles, chickenpox, SARS and smallpox Based on this hazard assessment, respiratory protection is required for all EMS personnel involved in transport and direct patient care of patients with signs and symptoms of these airborne diseases. Respirator Selection Only respirators approved by the National Institute for Occupational Safety and Health (NIOSH) will be selected and used. This approval can be recognized by the NIOSH approval or TC number on the respirator and its components. The program administrator will be responsible for contacting vendors and arranging to have available a variety of brands and sizes of the appropriate type of NIOSH-approved respirator for fit-testing Based on the biological hazards noted above, the following type of respirator will be issued: Disposable particulate respirators with filters certified by NIOSH to be at least 95% efficient. These respirators are commonly referred-to as N-95 respirators. They can be of the N, R or P series and filter efficiency

can be 95, 99 or 99.97% efficient 31 Source: http://www.doksinet The following brands, models and sizes of N-95 disposable particulate respirators will be available to employees for fit-testing: Medical Evaluation Persons assigned to tasks that require respiratory protection must be physically able to perform the tasks while wearing a respirator. Medical evaluation and clearance to wear the respirator is required before EMS personnel are fit-tested or need to wear the respirator. The health care provider listed below will determine individual medical clearance by administering a medical questionnaire and/or providing an in-person medical evaluation. Employees refusing a medical evaluation will not be allowed to work in conditions requiring respirator use. Health Care Provider for

Respirator Medical Evaluations: Name: Address: Phone Number: The Program Administrator will provide the health care professional with a copy of this program, a copy of the respiratory protection standard and the following information about respirator use and conditions: the type and weight of the respirator, duration and frequency of respirator use, expected physical work effort, additional clothing and equipment to be worn, temperature and humidity extremes that may be encountered. If the Respirator Medical Evaluation Questionnaire is administered, this information, as well as information from in-person medical evaluations will remain confidential between the EMS responder and the health care professional. The outcome of the medical evaluation is a written recommendation from the health

care professional to the Respiratory Protection Program Adminnstrator regarding the employee’s ability to wear a respirator. No confidential medical information is contained in this statement. It states only that the EMS responder is or is not cleared to use an N-95 respirator and whether there are any restrictions. If the responses on the medical questionnaire indicate to the medical provider that a further medical evaluation is required, this will be provided at no cost to EMS personnel by the medical provider listed above. The PEOSH Respiratory Protection Standard requires that the follow-up medical evaluation include “any medical tests, consultations or diagnostic procedures the health care professional deems necessary to make the final determination. 32 Source: http://www.doksinet Re-evaluation will be done in the following situations: - The EMS responder reports signs and symptoms relating to their ability to use a respirator, such as shortness of breath, dizziness, chest

pain or wheezing; - It is identified that a responder is having a medical problem during respirator use; - The healthcare professional recommends it; - A change occurs in workplace conditions that may result in increased physiologic burden on the member. Respirator Fit-Testing Fit tests are conducted to determine that the respirator fits the user adequately and that a good seal can be obtained. Respirators that do not seal do not offer adequate protection All EMS personnel who wear respirators will be fit-tested prior to initial use and at least annually thereafter or more frequently if there is a change in the status of the wearer (10% weight change or changes in facial structure) or if the model or type of respirator changes. All EMS personnel will be fit-tested with the make, model and size of the respirator that they will actually wear. They will be provided with several models and sizes so they may find an optimal fit. Personnel who wear corrective glasses or other PPE with their

respirator should wear them during the fit-test. will be responsible for conducting initial and annual fit-testing using one of the fit-test protocols applicable to N-95, N-99 and N-100 Disposable Particulate Respirators (Quantitative, Bitrex or Saccharin). This EMS agency has chosen to use the fit-test protocol checked below: q q q Quantitative Fit Test (computer) Qualitative Fit Test with Bitrex Qualitative Fit Test with Saccharin *Please note: Banana oil (Isoamyl Acetate) is not an appropriate fit-test for N-95 disposable particulate respirators. The irritant smoke protocol is not recommended by NIOSH due to health effects. Documentation of fit-testing will include the information required by the PEOSH Respiratory Protection Standard (name, date, type of test, make, model and size of respirator and pass/fail results). Fit test results are kept in the following location:

Seal Checks before Each Use Respirators will be checked for the proper sealing by the user whenever the respirator is first put on, using the seal check procedure recommended by the manufacturer (See attached procedure or describe below). 33 Source: http://www.doksinet Proper Respirator Use and Disposal EMS personnel will use their respirators under conditions specified by this program, and in accordance with the training they receive on the use of the selected models. In addition, the respirator shall not be used in a manner for which it was not certified by NIOSH or recommended by the manufacturer. ♦ ♦ ♦ ♦ ♦ ♦ ♦ EMS personnel are not permitted to wear respirators if they have any condition that prevents them from achieving a tight seal, including facial hair, facial scars or missing dentures. They are not permitted to wear headphones, jewelry or other articles that may interfere with face to facepiece seal. Glasses or goggles should be worn in a way that

doesn’t interfere with the seal. Prior to donning the respirator, inspect to see if the respirator is damaged, misshapen or soiled. If so, discard the respirator When donning the respirator, determine whether the straps hold the respirator tightly against the face, and if the metal noseclip (if applicable on the chosen model) is in place and functions properly. If not, discard the respirator EMS personnel will conduct seal checks each time they wear a respirator following the manufacturer’s recommended procedures. In general, the seal check involves placing both hands completely over the filtering facepiece, inhaling sharply and repositioning the respirator if air leaks are detected between the face and faceseal. If a proper seal cannot be achieved, do not enter a contaminated area. If the patient requires airborne precautions alone (i.e, TB), the respirator could be reused as long as a successful seal can be achieved If the patient requires contact precautions (i.e, SARS,

smallpox), discard disposable respirators after each use EMS personnel should leave a contaminated area if the respirator needs to be changed. N-95 disposable respirators should be stored in a clean, dry area where they won’t be crushed or misshapen. Respirator Training The Program Administrator will provide or arrange for training of personnel when respirators are issued and annually thereafter. In this EMS agency, the following person(s) will provide respirator training: If a new type of respirator is issued or conditions affecting respirator use change, additional training in using that respirator will be provided. After completing training, personnel must be able to demonstrate their understanding of the topics covered in the training. Training will include the elements required by the PEOSH Respiratory Protection Standard: ♦ ♦ ♦ ♦ Why the respirator is necessary – potential hazards and health

effects The respirator’s capabilities and limitations How improper fit, use or maintenance can make the respirator ineffective How to properly inspect, put on, seal, check use and remove the respirator 34 Source: http://www.doksinet ♦ ♦ Procedures for cleaning, maintenance and repair Where to find the department’s written respiratory protection program and the PEOSH Respiratory Protection Standard Documentation of attendance at training will be maintained by: Recordkeeping The following records are kept by the Program Administrator: Record A copy of this completed written respiratory protection program A copy of the PEOSH Respiratory Protection Standard A list of employees who have been issued respirators and the type, model and size for which each employee has been trained and fit-tested Employees’ latest fit-testing results Location Employee respirator training records Written medical clearance

recommendations from the medical provider Respiratory Program Evaluation will complete an evaluation of the program on at least an annual basis by taking the following steps and is responsible for correcting any problems identified during the evaluation and updating the written program. ♦ ♦ ♦ ♦ ♦ Talking with employees who wear respirators about their respirators Checking results of fit-tests and health provider evaluations Periodically checking employee job duties for changes in exposure Periodically checking how employees use their respirators Periodically checking maintenance and storage of respirators (if applicable) Revision dates will be noted on the cover of this written program. 35 Source: http://www.doksinet SECTION 2 N-95, N-99, N-100 Disposable Particulate Respirator Product Information After determining which brand, styles and sizes of respirators will be made available for fit-testing, obtain product information

from the manufacturer and insert here. Be sure to obtain the manufacturer’s recommended seal check and donning procedures. 36 Source: http://www.doksinet SECTION 3 NIOSH Approval Documentation Provide evidence of NIOSH approval of the brands and styles of respirators issued by providing at least one of the following: 1) NIOSH approval label provided in box of respirators 2) A printout of the NIOSH certified equipment list web page where the NIOSH approval is listed 3) The NIOSH “84A”approval number which should be in the following format: 84A-#### 37 Source: http://www.doksinet SECTION 4 Medical Evaluation Forms In this section, place the medical clearance forms from the doctor, nurse or physician’s assistant stating whether each EMS responder is cleared to use an N-95, N-99 or N-100 disposable particulate respirator and whether there are any restrictions. NO CONFIDENTIAL MEDICAL INFORMATION SHOULD BE CONTAINED IN THIS STATEMENT. A sample medical clearance form is

included in this section if the medical provider does not have one of their own. A copy of the PEOSH Respirator Medical Evaluation Questionnaire is included on page 124 of this program. It can be copied and distributed to EMS personnel if so directed by your medical provider. If EMS personnel need to fill-out the questionnaire, it should be done confidentially. Completed questionnaires should be maintained as a confidential medical record by the medical provider, not retained by the EMS agency or employer. 38 Source: http://www.doksinet Documentation of Medical Evaluation for Respirator Use Name of EMS Agency: Name of EMS Responder: This EMS responder has been medically evaluated regarding their ability to be fit-tested for and wear the type of respirator(s) listed below. The information required by the PEOSH Respiratory Protection Standard 1910.134 (Section (e) and Appendix A, Part A, Sections 1

& 2) was obtained in the course of performing this evaluation. Based on the medical evaluation, the employee/volunteer is cleared (with any limitations shown) to be fit-tested for and wear the following respirators: AIR PURIFYING RESPIRATOR(S) Disposable N or P or R, - 95, 99 or 100 filtering facepiece respirator Elastomeric respirator with particulate/gas/vapor cartridges SUPPLIED AIR RESPIRATOR(S) SCBA – Self-Contained Breathing Apparatus LIMITATIONS No Yes Description: Date of this written recommendation: Health Care Professional Name: Address: Phone: (A copy of this form has been provided to the EMS responder.) 39 Source: http://www.doksinet Section 5 Fit-test Records In this

section, place the records of fit-testing stating whether or not each EMS responder was successfully fitted for an N-95, N-99 or N100 disposable particulate respirator. The record should contain the brand, model and size of the respirator and the fit-test protocol used. A sample fit test form is included in this section. 40 Source: http://www.doksinet Fit-test Record [Responder has been medically cleared to wear a respirator prior to fit-testing.] Name of EMS agency: Name of EMS responder: Date of fit-test: Type of fit-test: Please circle: Qualitative Bitrex Saccharin OR Quantitative List device used: Respirator Model NIOSH Size PASS/FAIL Fit Factor Brand # approval # P F P F

Person conducting test: Title 41 Source: http://www.doksinet Section 6 Copy of Fit-Test Protocol The fit-test protocols that are appropriate for N-95, N-99 and N-100 disposable particulate respirators are printed on the following pages. Place a check mark next to the test(s) used: q Qualitative Fit Test with Saccharin q Qualitative Fit Test with Bitrex q Quantitative Fit Test (computer) 42 Source: http://www.doksinet Copy of Fit-Test Protocol(s) for N-95 Disposable Particulate Respirators Appropriate fit-test protocols for N-95 disposable filtering-facepiece respirators. The General Requirements outlined below in Section A must be followed for all fit-tests, whether qualitative or quantitative. Include a copy of Section A, the general requirements, as well as the protocol for the specific qualitative or quantitative fit-test chosen in the Written Respiratory Protection Program. Be sure to follow

the protocols carefully when performing the fit-tests. PEOSH-Accepted Fit-Test Protocols (Appendix A of 1910.134) A. Fit-Testing Procedures -- General Requirements B. Qualitative Fit-Test (QLFT) Protocols 1. General 3. Saccharin 4. Bitrex 5. Irritant Smoke * C. Quantitative Fit-Test (QNFT) Protocols 1. Ambient Aerosol Condensation Nuclei Counter Quantitative Fit Testing Protocol (Portacount TM) * NIOSH does not recommend qualitative fit-testing using irritant smoke because of the health risk associated with exposure to the irritant fume. 43 Source: http://www.doksinet Appendix A to 1910.134: Fit Testing Procedures (Mandatory) A. Fit Testing Procedures -- General Requirements The employer shall conduct fit testing using the following procedures. The requirements in this appendix apply to all PEOSH-accepted fit test methods, both QLFT and QNFT. 1. The test subject shall be allowed to pick the most acceptable respirator from a sufficient number of respirator models and sizes so that

the respirator is acceptable to, and correctly fits, the user. 2. Prior to the selection process, the test subject shall be shown how to put on a respirator, how it should be positioned on the face, how to set strap tension and how to determine an acceptable fit. A mirror shall be available to assist the subject in evaluating the fit and positioning of the respirator. This instruction may not constitute the subjects formal training on respirator use, because it is only a review. 3. The test subject shall be informed that he/she is being asked to select the respirator that provides the most acceptable fit. Each respirator represents a different size and shape, and if fitted and used properly, will provide adequate protection. 4. The test subject shall be instructed to hold each chosen facepiece up to the face and eliminate those that obviously do not give an acceptable fit. 5. The more acceptable facepieces are noted in case the one selected proves unacceptable; the most comfortable

mask is donned and worn at least five minutes to assess comfort. Assistance in assessing comfort can be given by discussing the points in the following item A.6 If the test subject is not familiar with using a particular respirator, the test subject shall be directed to don the mask several times and to adjust the straps each time to become adept at setting proper tension on the straps. 6. Assessment of comfort shall include a review of the following points with the test subject and allowing the test subject adequate time to determine the comfort of the respirator: (a) Position of the mask on the nose (b) Room for eye protection (c) Room to talk (d) Position of mask on face and cheeks 7. The following criteria shall be used to help determine the adequacy of the respirator fit: (a) Chin properly placed; (b) Adequate strap tension, not overly tightened; (c) Fit across nose bridge; (d) Respirator of proper size to span distance from nose to chin; 44 Source: http://www.doksinet (e)

Tendency of respirator to slip; (f) Self-observation in mirror to evaluate fit and respirator position. 8. The test subject shall conduct a user seal check, either the negative and positive pressure seal checks described in Appendix B-1 of this section or those recommended by the respirator manufacturer which provide equivalent protection to the procedures in Appendix B-1. Before conducting the negative and positive pressure checks, the subject shall be told to seat the mask on the face by moving the head from side-to-side and up and down slowly while taking in a few slow deep breaths. Another facepiece shall be selected and retested if the test subject fails the user seal check tests. 9. The test shall not be conducted if there is any hair growth between the skin and the facepiece sealing surface, such as stubble beard growth, beard, mustache or sideburns which cross the respirator sealing surface. Any type of apparel which interferes with a satisfactory fit shall be altered or

removed. 10. If a test subject exhibits difficulty in breathing during the tests, she or he shall be referred to a physician or other licensed health care professional, as appropriate, to determine whether the test subject can wear a respirator while performing her or his duties. 11. If the employee finds the fit of the respirator unacceptable, the test subject shall be given the opportunity to select a different respirator and to be retested. 12. Exercise regimen Prior to the commencement of the fit test, the test subject shall be given a description of the fit test and the test subjects responsibilities during the test procedure. The description of the process shall include a description of the test exercises that the subject will be performing. The respirator to be tested shall be worn for at least 5 minutes before the start of the fit test. 13. The fit test shall be performed while the test subject is wearing any applicable safety equipment that may be worn during actual respirator

use which could interfere with respirator fit. 14. Test Exercises (a) Employers must perform the following test exercises for all fit testing methods prescribed in this appendix, except for the CNP quantitative fit testing protocol and the CNP REDON quantitative fit testing protocol. For these two protocols, employers must ensure that the test subjects (i.e, employees) perform the exercise procedure specified in Part IC4(b) of this appendix for the CNP quantitative fit testing protocol, or the exercise procedure described in Part I.C5(b) of this appendix for the CNP REDON quantitative fit-testing protocol For the remaining fit testing methods, employers must ensure that employees perform the test exercises in the appropriate test environment in the following manner: (1) Normal breathing. In a normal standing position, without talking, the subject shall breathe normally. (2) Deep breathing. In a normal standing position, the subject shall breathe slowly and deeply, taking caution so as

not to hyperventilate. (3) Turning head side to side. Standing in place, the subject shall slowly turn his/her head 45 Source: http://www.doksinet from side to side between the extreme positions on each side. The head shall be held at each extreme momentarily so the subject can inhale at each side. (4) Moving head up and down. Standing in place, the subject shall slowly move his/her head up and down. The subject shall be instructed to inhale in the up position (ie, when looking toward the ceiling). (5) Talking. The subject shall talk out loud slowly and loud enough so as to be heard clearly by the test conductor. The subject can read from a prepared text such as the Rainbow Passage, count backward from 100, or recite a memorized poem or song. Rainbow Passage When the sunlight strikes raindrops in the air, they act like a prism and form a rainbow. The rainbow is a division of white light into many beautiful colors. These take the shape of a long round arch, with its path high above,

and its two ends apparently beyond the horizon. There is, according to legend, a boiling pot of gold at one end People look, but no one ever finds it. When a man looks for something beyond reach, his friends say he is looking for the pot of gold at the end of the rainbow. (6) Grimace. The test subject shall grimace by smiling or frowning (This applies only to QNFT testing; it is not performed for QLFT) (7) Bending over. The test subject shall bend at the waist as if he/she were to touch his/her toes. Jogging in place shall be substituted for this exercise in those test environments such as shroud type QNFT or QLFT units that do not permit bending over at the waist. (8) Normal breathing. Same as exercise (1) (b) Each test exercise shall be performed for one minute except for the grimace exercise which shall be performed for 15 seconds. The test subject shall be questioned by the test conductor regarding the comfort of the respirator upon completion of the protocol. If it has become

unacceptable, another model of respirator shall be tried. The respirator shall not be adjusted once the fit test exercises begin. Any adjustment voids the test, and the fit test must be repeated B. Qualitative Fit Test (QLFT) Protocols 1. General (a) The employer shall ensure that persons administering QLFT are able to prepare test solutions, calibrate equipment and perform tests properly, recognize invalid tests, and ensure that test equipment is in proper working order. (b) The employer shall ensure that QLFT equipment is kept clean and well maintained so as to operate within the parameters for which it was designed. 2. Saccharin Solution Aerosol Protocol The entire screening and testing procedure shall be explained to the test subject prior to the conduct of the screening test. 46 Source: http://www.doksinet (a) Taste threshold screening. The saccharin taste threshold screening, performed without wearing a respirator, is intended to determine whether the individual being tested

can detect the taste of saccharin. (1) During threshold screening as well as during fit testing, subjects shall wear an enclosure about the head and shoulders that is approximately 12 in. in diameter by 14 in tall with at least the front portion clear and that allows free movements of the head when a respirator is worn. An enclosure substantially similar to the 3M hood assembly, parts # FT 14 and # FT 15 combined, is adequate. (2) The test enclosure shall have a 3/4-inch (1.9 cm) hole in front of the test subjects nose and mouth area to accommodate the nebulizer nozzle. (3) The test subject shall don the test enclosure. Throughout the threshold screening test, the test subject shall breathe through his/her slightly open mouth with tongue extended. The subject is instructed to report when he/she detects a sweet taste. (4) Using a DeVilbiss Model 40 Inhalation Medication Nebulizer or equivalent, the test conductor shall spray the threshold check solution into the enclosure. The nozzle is

directed away from the nose and mouth of the person. This nebulizer shall be clearly marked to distinguish it from the fit test solution nebulizer. (5) The threshold check solution is prepared by dissolving 0.83 gram of sodium saccharin USP in 100 ml of warm water. It can be prepared by putting 1 ml of the fit test solution (see (b)(5) below) in 100 ml of distilled water. (6) To produce the aerosol, the nebulizer bulb is firmly squeezed so that it collapses completely, then released and allowed to fully expand. (7) Ten squeezes are repeated rapidly and then the test subject is asked whether the saccharin can be tasted. If the test subject reports tasting the sweet taste during the ten squeezes, the screening test is completed. The taste threshold is noted as ten regardless of the number of squeezes actually completed. (8) If the first response is negative, ten more squeezes are repeated rapidly and the test subject is again asked whether the saccharin is tasted. If the test subject

reports tasting the sweet taste during the second ten squeezes, the screening test is completed. The taste threshold is noted as twenty regardless of the number of squeezes actually completed. (9) If the second response is negative, ten more squeezes are repeated rapidly and the test subject is again asked whether the saccharin is tasted. If the test subject reports tasting the sweet taste during the third set of ten squeezes, the screening test is completed. The taste threshold is noted as thirty regardless of the number of squeezes actually completed. (10) The test conductor will take note of the number of squeezes required to solicit a taste response. (11) If the saccharin is not tasted after 30 squeezes (step 10), the test subject is unable to taste saccharin and may not perform the saccharin fit test. 47 Source: http://www.doksinet Note to paragraph 3. (a): If the test subject eats or drinks something sweet before the screening test, he/she may be unable to taste the weak

saccharin solution. (12) If a taste response is elicited, the test subject shall be asked to take note of the taste for reference in the fit test. (13) Correct use of the nebulizer means that approximately 1 ml of liquid is used at a time in the nebulizer body. (14) The nebulizer shall be thoroughly rinsed in water, shaken dry, and refilled at least each morning and afternoon or at least every four hours. (b) Saccharin solution aerosol fit test procedure. (1) The test subject may not eat, drink (except plain water), smoke, or chew gum for 15 minutes before the test. (2) The fit test uses the same enclosure described in 3. (a) above (3) The test subject shall don the enclosure while wearing the respirator selected in section I. A of this appendix The respirator shall be properly adjusted and equipped with a particulate filter(s). (4) A second DeVilbiss Model 40 Inhalation Medication Nebulizer or equivalent is used to spray the fit test solution into the enclosure. This nebulizer shall

be clearly marked to distinguish it from the screening test solution nebulizer. (5) The fit test solution is prepared by adding 83 grams of sodium saccharin to 100 ml of warm water. (6) As before, the test subject shall breathe through the slightly open mouth with tongue extended, and report if he/she tastes the sweet taste of saccharin. (7) The nebulizer is inserted into the hole in the front of the enclosure and an initial concentration of saccharin fit test solution is sprayed into the enclosure using the same number of squeezes (either 10, 20 or 30 squeezes) based on the number of squeezes required to elicit a taste response as noted during the screening test. A minimum of 10 squeezes is required. (8) After generating the aerosol, the test subject shall be instructed to perform the exercises in section I. A 14 of this appendix (9) Every 30 seconds the aerosol concentration shall be replenished using one half the original number of squeezes used initially (e.g, 5, 10 or 15) (10) The

test subject shall indicate to the test conductor if at any time during the fit test the taste of saccharin is detected. If the test subject does not report tasting the saccharin, the test is passed. (11) If the taste of saccharin is detected, the fit is deemed unsatisfactory and the test is failed. A different respirator shall be tried and the entire test procedure is repeated (taste 48 Source: http://www.doksinet threshold screening and fit testing). (12) Since the nebulizer has a tendency to clog during use, the test operator must make periodic checks of the nebulizer to ensure that it is not clogged. If clogging is found at the end of the test session, the test is invalid. 3. BitrexTM (Denatonium Benzoate) Solution Aerosol Qualitative Fit Test Protocol The BitrexTM (Denatonium benzoate) solution aerosol QLFT protocol uses the published saccharin test protocol because that protocol is widely accepted. Bitrex is routinely used as a taste aversion agent in household liquids which

children should not be drinking and is endorsed by the American Medical Association, the National Safety Council, and the American Association of Poison Control Centers. The entire screening and testing procedure shall be explained to the test subject prior to the conduct of the screening test. (a) Taste Threshold Screening. The Bitrex taste threshold screening, performed without wearing a respirator, is intended to determine whether the individual being tested can detect the taste of Bitrex. (1) During threshold screening as well as during fit testing, subjects shall wear an enclosure about the head and shoulders that is approximately 12 inches (30.5 cm) in diameter by 14 inches (35.6 cm) tall The front portion of the enclosure shall be clear from the respirator and allow free movement of the head when a respirator is worn. An enclosure substantially similar to the 3M hood assembly, parts # FT 14 and # FT 15 combined, is adequate. (2) The test enclosure shall have a 3/4 inch (1.9 cm)

hole in front of the test subjects nose and mouth area to accommodate the nebulizer nozzle. (3) The test subject shall don the test enclosure. Throughout the threshold screening test, the test subject shall breathe through his or her slightly open mouth with tongue extended. The subject is instructed to report when he/she detects a bitter taste (4) Using a DeVilbiss Model 40 Inhalation Medication Nebulizer or equivalent, the test conductor shall spray the Threshold Check Solution into the enclosure. This Nebulizer shall be clearly marked to distinguish it from the fit test solution nebulizer. (5) The Threshold Check Solution is prepared by adding 13.5 milligrams of Bitrex to 100 ml of 5% salt (NaCl) solution in distilled water. (6) To produce the aerosol, the nebulizer bulb is firmly squeezed so that the bulb collapses completely, and is then released and allowed to fully expand. (7) An initial ten squeezes are repeated rapidly and then the test subject is asked whether the Bitrex can

be tasted. If the test subject reports tasting the bitter taste during the ten squeezes, the screening test is completed. The taste threshold is noted as ten regardless of the number of squeezes actually completed. (8) If the first response is negative, ten more squeezes are repeated rapidly and the test 49 Source: http://www.doksinet subject is again asked whether the Bitrex is tasted. If the test subject reports tasting the bitter taste during the second ten squeezes, the screening test is completed. The taste threshold is noted as twenty regardless of the number of squeezes actually completed. (9) If the second response is negative, ten more squeezes are repeated rapidly and the test subject is again asked whether the Bitrex is tasted. If the test subject reports tasting the bitter taste during the third set of ten squeezes, the screening test is completed. The taste threshold is noted as thirty regardless of the number of squeezes actually completed. (10) The test conductor will

take note of the number of squeezes required to solicit a taste response. (11) If the Bitrex is not tasted after 30 squeezes (step 10), the test subject is unable to taste Bitrex and may not perform the Bitrex fit test. (12) If a taste response is elicited, the test subject shall be asked to take note of the taste for reference in the fit test. (13) Correct use of the nebulizer means that approximately 1 ml of liquid is used at a time in the nebulizer body. (14) The nebulizer shall be thoroughly rinsed in water, shaken to dry, and refilled at least each morning and afternoon or at least every four hours. (b) Bitrex Solution Aerosol Fit Test Procedure. (1) The test subject may not eat, drink (except plain water), smoke, or chew gum for 15 minutes before the test. (2) The fit test uses the same enclosure as that described in 4. (a) above (3) The test subject shall don the enclosure while wearing the respirator selected according to section I. A of this appendix The respirator shall be

properly adjusted and equipped with any type particulate filter(s). (4) A second DeVilbiss Model 40 Inhalation Medication Nebulizer or equivalent is used to spray the fit test solution into the enclosure. This nebulizer shall be clearly marked to distinguish it from the screening test solution nebulizer. (5) The fit test solution is prepared by adding 337.5 mg of Bitrex to 200 ml of a 5% salt (NaCl) solution in warm water. (6) As before, the test subject shall breathe through his or her slightly open mouth with tongue extended, and be instructed to report if he/she tastes the bitter taste of Bitrex. (7) The nebulizer is inserted into the hole in the front of the enclosure and an initial concentration of the fit test solution is sprayed into the enclosure using the same number of squeezes (either 10, 20 or 30 squeezes) based on the number of squeezes required to elicit a taste response as noted during the screening test. (8) After generating the aerosol, the test subject shall be

instructed to perform the 50 Source: http://www.doksinet exercises in section I. A 14 of this appendix (9) Every 30 seconds the aerosol concentration shall be replenished using one half the number of squeezes used initially (e.g, 5, 10 or 15) (10) The test subject shall indicate to the test conductor if at any time during the fit test the taste of Bitrex is detected. If the test subject does not report tasting the Bitrex, the test is passed. (11) If the taste of Bitrex is detected, the fit is deemed unsatisfactory and the test is failed. A different respirator shall be tried and the entire test procedure is repeated (taste threshold screening and fit testing). C. Quantitative Fit Test (QNFT) Protocols The following quantitative fit testing procedures have been demonstrated to be acceptable: Quantitative fit testing using a non-hazardous test aerosol (such as corn oil, polyethylene glycol 400 [PEG 400], di-2-ethyl hexyl sebacate [DEHS], or sodium chloride) generated in a test

chamber, and employing instrumentation to quantify the fit of the respirator; Quantitative fit testing using ambient aerosol as the test agent and appropriate instrumentation (condensation nuclei counter) to quantify the respirator fit; Quantitative fit testing using controlled negative pressure and appropriate instrumentation to measure the volumetric leak rate of a facepiece to quantify the respirator fit. 1. General (a) (b) The employer shall ensure that persons administering QNFT are able to calibrate equipment and perform tests properly, recognize invalid tests, calculate fit factors properly and ensure that test equipment is in proper working order. The employer shall ensure that QNFT equipment is kept clean, and is maintained and calibrated according to the manufacturers instructions so as to operate at the parameters for which it was designed. 2. Ambient Aerosol Condensation Nuclei Counter (CNC) Quantitative Fit Testing (Portacount TM) Protocol. The ambient aerosol

condensation nuclei counter (CNC) quantitative fit testing (Portacount TM ) protocol quantitatively fit tests respirators with the use of a probe. The probed respirator is only used for quantitative fit tests. A probed respirator has a special sampling device, installed on the respirator, that allows the probe to sample the air from inside the mask. A probed respirator is required for each make, style, model, and size that the employer uses and can be obtained from the respirator manufacturer or distributor. The CNC instrument manufacturer, TSI Inc, also provides probe attachments (TSI sampling adapters) that permit fit testing in an employees own respirator. A minimum fit factor pass level of at least 100 is necessary for a half-mask respirator and a minimum fit factor pass level of at least 500 is required for a full facepiece negative pressure respirator. The entire screening and testing procedure shall be explained to the test subject prior to the conduct of the screening test. 51

Source: http://www.doksinet (a) Portacount Fit Test Requirements. (1) Check the respirator to make sure the sampling probe and line are properly attached to the facepiece and that the respirator is fitted with a particulate filter capable of preventing significant penetration by the ambient particles used for the fit test (e.g, NIOSH 42 CFR 84 series 100, series 99, or series 95 particulate filter) per manufacturers instruction. (2) Instruct the person to be tested to don the respirator for five minutes before the fit test starts. This purges the ambient particles trapped inside the respirator and permits the wearer to make certain the respirator is comfortable. This individual shall already have been trained on how to wear the respirator properly. (3) Check the following conditions for the adequacy of the respirator fit: Chin properly placed; Adequate strap tension, not overly tightened; Fit across nose bridge; Respirator of proper size to span distance from nose to chin; Tendency

of the respirator to slip; Selfobservation in a mirror to evaluate fit and respirator position. (4) Have the person wearing the respirator do a user seal check. If leakage is detected, determine the cause. If leakage is from a poorly fitting facepiece, try another size of the same model respirator, or another model of respirator. (5) Follow the manufacturers instructions for operating the Portacount and proceed with the test. (6) The test subject shall be instructed to perform the exercises in section I. A 14 of this appendix. (7) After the test exercises, the test subject shall be questioned by the test conductor regarding the comfort of the respirator upon completion of the protocol. If it has become unacceptable, another model of respirator shall be tried. (b) Portacount Test Instrument. (1) The Portacount will automatically stop and calculate the overall fit factor for the entire set of exercises. The overall fit factor is what counts The Pass or Fail message will indicate whether

or not the test was successful. If the test was a Pass, the fit test is over (2) Since the pass or fail criterion of the Portacount is user programmable, the test operator shall ensure that the pass or fail criterion meet the requirements for minimum respirator performance in this Appendix. (3) A record of the test needs to be kept on file, assuming the fit test was successful. The record must contain the test subjects name; overall fit factor; make, model, style, and size of respirator used; and date tested. 4. Controlled Negative Pressure (CNP) Quantitative Fit Testing protocol (Not appropriate for facepieces that are not elastomeric, so not appropriate for N-95 disposable filtering facepieces) 52 Source: http://www.doksinet SECTION 7 Documentation of Attendance at Initial and Annual Respiratory Protection Training Copies of attendance sheets/rosters/certificates for PEOSH-required respiratory protection training should be inserted in this section. All EMS personnel who have

been issued respirators are required to attend initial and annual training. 53 Source: http://www.doksinet Documentation of Respirator Training Name of EMS agency: The following individual has successfully completed Respiratory Protection Training for use of N-95/N-99/N-100 disposable particulate respirators. The training included the elements required by the PEOSH Respiratory Protection Standard (29 CFR 1910.134(k)) (name of EMS responder) Date of training: Type of training: Initial Instructor Name: Title Phone: Day: OR Refresher Eve: 54 Source: http://www.doksinet SECTION 8 Training Materials In this section, EMS agencies should insert copies of training materials provided to their personnel or an outline of the content reviewed. The PEOSH Program has developed a basic

Respiratory Protection Training Program for N-95, N-99 and N-100 Disposable Particulate Respirators which is included in this section and can be used by EMS agencies. The program is printed in handout form here and can be downloaded and modified as a power point presentation at: http://www.njgov/health/eoh/peoshweb/odispubphtm Other useful handouts for respiratory protection training include the following materials which can be found in Appendix A and C of this program. Links to the websites are listed: Guidance for Protecting Workers Against Avian Flu U.S Department of Labor, Occupational Safety and Health Administration, 2006 [http://www.oshagov/dsg/guidance/avian-fluhtml] Understanding Respiratory Protection Against SARS U.S Centers for Disease Control and Prevention, NIOSH, 2005 [http://www.cdcgov/niosh/npptl/topics/respirators/factsheets/respsarshtml] Guidelines for Preventing the Transmission of Mycobacterium Tuberculosis in Healthcare Settings, 2005 U.S Centers for Disease

Control and Prevention Selected sections: Introduction on pages 1-3, Respiratory Protection on pages 38-41, Nontraditional Facility-Based Settings –EMS on pages 25-26. [http://wwwcdcgov/mmwr/PDF/rr/rr5417pdf] What you Should Know in Deciding Whether to Buy Escape Hoods, Gas Masks or Other Respirators for Preparedness at Home and Work U.S Centers for Disease Control and Prevention, NIOSH, 2005 http://www.cdcgov/niosh/npptl/topics/respirators/factsheets/respfacthtml 55 Source: http://www.doksinet PEOSH Basic Respiratory Protection Training Module for use of N-95 Disposable Particulate Respirators in Emergency Medical Services These handouts can be used for training or the power point presentation can be downloaded from the following website and adapted with your EMS agency name and specific information: http://www.njgov/health/eoh/peoshweb/odispubphtm Information about the brand and type of respirator used by the EMS agency and the procedures described in the site-specific

written program should be added to the training. 56 Source: http://www.doksinet Respiratory Protection from Airborne I nfectious Agents Use of N-95, N-99 and N-100 Disposable Particulate Respirators in Emergency Medical Services Public Employees Occupational Safety and Health Program New Jersey Department of Health and Senior Services, 2006 Objectives n Explain what N-95 disposable particulate respirators are and why they are necessary n Discuss their capabilities and limitations. n Demonstrate proper use. n Review the requirements of the respiratory protection program. 57 Source: http://www.doksinet Why is an N-95 disposable particulate respirator necessary? For personal protection from airborne pathogens like Tuberculosis, SARS, Chickenpox, Measles and Smallpox. It protects by filtering out infectious particles from the air you breathe. Why is an N-95 disposable particulate respirator necessary? I f a respiratory disease outbreak or an intentional biological event

occurs, EMS personnel, public safety officers and local public health workers will be on the front lines and need ready protection. N-95 disposable particulate respirators are the minimum level of protection needed for airborne infectious agents. 58 Source: http://www.doksinet NJ Department of Health & Senior Services Memo to the EMS Community, March 2005 “N-95 respirators should be worn when responding to patients with unknown, potentially infectious respiratory or influenza-like illness.and when caring for patients with diagnosed infectious illnesses such as tuberculosis. Properly fitted, N-95 respirators should protect the worker against bioterrorism and non -bioterrorism related respiratory pathogens.” Eddy Bresnitz, MD, MS, Deputy Commissioner/ State Epidemiologist http:/ / www.statenjus/ health/ ems/ documents/ n95pdf What are N-95 disposable particulate respirators? 59 Source: http://www.doksinet N-95’s reduce exposure to particles that are small enough to be

inhaled Micron sizes of some pathogen groups Fungi Particles < 100 microns can be inhaled through nose and mouth 2-200 Mold spores 1-70 Bacteria 0.5-10 Viruses 0.02-03 1-5 micron particles can enter upper airways 0.1 – 1 micron particles can enter lower lungs and alveoli [ N-95 filters are tested on particles greater than 0.3 microns in size ] What does “N-95” mean? An N-series filter that is at least 95% efficient in removing particles greater than 0.3 microns in diameter • Named by NIOSH, the agency that approves respirators • N-95s used to protect workers must be NIOSH-approved • Belongs to a class of respirators called filtering facepieces • 9 filter classes ranging from 95-99.97% efficient • Over 300 different models of N-95 respirators approved http:/ / www.cdcgov/ niosh/ npptl/ topics/ respirators/ disp part/ n95list1html 60 Source: http://www.doksinet How can you tell if a respirator is NI OSH-approved? NIOSH approval number on respirator:

84A-#### Approval label in box NIOSH Certified Equipment List Website http://www.cdcgov/niosh/npptl/topics/respirators/disp part/n95list1html I s an N-95 disposable respirator the same as a surgical mask? NO !! A surgical mask is not a respirator. I t is NOT NI OSH- approved. 61 Source: http://www.doksinet I s an N-95 disposable respirator the same as a surgical mask? A surgical mask does not provide adequate protection for EMS responders. HOWEVER A surgical mask MAY be placed on the patient to limit spread of respiratory secretions. What N-95 respirator is being issued? This EMS agency uses the following brand(s) and model(s) of N-95 disposable particulate respirators: # 1 # 2 # 3 62 Source: http://www.doksinet Advantages of N-95 disposable particulate respirators n Lightweight n Fairly comfortable to wear n Don’t restrict mobility n Disposable n Low cost n Require no cleaning or

maintenance Limitations of N-95 disposable particulate respirators They DON’T protect from: n Oxygen deficiency n Harmful chemical gases and vapors n Skin or eye contact with pathogens n High concentrations of pathogens 63 Source: http://www.doksinet What do these limitations mean for EMS activities? n Don’t enter an oxygen deficient atmosphere while wearing an N-95 disposable particulate respirator. I t does not supply air n Don’t use an N-95 disposable particulate respirator for protection from chemical hazards; it does not have the capacity to filter chemical gases and vapors; it only filters particles. n I f the airborne infectious agent is also spread by skin or mucous membrane contact (such as SARS), use goggles, gloves and gown. n I f an intentional biological event has occurred, higher levels o f respiratory protection may be required. Work within the incident command structure to obtain proper instructions about respiratory protection. n N-95

disposable particulate respirators must be worn the entire time the wearer is in the contaminated area or in close proximity to potentially infectious persons. I f N-95 disposable particulate respirators are issued, EMS agencies must comply with the PEOSH Respiratory Protection Standard 1. Written respiratory protection program with an assigned program administrator 2. Proper selection of respirators 3. Training about the hazards and proper use 4. Medical clearance (initially and if there are changes) 5. Fit testing (annually) 6. Evaluation of program effectiveness (annually) 64 Source: http://www.doksinet Proper Use of Your Brand and Model of Respirator OBTAI N AND REVI EW THE MANUFACTURER’S I NSTRUCTI ONS FOR: ü ü ü ü Proper donning Seal check Removal Reuse General Seal Check Procedures for N-95 Disposable Respirators Whenever the respirator is donned: 1. Place one or both hands completely over the filtering facepiece. 2. I nhale and exhale sharply I f air leaks around

your nose, readjust the nosepiece. I f air leaks between the face and faceseal of the respirator, reposition it by adjusting the panels and straps. 3. I f you cannot achieve a proper seal, do not enter the contaminated area. See your respiratory program administrator. 65 Source: http://www.doksinet Proper Use n No facial hair that interferes with face to facepiece seal n I f shape of the N-95 is compromised, it may not fit properly n I f respirator becomes damaged, soiled or if breathing becomes difficult, leave the contaminated area and replace the respirator n I f used in caring for patient with a disease spread through contact, dispose of N-95 after each use. The question about respirators and beards Anything that prevents the face mask from fitting tightly against the face, such as a beard, goatee or long sideburns, may cause leakage. No facial hair or even stubble should interfere with the face-to-facepiece seal or valve function. The PEOSH standard assigns employers

the responsibility for monitoring proper respirator use by their employees or volunteers. 66 Source: http://www.doksinet Medical Evaluation n Even though N-95’s are lightweight and non -restrictive, they require medical evaluation and cleared to use them. n The medical evaluation must take place prior to initial use and later, if there are symptoms related to respirator use. n The medical evaluation entails a confidential respiratory questionnaire and/ or in-person medical evaluation. n Written clearance form should only tell employer if the EMS responder can or cannot wear a specific respirator – no confidential information should be included. n Medical provider keeps questionnaire in confidential file. Fit-Testing I f a respirator does not make a tight seal around the face during inhalation, contaminated air may leak around the edges of the face seal. The only way to tell if a respirator fits and is capable of protecting properly is to fit -test the respirator.

PEOSH requires fit-testing prior to initial use and annually thereafter. 67 Source: http://www.doksinet Fit-Testing The fit -test can be qualitative or quantitative and must follow one of the PEOSH-approved protocols described in the Respiratory Protection Standard. I dentify the fit -test protocol used in this EMS agency: q Quantitative fit-test using Portacount computer q Qualitative fit-test with Bitrex q Qualitative fit-test with Saccharin Quantitative vs. Qualitative Fit - Testing Quantitative: Computerized means of detecting faceseal leakage Qualitative: Relies on w earer’s subjective response to taste, odor or irritation 68 Source: http://www.doksinet I f there are problems make changes q periodic program evaluation required – PEOSH recommends annual evaluation q responsibility of program administrator Escape-Only Respirators n Only one part of an emergency plan n Designed to be used ONLY in an emergency n ONLY PURPOSE: escape from a dangerous area to a

safe area n NOT to be used to enter a contaminated area 69 Source: http://www.doksinet THEREFORE. I N ORDER TO USE THE ESCAPE RESPI RATOR AS I NTENDED. .YOU MUST HAVE THE RESPI RATOR WI TH YOU !!!!!! Escape-only respirators n n n Designed for one-time use for a short period May not protect from all chemicals or infectious particles Wearer needs to know : n n n n n Does it supply oxygen????? Does it filter particulates? Does it protect against toxic gases? Which ones? How long w ill the filters w ork? Most escape respirators NOT NI OSH- approved 70 Source: http://www.doksinet Escape-Only Respirators When exposures of EMS personnel to specific respiratory hazards can be anticipated, PEOSH requires that a NI OSH-approved respirator capable of protecting responders from the specific hazard be issued. Respiratory protection is effective only if: n The correct respirator is used n I t’s available when you need it n You know when and how to put in on and take it off

n You have stored it and kept in in working order in accordance with the manufacturer’s instructions 71 Source: http://www.doksinet NJ Department of Health & Senior Services PEOSH Program 609-984-1863 http:/ / www.statenjus/ health/ eoh/ peoshweb 72 Source: http://www.doksinet SECTION 9 Respiratory Protection Program Evaluation Employers must conduct periodic evaluations to ensure that the respiratory protection program is being properly implemented. PEOSH recommends that evaluations be conducted at least annually. A form that can be distributed to EMS personnel to begin this assessment process is included in this section. 73 Source: http://www.doksinet Emergency Medical Services Respiratory Protection Program Evaluation Questionnaire Training Program Evaluation Questions Strongly Agree Agree No Position Disagree Strongly Disagree No Position Disagree Strongly Disagree The EMS Respiratory Protection training was well organized and well structured. The

educational materials were easily understood. The trainer was knowledgeable about the material, kept the training on target and was sensitive to group dynamics. Participation in this program is appropriate for someone in my position. The environment in which the training was held was conducive to learning. Overall Respiratory Protection Program Evaluation Strongly Agree Agree The respirator assigned to me is an appropriate selection for the hazards to which I am exposed. I am able to don and doff my respirator correctly. I am able to adequately store my respirator as appropriate. The Program Administrator is accessible for my questions and needs regarding the program. I feel that I have been adequately trained to use the respirator appropriately and understand the conditions when a respirator may need to be used as outlined in the written program or standard operating procedures. What changes would you make to improve the EMS Respiratory Protection Program?

74 Source: http://www.doksinet SECTION 10 Copy of the PEOSH Respiratory Protection Standard 29 CFR 1910.134 A copy of the PEOSH Respiratory Protection Standard can be found on the following pages as required by the Standard. It should be readily available to EMS personnel. 75 Source: http://www.doksinet PEOSH Re spir a t or y Pr ot e ct ion St a nda r d CFR 1 9 1 0 .1 3 4 ( 1 9 9 8 ) [ 63 FR 1152, Jan. 8, 1998; 63 FR 20098, April 23, 1998] 1 9 1 0 .1 3 4 ( a ) Perm issible pract ice 1 9 1 0 .1 3 4 ( a ) ( 1 ) I n t he cont rol of t hose occupat ional diseases caused by breat hing air cont am inat ed wit h harm ful dust s, fogs, fum es, m ist s, gases, sm okes, sprays, or vapors, t he prim ary obj ect ive shall be t o prevent at m ospheric cont am inat ion. This shall

be accom plished as far as feasible by accept ed engineering cont rol m easures ( for exam ple, enclosure or confinem ent of t he operat ion, general and local vent ilat ion, and subst it ut ion of less t oxic m at erials) . When effect ive engineering cont rols are not feasible, or while t hey are being inst it ut ed, appropriat e respirat ors shall be used pursuant t o t his sect ion. 1 9 1 0 .1 3 4 ( a ) ( 2 ) Respirat ors shall be provided by t he em ployer when such equipm ent is necessary t o prot ect t he healt h of t he em ployee. The em ployer shall provide t he respirat ors which are applicable and suit able for t he purpose int ended. The em ployer shall be responsible for t he est ablishm ent and m aint enance of a respirat ory prot ect ion program which shall include t he requirem ent s out lined in paragraph ( c) of t his sect ion. 1 9 1 0 .1 3 4 ( b) Definit ions The following definit ions are im port ant t erm s used in t he respirat ory prot ect ion st andard in t his

sect ion. Air-pur ifying r e spir a t or m eans a respirat or wit h an air-purifying filt er, cart ridge, or canist er t hat rem oves specific air cont am inant s by passing am bient air t hrough t he air- purifying elem ent . Assigned prot ect ion fact or ( APF) m eans t he workplace level of respirat ory prot ect ion t hat a respirat or or class of respirat ors is expect ed t o provide t o em ployees when t he em ployer im plem ent s a cont inuing, effect ive respirat ory prot ect ion program as specified by t his sect ion. At m osphere- supplying respira t or m eans a respirat or t hat supplies t he respirat or user wit h breat hing air from a source independent of t he am bient at m osphere, and includes supplied - air respirat ors ( SARs) and self-cont ained breat hing apparat us ( SCBA) unit s. Ca nist e r or ca r t r idge m eans a cont ainer wit h a filt er, sorbent , or cat alyst , or com binat ion of t hese it em s, which rem oves specific cont am inant s from t he air passed

t hrough t he cont ainer. D e m a nd r e spir a t or m eans an at m osphere-supplying respirat or t hat adm it s breat hing air t o t he facepiece only when a negat ive pressure is creat ed inside t he facepiece by inhalat ion. Em ergency sit ua t ion m eans any occurrence such as, but not lim it ed t o, equipm ent failure, rupt ure of cont ainers, or failure of cont rol equipm ent t hat m ay or does result in an uncont rolled significant release of an airborne cont am inant . Em ployee exposure m eans exposure t o a concent rat ion of an airborne cont am inant t hat would occur if t he em ployee were not using respirat ory prot ect ion. 76 Source: http://www.doksinet En d-o f- se r vice - life indicat or ( ESLI ) m eans a syst em t hat warns t he respirat or user of t he approach of t he end of adequat e respirat ory prot ect ion, for exam ple, t hat t he sorbent is approaching sat urat ion or is no longer effect ive. Esca pe -only r e spir a t or m eans a respirat or int ended t

o be used only for em ergency exit . Filt er or air purifying elem ent m eans a com ponent used in respirat ors t o rem ove solid or liquid aerosols from t he inspired air. Filt ering fa cepiece ( dust m a sk ) m eans a negat ive pressure part iculat e respirat or wit h a filt er as an int egral part of t he facepiece or wit h t he ent ire facepiece com posed of t he filt ering m edium . Fit fa ct or m eans a quant it at ive est im at e of t he fit of a part icular respirat or t o a specific individual, and t ypically est im at es t he rat io of t he concent rat ion of a subst ance in am bient air t o it s concent rat ion inside t he respirat or when worn. Fit t e st m eans t he use of a prot ocol t o qualit at ively or quant it at ively evaluat e t he fit of a respirat or on an individual. ( See also Qualit at ive fit t est QLFT and Quant it at ive fit t est QNFT.) H elm et m eans a rigid respirat ory inlet covering t hat also provides head prot ect ion against im pact and penet rat

ion. H igh efficiency part iculat e air ( H EPA) filt er m eans a filt er t hat is at least 99.97% efficient in rem oving m onodisperse part icles of 03 m icrom et ers in diam et er The equivalent NI OSH 42 CFR 84 part iculat e filt ers are t he N100, R100, and P100 filt ers. Hood m eans a respirat ory inlet covering t hat com plet ely covers t he head and neck and m ay also cover port ions of t he shoulders and t orso. I m m edia t ely da ngerous t o life or hea lt h ( I DLH ) m eans an at m osphere t hat poses an im m ediat e t hreat t o life, would cause irreversible adverse healt h effect s, or would im pair an individuals abilit y t o escape from a dangerous at m osphere. I nt erior st ruct ura l firefight ing m eans t he physical act ivit y of fire suppression, rescue or bot h, inside of buildings or enclosed st ruct ures which are involved in a fire sit uat ion beyond t he incipient st age. ( See 29 CFR 1910155) Loose - fit t ing facepiece m eans a respirat ory inlet covering t

hat is designed t o form a part ial seal wit h t he face. M a x im um use concent ra t ion ( M UC) m eans t he m axim um at m ospheric concent rat ion of a hazardous subst ance from which an em ployee can be expect ed t o be prot ect ed when wearing a respirat or, and is det erm ined by t he assigned prot ect ion fact or of t he respirat or or class of respirat ors and t he exposure lim it of t he hazardous subst ance. The MUC can be det erm ined m at hem at ically by m ult iplying t he assigned prot ect ion fact or specified for a respirat or by t he required OSHA perm issible exposure lim it , short - t erm exposure lim it , or ceiling lim it . When no OSHA exposure lim it is available for a hazardous subst ance, an em ployer m ust det erm ine an MUC on t he basis of relevant available inform at ion and inform ed professional j udgm ent . N e ga t ive pr e ssure respira t or ( t ight fit t ing) m eans a respirat or in which t he air pressure inside t he facepiece is negat ive during

inhalat ion wit h respect t o t he am bient air pressure out side t he respirat or. 77 Source: http://www.doksinet Ox ygen deficient at m osphere m eans an at m osphere wit h an oxygen cont ent below 19.5% by volum e Physician or ot her licensed healt h care professional ( PLH CP) m eans an individual whose legally perm it t ed scope of pract ice ( i.e, license, regist rat ion, or cert ificat ion) allows him or her t o independent ly provide, or be delegat ed t he responsibilit y t o provide, som e or all of t he healt h care services required by paragraph ( e) of t his sect ion. Posit ive pressure respira t or m eans a respirat or in which t he pressure inside t he respirat ory inlet covering exceeds t he am bient air pressure out side t he respirat or. Pow e r e d a ir-purifying respirat or ( PAPR) m eans an air- purifying respirat or t hat uses a blower t o force t he am bient air t hrough air-purifying elem ent s t o t he inlet covering. Pressure dem a nd respira t or m eans a

posit ive pressure at m osphere- supplying respirat or t hat adm it s breat hing air t o t he facepiece when t he posit ive pressure is reduced inside t he facepiece by inhalat ion. Qua lit a t ive fit t est ( QLFT) m eans a pass/ fail fit t est t o assess t he adequacy of respirat or fit t h at relies on t he individuals response t o t he t est agent . Qua nt it a t ive fit t e st ( QN FT) m eans an assessm ent of t he adequacy of respirat or fit by num erically m easuring t he am ount of leakage int o t he respirat or. Re spir a t or y inle t cove r ing m eans t hat port i on of a respirat or t hat form s t he prot ect ive barrier bet ween t he users respirat ory t ract and an air-purifying device or breat hing air source, or bot h. I t m ay be a facepiece, helm et , hood, suit , or a m out hpiece respirat or wit h nose clam p. Se lf- cont ained breat hing apparat us ( SCBA) m eans an at m osphere- supplying respirat or for which t he breat hing air source is designed t o be carried

by t he user. Se r vice life m eans t he period of t im e t hat a respirat or, filt er or sorbent , or ot her respirat ory equipm ent provides adequat e prot ect ion t o t he wearer. Supplie d- air respirat or ( SAR) or airline respirat or m eans an at m ospheresupplying respirat or for which t he source of breat hing air is not designed t o be carried by t he user. This se ct ion m eans t his respirat ory prot ect ion st andard. Tight - fit t ing facepiece m eans a respirat ory inlet covering t hat form s a com plet e seal wit h t he face. User seal check m eans an act ion conduct ed by t he respirat or user t o det erm ine if t he respirat or is properly seat ed t o t he face. 1 9 1 0 .1 3 4 ( c) Respirat ory prot ect ion program This paragraph requires t he em ployer t o develop and im plem ent a writ t en respirat ory prot ect ion program wit h required worksit e-specific procedures and elem ent s for required respirat or use. The program m ust be adm inist ered by a suit ably t

rained program adm inist rat or. I n addit ion, cert ain program elem ent s m ay be required for volunt ary use t o prevent pot ent ial hazards associat ed wit h t he use of t he respirat or. The Sm all Ent it y Com pliance Guide cont ains crit eria for t he select ion of a program adm inist rat or and a sam ple program t hat m eet s t he requirem ent s of t his paragraph. Copies of t he Sm all Ent it y 78 Source: http://www.doksinet Com pliance Guide will be available on or about April 8, 1998 from t he Occupat ional Safet y and Healt h Adm inist rat ions Office of Publicat ions, Room N 3101, 200 Const it ut ion Avenue, NW, Washingt on, DC, 20210 ( 202- 219-4667) . 1 9 1 0 .1 3 4 ( c) ( 1 ) I n any workplace where respirat ors are necessary t o prot ect t he healt h of t he em ployee or whenever respirat ors are required by t he em ployer, t he em ployer shall est ablish and im plem ent a writ t en respirat ory prot ect ion program wit h worksit especific procedures. The program

shall be updat ed as necessary t o reflect t hose changes in workplace condit ions t hat affect respirat or use. The em ployer shall include in t he program t he following provisions of t his sect ion, as applicable: 1 9 1 0 .1 3 4 ( c) ( 1 ) ( i) Procedures for select ing respirat ors for use in t he workplace; 1 9 1 0 .1 3 4 ( c) ( 1 ) ( ii) Medical evaluat ions of em ployees required t o use respirat ors; 1 9 1 0 .1 3 4 ( c) ( 1 ) ( iii) Fit t est ing procedures for t ight- fit t ing respirat ors; 1 9 1 0 .1 3 4 ( c) ( 1 ) ( iv) Procedures for proper use of respirat ors in rout ine and reasonably foreseeable em ergency sit uat ions; 1 9 1 0 .1 3 4 ( c) ( 1 ) ( v) Procedures and schedules for cleaning, disinfect ing, st oring, inspect ing, repairing, discarding, and ot herwise m aint aining respirat ors; 1 9 1 0 .1 3 4 ( c) ( 1 ) ( vi) Procedures t o ensure adequat e air qualit y, quant it y, and flow of breat hing air for at m osphere- supplying respirat ors; 1 9 1 0 .1 3 4 ( c) ( 1

) ( vii) Training of em ployees in t he respirat ory hazards t o which t hey are pot ent ially exposed during rout ine and em ergency si tuations; 1 9 1 0 .1 3 4 ( c) ( 1 ) ( viii) Training of em ployees in t he proper use of respirat ors, including put t ing on and rem oving t hem , any lim it at ions on t heir use, and t heir m aint enance; and 1 9 1 0 .1 3 4 ( c) ( 1 ) ( ix ) Procedures for regularly evaluat ing t he effect iveness of t he program . 1 9 1 0 .1 3 4 ( c) ( 2 ) Where respirat or use is not required: 1 9 1 0 .1 3 4 ( c) ( 2 ) ( i) An em ployer m ay provide respirat ors at t he request of em ployees or perm it em ployees t o use t heir own respirat ors, if t he em ployer det erm ines t hat such respirat or use will not in it self creat e a hazard. I f t he em ployer det erm ines t hat any volunt ary respirat or use is perm issible, t he em ployer shall provide t he respirat or users wit h t he inform at ion cont ained in Appendix D t o t his sect ion ( "I nform at

ion for Em ployees Using Respirat ors When Not Required Under t he St andard") ; and 79 Source: http://www.doksinet 1 9 1 0 .1 3 4 ( c) ( 2 ) ( ii) I n addit ion, t he em ployer m ust est ablish and im plem ent t hose elem ent s of a writ t en respirat ory prot ect ion program necessary t o ensure t hat any em ployee using a respirat or volunt arily is m edically able t o use t hat respirat or, and t hat t he respirat or is cleaned, st ored, and m aint ained so t hat it s use does not present a healt h hazard t o t he user. Except ion: Em ployers are not required t o include in a writ t en respirat ory prot ect ion program t hose em ployees whose only use of respirat ors involves t he volunt ary use of filt ering facepieces ( dust m asks) . 1 9 1 0 .1 3 4 ( c) ( 3 ) The em ployer shall designat e a program adm inist rat or who is qualified by appropriat e t raining or experience t hat is com m ensurat e wit h t he com plexit y of t he program t o adm inist er or oversee t he

respirat ory prot ect ion program and conduct t he required evaluat ions of program effect iveness. 1 9 1 0 .1 3 4 ( c) ( 4 ) The em ployer shall provide respirat ors, t raining, and m edical evaluat ions at no cost t o t he em ployee. 1 9 1 0 .1 3 4 ( d) Select ion of respirat ors This paragraph requires t he em ployer t o evaluat e respirat ory hazard( s) in t he workplace, ident ify relevant workplace and user fact ors, and base respirat or select ion on t hese fact ors. The paragraph also specifies appropriat ely prot ect ive respirat ors for use in I DLH at m ospheres, and lim it s t he select ion and use of air-purifying respirat ors. 1 9 1 0 .1 3 4 ( d) ( 1 ) Genera l requirem ent s 1 9 1 0 .1 3 4 ( d) ( 1 ) ( i) The em ployer shall select and provide an appropriat e respirat or based on t he respirat ory hazard( s) t o which t he worker is exposed and workplace and user fact ors t hat affect respirat or perform ance and reliabilit y. 1 9 1 0 .1 3 4 ( d) ( 1 ) ( ii) The em

ployer shall select a NI OSH- cert ified respirat or. The respirat or shall be used in com pliance wit h t he condit ions of it s cert ificat ion. 1 9 1 0 .1 3 4 ( d) ( 1 ) ( iii) The em ployer shall ident ify and evaluat e t he respirat ory hazard( s) in t he workplace; t his evaluat ion shall include a reasonable est im at e of em ployee exposures t o respirat ory hazard( s) and an ident ificat ion of t he cont am inant s chem ical st at e and physical form . Where t he em ployer cannot ident ify or reasonably est im at e t he em ployee exposure, t he em ployer shall consider t he at m osphere t o be I DLH. 1 9 1 0 .1 3 4 ( d) ( 1 ) ( iv) The em ployer shall select respirat ors from a sufficient num ber of respirat or m odels and sizes so t hat t he respirat or is accept able t o, and correct ly fit s, t he user. 1 9 1 0 .1 3 4 ( d) ( 2 ) Respirat ors for I DLH at m ospheres 1 9 1 0 .1 3 4 ( d) ( 2 ) ( i) The em ployer shall provide t he following respirat ors for em ployee use in I

DLH at m ospheres: 80 Source: http://www.doksinet 1 9 1 0 .1 3 4 ( d) ( 2 ) ( i) ( A) A full facepiece pressure dem and SCBA cert ified by NI OSH for a m inim um service life of t hirt y m inut es, or 1 9 1 0 .1 3 4 ( d) ( 2 ) ( i) ( B) A com binat ion full facepiece pressure dem and supplied- air respirat or ( SAR) wit h auxiliary self- cont ained air supply. 1 9 1 0 .1 3 4 ( d) ( 2 ) ( ii) Respirat ors provid ed only for escape from I DLH at m ospheres shall be NI OSHcert ified for escape from t he at m osphere in which t hey will be used. 1 9 1 0 .1 3 4 ( d) ( 2 ) ( iii) All oxygen -deficient at m ospheres shall be considered I DLH. Except ion: I f t he em ployer dem onst rat es t hat , under all foreseeable condit ions, t he oxygen concent rat ion can be m aint ained wit hin t he ranges specified in Table I I of t his sect ion ( i.e, for t he alt it udes set out in t he t able) , t hen any at m ospheresupplying respirat or m ay be used 1 9 1 0 .1 3 4 ( d) ( 3 ) Respirat o rs

for at m ospheres t hat are not I DLH 1 9 1 0 .1 3 4 ( d) ( 3 ) ( i) The em ployer shall provide a respirat or t hat is adequat e t o prot ect t he healt h of t he em ployee and ensure com pliance wit h all ot her OSHA st at ut ory and regulat ory requirem ent s, under rout ine and reasonably foreseeable em ergency sit uat ions. 1 9 1 0 .1 3 4 ( d) ( 3 ) ( i) ( A) Assigned Prot ect ion Fa ct ors ( APFs) Em ployers m ust use t he assigned prot ect ion fact ors list ed in Table 1 t o select a respirat or t hat m eet s or exceeds t he required level of em ployee prot ect ion. When using a com binat ion respirat or ( e.g, airline respirat ors wit h an airpurifying filt er) , em ployers m ust ensure t hat t he assigned prot ect ion fact or is appropriat e t o t he m ode of operat ion in which t he respirat or is being used. Table 1. - - Assigned Prot ect ion Fact ors 5 Type of respirat or 1 , 2 Quart er Half m ask Full Helm et / m ask facepiece h ood Loosefit t ing facepiece 5 0 . 1, 000

4 25/ 1,000 25 3 1. Air - Purifying Respirat or 5 10 2. Powered Air - Pur ifying . 50 Respirat or ( PAPR) 3. Supplied- Air Respirat or ( SAR) or Airline Respirat or • Dem and m ode . 10 5 0 . • Cont inuous flow m ode . 50 1, 000 4 25/ 1,000 25 • Pressure- dem and or . 50 1, 000 . ot her posit ive- pressure m ode 4. Self - Cont ained Breat hing Apparat us ( SCBA) . 10 50 5 0 . • Dem and m ode . 10,000 10,000 . • Pressure- dem and or ot her posit ive- pressure m ode ( e.g, open/ closed circuit ) N ot es: 1 Em ployers m ay select respirat ors assigned for use in higher workplace 81 Source: http://www.doksinet concent rat ions of a hazardous subst ance for use at lower concent rat ions of t hat subst ance, or when required respirat or use is independent of concent rat ion. 2 The assigned prot ect ion fact ors in Table 1 are only effect ive when t he em ployer im plem ent s a cont inuing, effect ive respirat or program as required by t his sect ion ( 29 CFR 1910.134) ,

including t raining, fit t est ing, m aint enance, and use requirem ent s. 3 This APF cat egory includes filt ering facepieces, and half m asks wit h elast om eric facepieces. 4 The em ployer m ust have evidence provided by t he respirat or m anufact urer t hat t est ing of t hese respirat ors dem onst rat es perform ance at a level of prot ect ion of 1,000 or great er t o receive an APF of 1,000. This level of perform ance can best be dem onst rat ed by perform ing a WPF or SWPF st udy or equivalent t est ing. Absent such t est ing, all ot her PAPRs and SARs wit h helm et s/ hoods are t o be t reat ed as loose- fit t ing facepiece respirat ors, and r eceive an APF of 25. 5 These APFs do not apply t o respirat ors used solely for escape. For escape respirat ors used in associat ion wit h specific subst ances covered by 29 CFR 1910 subpart Z, em ployers m ust refer t o t he appropriat e subst ance- specific st andards in t hat subpart . Escape respirat ors for ot her I DLH at m ospheres

are specified by 29 CFR 1910.134 ( d) ( 2) ( ii) 1 9 1 0 .1 3 4 ( d) ( 3 ) ( i) ( B) M ax im um Use Concent rat ion ( M UC) 1 9 1 0 .1 3 4 ( d) ( 3 ) ( i) ( B) ( 1 ) The em ployer m ust select a respirat or for em ployee use t hat m aint ains t he em ployees exposure t o t he hazardous subst ance, when m easured out side t he respirat or, at or below t he MUC. 1 9 1 0 .1 3 4 ( d) ( 3 ) ( i) ( B) ( 2 ) Em ployers m ust not apply MUCs t o condit ions t hat are im m ediat ely dangerous t o life or healt h ( I DLH) ; inst ead, t hey m ust use respirat ors list ed for I DLH condit ions in paragraph ( d) ( 2) of t his st andard. 1 9 1 0 .1 3 4 ( d) ( 3 ) ( i) ( B) ( 3 ) When t he calculat ed MUC exceeds t he I DLH level for a hazardous subst ance, or t he perform ance lim it s of t he cart ridge or canist er, t hen em ployers m ust set t he m axim um MUC at t hat lower lim it . 1 9 1 0 .1 3 4 ( d) ( 3 ) ( ii) The respirat or select ed shall be appropriat e for t he chem ical st at e and

physical form of t he cont am inant . 1 9 1 0 .1 3 4 ( d) ( 3 ) ( iii) For prot ect ion against gases and vapors, t he em ployer shall provide: 1 9 1 0 .1 3 4 ( d) ( 3 ) ( iii) ( A) An at m osphere-supplying respirat or, or 1 9 1 0 .1 3 4 ( d) ( 3 ) ( iii) ( B) An air-purifying respirat or, provided t hat : 1 9 1 0 .1 3 4 ( d) ( 3 ) ( iii) ( B) ( 1 ) The respirat or is equipped wit h an end- of- service- life indicat or ( ESLI ) cert ified b y NI OSH for t he cont am inant ; or 1 9 1 0 .1 3 4 ( d) ( 3 ) ( iii) ( B) ( 2 ) I f t here is no ESLI appropriat e for condit ions in t he em ployers workplace, t he em ployer im plem ent s a change schedule for 82 Source: http://www.doksinet canist ers and cart ridges t hat is based on obj ect ive inform at ion or dat a t hat will ensure t hat canist ers and cart ridges are changed before t he end of t heir service life. The em ployer shall describe in t he respirat or program t he inform at ion and dat a relied upon and t he basis for t he

canist er and cart ridge change schedule and t he b asis for reliance on t he dat a. 1 9 1 0 .1 3 4 ( d) ( 3 ) ( iv) For prot ect ion against part iculat es, t he em ployer shall provide: 1 9 1 0 .1 3 4 ( d) ( 3 ) ( iv) ( A) An at m osphere- supplying respirat or; or 1 9 1 0 .1 3 4 ( d) ( 3 ) ( iv) ( B) An air-purifying respirat or equipped wit h a filt er cert ified by NI OSH under 30 CFR part 11 as a high efficiency part iculat e air ( HEPA) filt er, or an air-purifying respirat or equipped wit h a filt er cert ified for part iculat es by NI OSH under 42 CFR part 84; or 1 9 1 0 .1 3 4 ( d) ( 3 ) ( iv) ( C) For cont am inant s consist ing prim arily of part icles wit h m ass m edian aerodynam ic diam et ers ( MMAD) of at least 2 m icrom et ers, an ai rpurifying respirat or equipped wit h any filt er cert ified for part iculat es by NI OSH. TABLE I . - - ASSI GNED PROTECTI ON FACTORS [ RESERVED] TABLE I I Alt it ude ( ft .) Oxygen deficient At m ospheres ( % 0 2 ) for which t he em

ployer at m ospherem ay rely on supplying respirat ors Less t han 3,001 3, 001- 4,000 4, 001- 5,000 5, 001- 6,000 6, 001- 7,000 7, 001- 8,0001 16.0 -195 16.4 -195 17.1 -195 17.8 -195 18.5 -195 19.3 -19 5 1 Above 8,000 feet t he except ion does not apply. Oxygenenriched breat hing air m ust be supplied above 14,0 00 feet 1 9 1 0 .1 3 4 ( e) M edical evaluat ion Using a respirat or m ay place a physiological burden on em ployees that varies wit h t he t ype of respirat or worn, t he j ob and workplace condit ions in which t he respirat or is used, and t he m edical st at us of t he em ployee. Accordingly, t his paragraph specifies t he m inim um requirem ent s for m edical evaluat ion t hat em ployers m ust im plem ent t o det erm ine t he em ployees abilit y t o use a respirat or. 1 9 1 0 .1 3 4 ( e) ( 1 ) Genera l The em ployer shall provide a m edical evaluat ion t o det erm ine t he em ployees abilit y t o use a respirat or, before t he em ployee is fit t est ed or required t o

use t he respirat or in t he workplace. The em ployer m ay discont inue an em ployees m edical evaluat ions when t he em ployee is no longer required t o use a respirat or. 83 Source: http://www.doksinet 1 9 1 0 .1 3 4 ( e) ( 2 ) M edical evaluat ion procedures 1 9 1 0 .1 3 4 ( e) ( 2 ) ( i) The em ployer shall ident ify a physician or ot her licensed healt h care professional ( PLHCP) t o perform m edical evaluat ions using a m edical quest ionnaire or an init ial m edical exam inat ion t hat obt ains t he sam e inform at ion as t he m edical quest ionnaire. 1 9 1 0 .1 3 4 ( e) ( 2 ) ( ii) The m edical evaluat ion shall obt ain t he inform at ion request ed by t he quest ionnaire in Sect ions 1 and 2, Part A of Appendix C of t his sect ion. 1 9 1 0 .1 3 4 ( e) ( 3 ) Follow - up m edica l ex a m ina t ion 1 9 1 0 .1 3 4 ( e) ( 3 ) ( i) The em ployer shall ensure t hat a follow- up m edical exam inat ion is provided for an em ployee who gives a posit ive response t o any quest ion

am ong quest ions 1 t hrough 8 in Sect ion 2, Part A of Appendix C or whose init ial m edical exam inat ion dem onst rat es t he need for a follow- up m edical exam inat ion. 1 9 1 0 .1 3 4 ( e) ( 3 ) ( ii) The follow - up m edical exam inat ion shall include any m edical t est s, con sult at ions, or diagnost ic procedures t hat t he PLHCP deem s necessary t o m ake a final det erm inat ion. 1 9 1 0 .1 3 4 ( e) ( 4 ) Adm inist rat ion of t he m edical quest ionnaire and ex a m ina t ions. 1 9 1 0 .1 3 4 ( e) ( 4 ) ( i) The m edical quest ionnaire and exam inat ions shall be adm inist ered confident ially during t he em ployees norm al working hours or at a t im e and place convenient t o t he em ployee. The m edical quest ionnaire shall be adm inist ered in a m anner t hat ensures t hat t he em ployee underst ands it s cont ent . 1 9 1 0 .1 3 4 ( e) ( 4 ) ( ii) The em ployer shall provide t he em ployee wit h an opport unit y t o discuss t he quest ionnaire and exam inat ion result s

wit h t he PLHCP. 1 9 1 0 .1 3 4 ( e) ( 5 ) Supplem ent al inform at ion for t he PLHCP 1 9 1 0 .1 3 4 ( e) ( 5 ) ( i) The following inform at ion m ust be provided t o t he PLHCP before t he PLHCP m akes a recom m endat ion concerning an em ployees abilit y t o use a respirat or: 1 9 1 0 .1 3 4 ( e) ( 5 ) ( i) ( A) ( A) The t ype and weight of t he respirat or t o be used by t he em ployee; 1 9 1 0 .1 3 4 ( e) ( 5 ) ( i) ( B) The durat ion and frequency of respirat or use ( including use for rescue and escape) ; 1 9 1 0 .1 3 4 ( e) ( 5 ) ( i) ( C) The expect ed physical work effort ; 84 Source: http://www.doksinet 1 9 1 0 .1 3 4 ( e) ( 5 ) ( i) ( D) Addit ional prot ect ive clot hing and equipm ent t o be worn; and 1 9 1 0 .1 3 4 ( e ) ( 5 ) ( i) ( E) Tem perat ure and hum idit y ext rem es t hat m ay be encount ered. 1 9 1 0 .1 3 4 ( e) ( 5 ) ( ii) Any supplem ent al inform at ion provided previously t o t he PLHCP regarding an em ployee need not be provided for a subsequent m

edical evaluat ion if t he inform at ion and t he PLHCP rem ain t he sam e. 1 9 1 0 .1 3 4 ( e) ( 5 ) ( iii) The em ployer shall provide t he PLHCP wit h a copy of t he writ t en respirat ory prot ect ion program and a copy of t his sect ion. N ot e t o Pa ra gra ph ( e) ( 5 ) ( iii) : When t he em ployer replaces a PLHCP, t he em ployer m ust ensure t hat t he n ew PLHCP obt ains t his inform at ion, eit her by providing t he docum ent s direct ly t o t he PLHCP or having t he docum ent s t ransferred from t he form er PLHCP t o t he new PLHCP. However, OSHA does not expect em ployers t o have em ployees m edically reevaluat ed solely b ecause a new PLHCP has been select ed. 1 9 1 0 .1 3 4 ( e) ( 6 ) M edical det erm inat ion I n det erm ining t he em ployees abilit y t o use a respirat or, t he em ployer shall: 1 9 1 0 .1 3 4 ( e) ( 6 ) ( i) Obt ain a writ t en recom m endat ion regarding t he em ployees abilit y t o use t he respirat or from t he PLHCP. The recom m endat ion shall

provide only t he following inform at ion: 1 9 1 0 .1 3 4 ( e) ( 6 ) ( i) ( A) Any lim it at ions on respirat or use relat ed t o t he m edical condit ion of t he em ployee, or relat ing t o t he workplace condit ions in which t he respirat or will be used, including whet her or not t he em ployee is m edically able t o use t he respirat or; 1 9 1 0 .1 3 4 ( e) ( 6 ) ( i) ( B) The need, if any, for follow- up m edical evaluat ions; and 1 9 1 0 .1 3 4 ( e) ( 6 ) ( i) ( C) A st at em ent t hat t he PLHCP has provided t he em ployee wit h a copy of t he PLHCPs writ t en recom m endat ion. 1 9 1 0 .1 3 4 ( e) ( 6 ) ( ii) I f t he respirat or is a negat ive pressure respirat or and t he PLHCP finds a m edical condit ion t hat m ay place t he em ployees healt h at increased risk if t he respirat or is used, t he em ployer shall provide a PAPR if t he PLHCPs m edical evaluat ion finds t hat t he em ployee can use such a respirat or; if a subsequent m edical evaluat ion finds t hat t he em

ployee is m edically able t o use a negat ive pressure respirat or, t hen t he em ployer is no longer required t o provide a PAPR. 1 9 1 0 .1 3 4 ( e) ( 7 ) Addit ional m edical evaluat ions At a m inim um , t he em ployer shall provide addit ional m edical evaluat ions t hat com ply wit h t he requirem ent s of t his sect ion if: 85 Source: http://www.doksinet 1 9 1 0 .1 3 4 ( e) ( 7 ) ( i) An em ployee report s m edical signs or sym pt om s t hat are relat ed t o abilit y t o use a respirat or; 1 9 1 0 .1 3 4 ( e) ( 7 ) ( ii) A PLHCP, supervisor, or t he respirat or program adm inist rat or inform s t he em ployer t hat an em ployee needs t o be reevaluat ed; 1 9 1 0 .1 3 4 ( e) ( 7 ) ( iii) I nform at ion from t he respirat ory prot ect ion program , including observat ions m ade during fit t est ing and program evaluat ion, indicat es a need for em ployee reevaluat ion; or 1 9 1 0 .1 3 4 ( e ) ( 7 ) ( iv) A change occurs in workplace condit ions ( e.g, physical work effort ,

prot ect ive clot hing, t em perat ure) t hat m ay result in a subst ant ial increase in t he physiological burden placed on an em ployee. 1 9 1 0 .1 3 4 ( f) Fit t e st ing This paragraph requires t hat , before an em ployee m ay be required t o use any respirat or wit h a negat ive or posit ive pressure t ight - fit t ing facepiece, t he em ployee m ust be fit t est ed wit h t he sam e m ake, m odel, st yle, and size of respirat or t hat will be used. This paragraph specifies t he kinds of fit t est s allowed, t he procedures for conduct ing t hem , and how t he result s of t he fit t est s m ust be used. 1 9 1 0 .1 3 4 ( f) ( 1 ) The em ployer shall ensure t hat em ployees using a t ight - fit t ing facepiece respirat or pass an appropriat e qualit at ive fit t est ( QLFT) or quant it at ive fit t est ( QNFT) as st at ed in t his paragraph. 1 9 1 0 .1 3 4 ( f) ( 2 ) The em ployer shall ensure t hat an em ployee using a t ight - fit t ing facepiece respirat or is fit t est ed prior t

o init ial use of t he respirat or, whenever a different respirat or facepiece ( size, st yle, m odel or m ake) is used, and at least annually t hereaft er. 1 9 1 0 .1 3 4 ( f) ( 3 ) The em ployer shall conduct an addit ional fit t est whenever t he em ployee report s, or t he em ployer, PLHCP, supervisor, or program adm inist rat or m akes visual observat ions of, changes in t he em ployees physical condit ion t hat could affect respirat or fit . Such condit ions include, but are not lim it ed t o, facial scarring, dent al changes, cosm et ic surgery, or an obvious change in body weight . 1 9 1 0 .1 3 4 ( f) ( 4 ) I f aft er passing a QLFT or QNFT, t he em ployee subsequent ly not ifies t he em ployer, program adm inist rat or, supervisor, or PLHCP t hat t he fit of t he respirat or is unaccept able, t he em ployee shall be given a reasonable opport unit y t o select a different respirat or facepiece and t o be ret est ed. 1 9 1 0 .1 3 4 ( f) ( 5 ) The fit t est shall be adm inist

ered using an OSHA- accept ed QLFT or QNFT prot ocol. The OSHA- accept ed QLFT and QNFT prot ocols and procedures are cont ained in Appendix A of t his sect ion. 1 9 1 0 .1 3 4 ( f) ( 6 ) QLFT m ay only be used t o fit t est negat ive pressure air-purifying respirat ors t hat m ust achieve a fit fact or of 100 or less. 86 Source: http://www.doksinet 1 9 1 0 .1 3 4 ( f) ( 7 ) I f t he fit fact or, as det erm ined t hrough an OSHA- accept ed QNFT prot ocol, is equal t o or great er t han 100 for t ight- fit t ing half facepieces, or equal t o or great er t han 500 for t ight- fit t ing full facepieces, t he QNFT has been passed wit h t hat respirat or. 1 9 1 0 .1 3 4 ( f) ( 8 ) Fit t est ing of t ight - fit t ing at m osphere-supplying respirat ors and t ight- fit t ing powered air- purifying respirat ors shall be accom plished by perform ing quant it at ive or qualit at ive fit t est ing in t he negat ive pressure m ode, regardless of the m ode of operat ion ( negat ive or posit ive

pressure) t hat is used for respirat ory prot ect ion. 1 9 1 0 .1 3 4 ( f) ( 8 ) ( i) Qualit at ive fit t est ing of t hese respirat ors shall be accom plished by t em porarily convert ing t he respirat or users act ual facepiece int o a neg at ive pressure respirat or wit h appropriat e filt ers, or by using an ident ical negat ive pressure air- purifying respirat or facepiece wit h t he sam e sealing surfaces as a surrogat e for t he at m osphere- supplying or powered air-purifying respirat or facepiece. 1 9 1 0 .1 3 4 ( f) ( 8 ) ( ii) Quant it at ive fit t est ing of t hese respirat ors shall be accom plished by m odifying t he facepiece t o allow sam pling inside t he facepiece in t he breat hing zone of t he user, m idway bet ween t he nose and m out h. This requirem ent shall be accom plished by inst alling a perm anent sam pling probe ont o a surrogat e facepiece, or by using a sam pling adapt er designed t o t em porarily provide a m eans of sam pling air from inside t he

facepiece. 1 9 1 0 .1 3 4 ( f) ( 8 ) ( iii) Any m odificat ions t o t he respirat or facepiece for fit t est ing shall be com plet ely rem oved, and t he facepiece rest ored t o NI OSH- approved configurat ion, before t hat facepiece can be used in t he workplace. 1 9 1 0 .1 3 4 ( g) Use of respira t ors This paragraph requires em ployers t o est ablish and im plem ent procedures for t he proper use of respirat ors. These requirem ent s include prohibit ing condit ions t hat m ay result in facepiece seal leakage, prevent ing em ployees from rem oving respirat ors in hazardous environm ent s, t aking act ions t o ensure cont inued effect ive respirat or operat ion t hroughout t he work shift , and est ablishing procedures for t he use of respirat ors in I DLH at m ospheres or in int erior st ruct ural firefight ing sit uat ions. 1 9 1 0 .1 3 4 ( g) ( 1 ) Fa cepiece sea l prot ect ion 1 9 1 0 .1 3 4 ( g) ( 1 ) ( i) The em ployer shall not perm it respirat ors wit h t ightfit t ing

facepieces t o be worn by em ployees who have: 1 9 1 0 .1 3 4 ( g) ( 1 ) ( i) ( A) Facial hair t hat com es bet ween t he sealing surface of t he facepiece and t he face or t hat int erferes wit h valve funct ion; or 1 9 1 0 .1 3 4 ( g) ( 1 ) ( i) ( B) Any condit ion t hat int erferes wit h t he face- t o-facepiece seal or valve funct ion. 1 9 1 0 .1 3 4 ( g) ( 1 ) ( ii) I f an em ployee wears correct ive glasses or goggles or ot her personal prot ect ive equipm ent , t he em ployer shall ensure t hat such equipm ent is worn 87 Source: http://www.doksinet in a m anner t hat does not int erfere wit h t he seal of t he facepiece t o t he face of t he user. 1 9 1 0 .1 3 4 ( g) ( 1 ) ( iii) For all t ight - fit t ing respirat ors, t he em ployer shall ensure t hat em ployees perform a user seal check each t im e t hey put on t he respirat or using t he procedures in Appendix B- 1 or procedures recom m ended by t he respirat or m anufact urer t hat t he em ployer dem onst rat es are as

effect ive as t hose in Appendix B- 1 of t his sect ion. 1 9 1 0 .1 3 4 ( g) ( 2 ) Cont inuing respira t or effect iveness 1 9 1 0 .1 3 4 ( g) ( 2 ) ( i) Appropriat e surveillance shall be m aint ained of work area condit ions and degree of em ployee exposure or st ress. When t here is a change in work area condit ions or degree of em ployee exposure or st ress t hat m ay affect respirat or effect iveness, t he em ployer shall reevaluat e t he cont inued effect iveness of t he respirat or. 1 9 1 0 .1 3 4 ( g) ( 2 ) ( ii) The em ployer shall ensure t hat em ployees leave t he respirat or use area: 1 9 1 0 .1 3 4 ( g) ( 2 ) ( ii) ( A) To wash t heir faces and respirat or facepieces as necessary t o prevent eye or skin irrit at ion associat ed wit h respirat or use; or 1 9 1 0 .1 3 4 ( g) ( 2 ) ( ii) ( B) I f t hey det ect vapor or gas breakt hrough, changes in breat hing resist ance, or leakage of t he facepiece; or 1 9 1 0 .1 3 4 ( g) ( 2 ) ( ii) ( C) To replace t he respirat or or t he

filt er, cart ridge, or canist er elem ent s. 1 9 1 0 .1 3 4 ( g) ( 2 ) ( iii) I f t he em ployee det ect s vapor or gas breakt hrough, changes in breat hing resist ance, or leakage of t he facepiece, t he em ployer m ust replace or repair t he respirat or before allowing t he em ployee t o ret urn t o t he work area. 1 9 1 0 .1 3 4 ( g) ( 3 ) Pr oce dures for I DLH at m ospheres For all I DLH at m ospheres, t he em ployer shall ensure t hat : 1 9 1 0 .1 3 4 ( g) ( 3 ) ( i) One em ployee or, when needed, m ore t han one em ployee is locat ed out side t he I DLH at m osphere; 1 9 1 0 .1 3 4 ( g) ( 3 ) ( ii) Visual, voice, or signal line com m unicat ion is m aint ained bet ween t he em ployee( s) in t he I DLH at m osphere and t he em ployee( s) locat ed out side t he I DLH at m osphere; 1 9 1 0 .1 3 4 ( g) ( 3 ) ( iii) The em ployee( s) locat ed out side t he I DLH at m osphere are t rained and equipped t o provide effect ive em ergency rescue; 1 9 1 0 .1 3 4 ( g) ( 3 ) ( iv) The em

ployer or designee is not ified before t he em ployee( s) locat ed out side t he I DLH at m osphere ent er t he I DLH at m osphere t o provide em ergency rescue; 88 Source: http://www.doksinet 1 9 1 0 .1 3 4 ( g) ( 3 ) ( v) The em ployer or designee aut horized t o do so by t he em ployer, once not ified, provides necessary assist ance appropriat e t o t he sit uat ion; 1 9 1 0 .1 3 4 ( g) ( 3 ) ( vi) Em ployee( s) locat ed out side t he I DLH at m ospheres are equipped wit h: 1 9 1 0 .1 3 4 ( g) ( 3 ) ( vi) ( A) Pressure dem and or ot her posit ive pressure SCBAs, or a pressure dem and or ot her posit ive pressure supplied- air respirat or wit h auxiliary SCBA; and eit her 1 9 1 0 .1 3 4 ( g) ( 3 ) ( vi) ( B) Appropriat e ret rieval equipm ent for rem oving t he em ployee( s) who ent er( s) t hese hazardous at m ospheres where ret rieval equipm ent would cont rib ut e t o t he rescue of t he em ployee( s) and would not increase t he overall risk result ing from ent ry; or 1 9 1 0

.1 3 4 ( g) ( 3 ) ( vi) ( C) Equivalent m eans for rescue where ret rieval equipm ent is not required under paragraph ( g) ( 3) ( vi) ( B) . 1 9 1 0 .1 3 4 ( g) ( 4 ) Procedures for int erior st ruct ura l firefight ing I n addit ion t o t he requirem ent s set fort h under paragraph ( g) ( 3) , in int erior st ruct ural fires, t he em ployer shall ensure t hat : 1 9 1 0 .1 3 4 ( g) ( 4 ) ( i) At least t wo em ployees ent er t he I DLH at m osphere and rem ain in visual or voice cont act wit h one anot her at all t im es; 1 9 1 0 .1 3 4 ( g) ( 4 ) ( ii) At least t wo em ployees are locat ed out si de t he I DLH at m osphere; and 1 9 1 0 .1 3 4 ( g) ( 4 ) ( iii) All em ployees engaged in int erior st ruct ural firefight ing use SCBAs. N ot e 1 t o paragraph ( g) : One of t he t wo individuals locat ed out side t he I DLH at m osphere m ay be assigned t o an addit ional role, such as incident com m ander in charge of t he em ergency or safet y officer, so long as t his individual is able

t o perform assist ance or rescue act ivit ies wit hout j eopardizing t he safet y or healt h of any firefight er working at t he incident . N ot e 2 t o paragraph ( g) : Not hing in t his sect ion is m eant t o preclude firefight ers from perform ing em ergency rescue act ivit ies before an ent ire t eam has assem bled. 1 9 1 0 .1 3 4 ( h) M aint enance and care of respirat ors This paragraph requires t he em ployer t o provide for t he cleaning and disinfect ing, st orage, inspect ion, and repair of respirat ors used by em ployees. 1 9 1 0 .1 3 4 ( h) ( 1 ) Cle a ning and disinfect ing The em ployer shall provide each respirat or user wit h a respirat or t hat is clean, sanit ary, and in good working order. The em ployer shall ensure t hat respirat ors are cleaned and disinfect ed using t he procedures in Appendix B- 2 of t his sect ion, or procedures recom m ended by t he respirat or m anufact urer, provided t hat such procedures are of equivalent effect iveness. The respirat ors

shall be cleaned and disinfect ed at t he following int ervals: 89 Source: http://www.doksinet 1 9 1 0 .1 3 4 ( h) ( 1 ) ( i) Respirat ors issued for t he exclusive use of an em ployee shall be cleaned and disinfect ed as oft en as necessary t o be m aint ained in a sanit ary condit ion; 1 9 1 0 .1 3 4 ( h) ( 1 ) ( ii) Respirat ors issued t o m ore t han one em ployee shall be cleaned and disinfect ed before being worn by different individuals; 1 9 1 0 .1 3 4 ( h) ( 1 ) ( iii) Respirat ors m aint ained for em ergency use shall be cleaned and disinfect ed aft er each use; and 1 9 1 0 .1 3 4 ( h) ( 1 ) ( iv) Respirat ors used in fit t est ing and t raining shall be cleaned and disinfect ed aft er each use. 1 9 1 0 .1 3 4 ( h) ( 2 ) St ora ge The em ployer shall ensure t hat respirat ors are st ored as follows: 1 9 1 0 .1 3 4 ( h) ( 2 ) ( i) All respirat ors shall be st ored t o prot ect t hem from dam age, cont am inat ion, dust , sunlight , ext rem e t em perat ures, excessive m

oist ure, and dam aging chem icals, and t hey shall be packed or st ored t o prevent deform at ion of t he facepiece and exhalat ion valve. 1 9 1 0 .1 3 4 ( h) ( 2 ) ( ii) I n addit ion t o t he requirem ent s of paragraph ( h) ( 2) ( i) of t his sect ion, em ergency respirat ors shall be: 1 9 1 0 .1 3 4 ( h) ( 2 ) ( ii) ( A) Kept accessible t o t he work area; 1 9 1 0 .1 3 4 ( h) ( 2 ) ( ii) ( B) St ored in com part m ent s or in covers t hat are clearly m arked as cont aining em ergency respirat ors; and 1 9 1 0 .1 3 4 ( h) ( 2 ) ( ii) ( C) St ored in accordance wit h any applicable m anufact urer inst ruct ions. 1 9 1 0 .1 3 4 ( h) ( 3 ) I nspect ion 1 9 1 0 .1 3 4 ( h) ( 3 ) ( i) The em ployer shall ensure t hat respirat ors are inspect ed as follows: 1 9 1 0 .1 3 4 ( h) ( 3 ) ( i) ( A) All respirat ors used in rout ine sit uat ions shall be inspect ed before each use and duri ng cleaning; 1 9 1 0 .1 3 4 ( h) ( 3 ) ( i) ( B) All respirat ors m aint ained for use in em ergency sit

uat ions shall be inspect ed at least m ont hly and in accordance wit h t he m anufact urers recom m endat ions, and shall be checked for proper funct ion before and aft er each use; and 1 9 1 0 .1 3 4 ( h) ( 3 ) ( i) ( C) Em ergency escape- only respirat ors shall be inspect ed before being carried int o t he workplace for use. 90 Source: http://www.doksinet 1 9 1 0 .1 3 4 ( h) ( 3 ) ( ii) The em ployer shall ensure t hat respirat or inspect ions include t he following: 1 9 1 0 .1 3 4 ( h) ( 3 ) ( ii) ( A) A check of respirat or funct ion, t ight ness of connect ions, and t he condit ion of t he various part s including, but not lim it ed t o, t he facepiece, head st raps, valves, connect ing t ube, and cart ridges, canist ers or filt ers; and 1 9 1 0 .1 3 4 ( h) ( 3 ) ( ii) ( B) A check of elast om eric part s for pliabilit y and signs of det eriorat ion. 1 9 1 0 .1 3 4 ( h) ( 3 ) ( iii) I n addit ion t o t he requirem ent s of paragraphs ( h) ( 3) ( i) and ( ii) of t his sect

ion, self-cont ained breat hing apparat us shall be inspect ed m ont hly. Air and oxygen cylinders shall be m aint ained in a fully charged st at e and shall be recharged when t he pressure falls t o 90% of t he m anufact urers recom m ended pressure level. The em ployer shall det erm ine t hat t he regulat or and warning devices funct ion properly. 1 9 1 0 .1 3 4 ( h) ( 3 ) ( iv) For respirat ors m aint ained for em ergency use, t he em ployer shall: 1 9 1 0 .1 3 4 ( h) ( 3 ) ( iv) ( A) Cert ify t he resp irat or by docum ent ing t he dat e t he inspect ion was perform ed, t he nam e ( or signat ure) of t he person who m ade t he inspect ion, t he findings, required rem edial act ion, and a serial num ber or ot her m eans of ident ifying t he inspect ed respirat or; and 1 9 1 0 .1 3 4 ( h) ( 3 ) ( iv) ( B) Provide t his inform at ion on a t ag or label t hat is at t ached t o t he st orage com part m ent for t he respirat or, is kept wit h t he respirat or, or is included in inspect

ion report s st ored as paper or elect ronic files. This inform at ion shall be m aint ain ed unt il replaced following a subsequent cert ificat ion. 1 9 1 0 .1 3 4 ( h) ( 4 ) Repairs The em ployer shall ensure t hat respirat ors t hat fail an inspect ion or are ot herwise found t o be defect ive are rem oved from service, and are discarded or repaired or adj ust ed in accordance wit h t he following procedures: 1 9 1 0 .1 3 4 ( h) ( 4 ) ( i) Repairs or adj ust m ent s t o respirat ors are t o be m ade only by persons appropriat ely t rained t o perform such operat ions and shall use only t he respirat or m anufact urers NI OSH- approved part s designed for t he respirat or; 1 9 1 0 .1 3 4 ( h) ( 4 ) ( ii) Repairs shall be m ade according t o t he m anufact urers recom m endat ions and specificat ions for t he t ype and ext ent of repairs t o be perform ed; and 1 9 1 0 .1 3 4 ( h) ( 4 ) ( iii) Reducing and adm ission valves, regulat ors, and alarm s shall be adj ust ed or repaired only

by t he m anufact urer or a t echnician t rained by t he m anufact urer. 1 9 1 0 .1 3 4 ( i) Breat hing air qualit y and use This paragraph requires t he em ployer t o provide em ployees using at m osphere- supplying respirat ors ( supplied - air and SCBA) wit h breat hing gases of high purit y. 91 Source: http://www.doksinet 1 9 1 0 .1 3 4 ( i) ( 1 ) The em ployer shall ensure t hat com p ressed air, com pressed oxygen, liquid air, and liquid oxygen used for respirat ion accords wit h t he following specificat ions: 1 9 1 0 .1 3 4 ( i) ( 1 ) ( i) Com pressed and liquid oxygen shall m eet t he Unit ed St at es Pharm acopoeia requirem ent s for m edical or breat hing oxygen; and 1 9 1 0 .1 3 4 ( i) ( 1 ) ( ii) Com pressed breat hing air shall m eet at least t he requirem ent s for Grade D breat hing air described in ANSI / Com pressed Gas Associat ion Com m odit y Specificat ion for Air, G- 7.1 - 1989, t o include: 1 9 1 0 .1 3 4 ( i) ( 1 ) ( ii) ( A) Oxygen cont ent ( v/ v) of 19.5

-235% ; 1 9 1 0 .1 3 4 ( i) ( 1 ) ( ii) ( B) Hydrocarbon ( condensed) cont ent of 5 m illigram s per cub ic m et er of air or less; 1 9 1 0 .1 3 4 ( i) ( 1 ) ( ii) ( C) Carbon m onoxide ( CO) cont ent of 10 ppm or less; 1 9 1 0 .1 3 4 ( i) ( 1 ) ( ii) ( D) Carbon dioxide cont ent of 1,000 ppm or less; and 1 9 1 0 .1 3 4 ( i) ( 1 ) ( ii) ( E) Lack of not iceable odor. 1 9 1 0 .1 3 4 ( i) ( 2 ) The em ployer shall ensure t hat com pressed oxygen is not used in at m ospheresupplying respirat ors t hat have previously used com pressed air. 1 9 1 0 .1 3 4 ( i) ( 3 ) The em ployer shall ensure t hat oxygen concent rat ions great er t han 23.5% are used only in equipm ent designed for oxygen service or dist ribut ion. 1 9 1 0 .1 3 4 ( i) ( 4 ) The em ployer shall ensure t hat cylinders used t o supply breat hing air t o respirat ors m eet t he following requirem ent s: 1 9 1 0 .1 3 4 ( i) ( 4 ) ( i) Cylinders are t est ed and m aint ained as prescribed in t he Shipping Cont ainer Specificat

ion Regulat ions of t he Depart m ent of Transport at ion ( 49 CFR part 173 and part 178) ; 1 9 1 0 .1 3 4 ( i) ( 4 ) ( ii) Cylinders of purchased breat hing air have a cert ificat e of analysis from t he supplier t hat t he breat hing air m eet s t he requirem ent s for Grade D breat hing air; and 1 9 1 0 .1 3 4 ( i) ( 4 ) ( iii) The m oist ure cont ent in t he cylinder does not exceed a dew point of - 50 deg.F ( - 45.6 degC) at 1 at m osphere pressure 92 Source: http://www.doksinet 1 9 1 0 .1 3 4 ( i) ( 5 ) The em ployer shall ensure t hat com pressors used t o supply breat hing air t o respirat ors are const ruct ed and sit uat ed so as t o: 1 9 1 0 .1 3 4 ( i) ( 5 ) ( i) Prevent ent ry of cont am inat ed air int o t he air-supply syst em ; 1 9 1 0 .1 3 4 ( i) ( 5 ) ( ii) Minim ize m oist ure cont ent so t hat t he dew point at 1 at m osphere pressure is 10 degrees F ( 5.56 degC) below t he am bient t em perat ure; 1 9 1 0 .1 3 4 ( i) ( 5 ) ( iii) Have suit able in - line

air-purifying sorbent beds and filt ers t o furt her ensure breat hing air qualit y. Sorbent beds and filt ers shall be m aint ained and replaced or refurbished periodically following t he m anufact urers inst ruct ions. 1 9 1 0 .1 3 4 ( i) ( 5 ) ( iv) Have a t ag cont aining t he m ost recent change dat e and t he signat ure of t he person aut horized by t he em ployer t o perform t he change. The t ag shall be m aint ained at t he com pressor. 1 9 1 0 .1 3 4 ( i) ( 6 ) For com pressors t hat are not oil-lubricat ed, t he em ployer shall ensure t hat carbon m onoxide levels in t he breat hing air do not exceed 10 ppm . 1 9 1 0 .1 3 4 ( i) ( 7 ) For oil- lubricat ed com pressors, t he em ployer shall use a high- tem perat ure or carbon m onoxide alarm , or bot h, t o m onit or carbon m onoxide levels. I f only hight em perat ure alarm s are used, t he air supply shall be m onit ored at int ervals sufficient t o prevent carbon m onoxide in t he breat hing air from exceeding 10 ppm . 1 9

1 0 .1 3 4 ( i) ( 8 ) The em ployer shall ensure t hat breat hing air couplings are incom pat ible wit h out let s for nonrespirable worksit e air or ot her gas syst em s. No asphyxiat ing subst ance shall be int roduced int o breat hing air lines. 1 9 1 0 .1 3 4 ( i) ( 9 ) The em ployer shall use breat hing gas cont ainers m arked in accordance wit h t he NI OSH respirat or cert ificat ion st andard, 42 CFR part 84. 1 9 1 0 .1 3 4 ( j ) I dent ifica t ion of filt ers, ca rt ridges, a nd ca nist ers The em ployer shall ensure t hat all filt ers, cart ridges and canist ers used in t he workplace are labeled and color coded wit h t he NI OSH approval label and t hat t he label is not rem oved and rem ains legible. 1 9 1 0 .1 3 4 ( k ) Tra ining a nd inform a t ion This paragraph requires t he em ployer t o provide effect ive t raining t o em ployees who are required t o use respirat ors. The t raining m ust be com prehensive, underst andable, and recur annually, and m ore oft en if

necessary. This paragraph also requires t he em ployer t o provide t he basic inform at ion on respirat ors in Appendix D of t his sect ion t o em ployees who wear respirat ors when not required by t his sect ion or by t he em ployer t o do so. 1 9 1 0 .1 3 4 ( k ) ( 1 ) The em ployer shall ensure t hat each em ployee can dem onst rat e knowledge of at least t he following: 93 Source: http://www.doksinet 1 9 1 0 .1 3 4 ( k ) ( 1 ) ( i) Why t he respirat or is necessary and how im proper fit , usage, or m aint enance can com prom ise t he prot ect ive effect of t he respirat or; 1 9 1 0 .1 3 4 ( k ) ( 1 ) ( ii) What t he lim it at ions and capabilit ies of t he respirat or are; 1 9 1 0 .1 3 4 ( k ) ( 1 ) ( iii) How t o use t he respirat or effect ively in em ergency sit uat ions, including sit uat ions in which t he respirat or m alfunct ions; 1 9 1 0 .1 3 4 ( k ) ( 1 ) ( iv) How t o inspect , put on and rem ove, use, and check t he seals of t he respirat or; 1 9 1 0 .1 3 4 ( k ) (

1 ) ( v) What t he procedures are for m aint enance and st orage of t he respirat or; 1 9 1 0 .1 3 4 ( k ) ( 1 ) ( vi) How t o recognize m edical signs and sym pt om s t hat m ay lim it or prevent t he effect ive use of respirat ors; and 1 9 1 0 .1 3 4 ( k ) ( 1 ) ( vii) The general requirem ent s of t his sect ion. 1 9 1 0 .1 3 4 ( k ) ( 2 ) The t raining shall be conduct ed in a m anner t hat is underst andable t o t he em ployee. ` 1 9 1 0 .1 3 4 ( k ) ( 3 ) The em ployer shall provide t he t raining prior t o requiring t he em ployee t o use a respirat or in t he workplace. 1 9 1 0 .1 3 4 ( k ) ( 4 ) An em ployer who is ab le t o dem onst rat e t hat a new em ployee has received t raining wit hin t he last 12 m ont hs t hat addresses t he elem ent s specified in paragraph ( k) ( 1) ( i) t hrough ( vii) is not required t o repeat such t raining provided t hat , as required by paragraph ( k) ( 1) , t he em ployee can dem onst rat e knowledge of t hose elem ent ( s) . Previous t

raining not repeat ed init ially by t he em ployer m ust be provided no lat er t han 12 m ont hs from t he dat e of t he previous t raining. 1 9 1 0 .1 3 4 ( k ) ( 5 ) Ret raining shall be adm inist ered annually, and when t he following sit uat ions occur: 1 9 1 0 .1 3 4 ( k ) ( 5 ) ( i) Changes in t he workplace or t he t ype of respirat or render previous t raining obsolet e; 1 9 1 0 .1 3 4 ( k ) ( 5 ) ( ii) I nadequacies in t he em ployees knowledge or use of t he respirat or indicat e t hat t he em ployee has not ret ained t he requisit e underst anding or skill; or 1 9 1 0 .1 3 4 ( k ) ( 5 ) ( iii) Any ot her sit uat ion arises in which ret raining appears necessary t o ensure safe respirat or use. 94 Source: http://www.doksinet 1 9 1 0 .1 3 4 ( k ) ( 6 ) The basic advisory inform at ion on respirat ors, as present ed in Appendix D of t his sect ion, shall be provided by t he em ployer in any writ t en or oral form at , t o em ployees who wear respirat ors when such use is

not required by t his sect ion or by t he em ployer. 1 9 1 0 .1 3 4 ( l) Program evaluat ion This sect ion requires t he em ployer t o conduct evaluat ions of t he workplace t o ensure t hat t he writ t en respirat ory prot ect ion program is being properly im plem ent ed, and t o consult em ployees t o ensure t hat t hey are using t he respirat ors properly. 1 9 1 0 .1 3 4 ( l) ( 1 ) The em ployer shall conduct evaluat ions of t he workplace as necessary t o ensure t hat t he provisions of t he current writ t en program are being effect ively im plem ent ed and t hat it cont inues t o be effect ive. 1 9 1 0 .1 3 4 ( l) ( 2 ) The em ployer shall regularly consult em ployees required t o use respirat ors t o assess t he em ployees views on program effect iveness and t o ident ify any problem s. Any problem s t hat are ident ified during t his assessm ent shall be correct ed. Fact ors t o be assessed include, but are not lim it ed t o: 1 9 1 0 .1 3 4 ( l) ( 2 ) ( i) Respirat or fit (

including t he abilit y t o use t he respirat or wit hout int erfering wit h effect ive workplace perform ance) ; 1 9 1 0 .1 3 4 ( l) ( 2 ) ( ii) Appropriat e respirat or select ion for t he hazards t o which t he em ployee is exposed; 1 9 1 0 .1 3 4 ( l) ( 2 ) ( iii) Proper respirat or use under t he workplace condit ions t he em ployee encount ers; and 1 9 1 0 .1 3 4 ( l) ( 2 ) ( iv) Proper respirat or m aint enance. 1 9 1 0 .1 3 4 ( m ) Recordk eeping This sect ion requires t he em ployer t o est ablish and ret ain writ t en inform at ion regarding m edical evaluat ions, fit t est ing, and t he respirat or program . This inform at ion will facilit at e em ployee involvem ent in t he respirat or program , assist t he em ployer in audit ing t he adequacy of t he program , and provide a record for com pliance det erm inat ions by OSHA. 1 9 1 0 .1 3 4 ( m ) ( 1 ) M edical evaluat ion Records of m edical evaluat ions required by t his sect ion m ust be ret ained and m ade available in

accordance wit h 29 CFR 1910.1020 1 9 1 0 .1 3 4 ( m ) ( 2 ) Fit t est ing 1 9 1 0 .1 3 4 ( m ) ( 2 ) ( i) The em ployer shall est ablish a record of t he qualit at ive and quant it at ive fit t est s adm inist ered t o an em ployee including: 1 9 1 0 .1 3 4 ( m ) ( 2 ) ( i) ( A) The nam e or ident ificat ion of t he em ployee t est ed; 95 Source: http://www.doksinet 1 9 1 0 .1 3 4 ( m ) ( 2 ) ( i) ( B) Type of fit t est perform ed; 1 9 1 0 .1 3 4 ( m ) ( 2 ) ( i) ( C) Specific m ake, m odel, st yle, and size of respirat or t est ed; 1 9 1 0 .1 3 4 ( m ) ( 2 ) ( i) ( D) Dat e of t est ; and 1 9 1 0 .1 3 4 ( m ) ( 2 ) ( i) ( E) The pass/ fail result s for QLFTs or t he fit fact or and st rip chart recording or ot her recording of t he t est result s for QNFTs. 1 9 1 0 .1 3 4 ( m ) ( 2 ) ( ii) Fit t est records shall be ret ained for respirat or users unt il t he next fit t est is adm inist ered. 1 9 1 0 .1 3 4 ( m ) ( 3 ) A writ t en copy of t he current respirat or program shall be

ret ained by t he em ployer. 1 9 1 0 .1 3 4 ( m ) ( 4 ) Writ t en m at erials required t o be ret ained under t his paragraph shall be m ade available upon request t o affect ed em ployees and t o t he Assist ant Secret ary or designee for exam inat ion and copying. 1 9 1 0 .1 3 4 ( n) Dat es 1 9 1 0 .1 3 4 ( n) ( 1 ) Effect ive da t e This sect ion is effect ive April 8, 1998. The obligat ions im posed by t his sect ion com m ence on t he effect ive dat e unless ot herwise not ed in t his paragraph. Com pliance wit h obligat ions t hat do not com m ence on t he effect ive dat e shall occur no lat er t han t he applicable st art -up dat e. 1 9 1 0 .1 3 4 ( n) ( 2 ) Com pliance dat es All obligat ions of t his sect ion com m ence on t he effect ive dat e except as fol lows: 1 9 1 0 .1 3 4 ( n) ( 2 ) ( i) The det erm inat ion t hat respirat or use is required ( paragraph ( a) ) shall be com plet ed no lat er t han Sept em ber 8, 1998. 1 9 1 0 .1 3 4 ( n) ( 2 ) ( ii) Com pliance wit h

provisions of t his sect ion for all ot her provisions shall be com plet ed no lat er t han Oct ober 5, 1998. 1 9 1 0 .1 3 4 ( n) ( 3 ) The provisions of 29 CFR 1910.134 and 29 CFR 1926103, cont ained in t he 29 CFR part s 1900 t o 1910.99 and t he 29 CFR part 1926 edit ions, revised as of July 1, 1997, are in effect and enforceable unt il Oct ober 5, 1998, or during any adm inist rat ive or j udicial st ay of t he provisions of t his sect ion. 1 9 1 0 .1 3 4 ( n) ( 4 ) Ex ist ing Respirat ory Prot ect ion Program s I f, in t he 12 m ont h period preceding April 8, 1998, t he em ployer has conduct ed annual respirat or t raining, fit t est ing, respirat or program evaluat ion, or m edical evaluat ions, t he em ployer m ay use t he result s of t hose act ivit ies t o com ply wit h t he corresponding provisions of t his sect ion, providing t hat t hese act ivit ies were conduct ed in a m anner t hat m eet s t he requ irem ent s of t his sect ion. 96 Source: http://www.doksinet 1 9 1

0 .1 3 4 ( o) Appendices 1 9 1 0 .1 3 4 ( o) ( 1 ) Com pliance wit h Appendix A, Appendix B-1, Appendix B- 2, and Appendix C of t his sect ion is m andat ory. 1 9 1 0 .1 3 4 ( o) ( 2 ) Appendix D of t his sect ion is non -m andat ory and is not int ended t o creat e any addit ional obligat ions not ot herwise im posed or t o det ract from any exist ing obligat ions. Appendix A t o 1 9 1 0 .1 3 4 : Fit Test ing Procedures ( M andat ory) Part I . OSH A- Accept ed Fit Test Prot ocols A. Fit Test ing Procedures -- General Requirem ent s The em ployer shall conduct fit t est ing using t he following procedures. The requirem ent s in t his appendix apply t o all OSHA- accept ed fit t est m et hods, bot h QLFT and QNFT. 1. The t est subj ect shall be allowed t o pick t he m ost accept able respirat or from a sufficient num ber of respirat or m odels and sizes so t hat t he respirat or is accept able t o, and correct ly fit s, t he user. 2. Prior t o t he select ion process, t he t est subj

ect shall be shown how t o put on a respirat or, how it should be posit ioned on t he face, how t o set st rap t ension and how t o det erm ine an accept able fit . A m irror shall be available t o assist t he subj ect in evaluat ing t he fit and posit ioning of t he respirat or. This inst ruct ion m ay not const it ut e t he subj ect s form al t raining on respirat or use, because it is only a review. 3. The t est subj ect shall be inform ed t hat he/ she is being asked t o select t he respirat or t hat provides t he m ost accept able fit . Each respirat or represent s a different size and shape, and if fit t ed and used properly, will p rovide adequat e prot ect ion. 4. The t est subj ect shall be inst ruct ed t o hold each chosen facepiece up t o t he face and elim inat e t hose t hat obviously do not give an accept able fit . 5. The m ore accept able facepieces are not ed in case t he one select ed proves unaccept able; t he m ost com fort able m ask is donned and worn at least

five m inut es t o assess com fort . Assist ance in assessing com fort can be given by discussing t he point s in t he following it em A.6 I f t he t est subj ect is not fam iliar wit h using a part icular respirat or, t he t est subj ect shall be direct ed t o don t he m ask several t im es and t o adj ust t he st raps each t im e t o becom e adept at set t ing proper t ension on t he st raps. 6. Assessm ent of com fort shall include a review of t he following point s wit h t he t est subj ect and allowing t he t est subj ect adequat e t im e t o det erm ine t he com fort of t he respirat or: ( a) Posit ion of t he m ask on t he nose ( b) Room for eye prot ect ion ( c) Room t o t alk ( d) Posit ion of m ask on face and cheeks 7. The following crit eria shall be used t o help det erm ine t he adequacy of t he respirat or fit : ( a) Chin properly placed; ( b) Adequat e st rap t ension, not overly t ight ened; 97 Source: http://www.doksinet ( c) Fit across nose bridge; ( d) Respirat

or of proper size t o span dist ance from nose t o chin; ( e) Tendency of respirat or t o slip; ( f) Self- observat ion in m irror t o evaluat e fit and respirat or posit ion. 8. The t est subj ect shall conduct a user seal check, eit her t he negat ive and posit ive pressure seal checks described in Appendix B-1 of t his sect ion or t hose recom m ended by t he respirat or m anufact urer which provide equivalent prot ect ion t o t he procedures in Appendix B- 1. Before conduct ing t he negat ive and posit ive pressure checks, t he subj ect shall be t old t o seat t he m ask on t he face by m oving t he head from side- t o- side and up and down slowly while t aking in a few slow deep breat hs. Anot her facepiece shall be select ed and ret est ed if t he t est subj ect fails t he user seal check t est s. 9. The t est shall not be conduct ed if t here is any hair growt h bet ween t he skin and t he facepiece sealing surface, such as st ubble beard growt h, beard, m ust ache or sideburns

which cross t he respirat or sealing surface. Any t ype of apparel which int erferes wit h a sat isfact ory fit shall be alt ered or rem oved. 10. I f a t est subj ect exhibit s difficult y in breat hing during t he t est s, she or he shall be referred t o a physician or ot her licensed healt h care professional, as appropriat e, t o det erm ine whet her t he t est subj ect can wear a respirat or while perform ing her or his dut ies. 11. I f t he em ployee finds t he fit of t he respirat or unaccept able, t he t est subj ect shall be given t he opport unit y t o select a different respirat or and t o be ret est ed. 12. Exercise regim en Prior t o t he com m encem ent of t he fit t est , t he t est subj ect shall b e given a descript ion of t he fit t est and t he t est subj ect s responsibilit ies during t he t est procedure. The descript ion of t he process shall include a descript ion of t he t est exercises t hat t he subj ect will be perform ing. The respirat or t o be t est ed

shall be worn for at least 5 m inut es before t he st art of t he fit t est . 13. The fit t est shall be perform ed while t he t est subj ect is wearing any applicable safet y equipm ent t hat m ay be worn during act ual respirat or use which could int erfere wit h respirat or fit . 14. Test Exercises ( a) Em ployers m ust perform t he following t est exercises for all fit t est ing m et hods prescribed in t his appendix, except for t he CNP quant it at ive fit t est ing prot ocol and t he CNP REDON quant it at ive fit t est ing prot ocol. For t hese two prot ocols, em ployers m ust ensure t hat t he t est subj ect s (i.e , em ployees) perform t he exercise procedure specified in Part I .C4( b) of t his appendix for t he CNP quant it at ive fit t est ing prot ocol, or t he exercise procedure described in Part I .C5( b) of this appendix for t he CNP REDON quant it at ive fit t est ing prot ocol For t he rem aining fit t est ing m et hods, em ployers m ust ensure t hat em ployees perform

t he t est exercises in t he appropriat e t est environm ent in t he following m anner: ( 1) Norm al breat hing. I n a norm al st anding posit ion, wit hout t alking, t he subj ect shall breat he norm ally. ( 2) Deep breat hing. I n a norm al st anding posit ion, t he subj ect shall breat he slowly and deeply, t aking caut ion so as not t o hypervent ilat e. ( 3) Turning head side t o side. St anding in place, t he subj ect shall slowly t urn his/ her head from side t o side bet ween t he ext rem e posit ions on each side. The head shall be held at each ext rem e m om ent arily so t he subj ect can inhale at each side. ( 4) Moving head up and down. St anding in place, t he subj ect shall slowly m ove his/ her head 98 Source: http://www.doksinet up and down. The subj ect shall be inst ruct ed t o inhale in t he up posit ion ( ie, when looking t oward t he ceiling) . ( 5) Talking. The subj ect shall t alk out loud slowly and loud enough so as t o be heard clearly by t he t est

conduct or. The subj ect can read from a prepared t ext such as t he Rainbow Passage, count backward from 100, or recit e a m em orized poem or song. Ra inbow Pa ssa ge When t he sunlight st rikes raindrops in t he air, t hey act like a prism and form a rainbow. The rainbow is a division of whit e light int o m any beaut iful colors. These t ake t he shape of a long round arch, wit h it s pat h high above, and it s t wo ends apparent ly beyond t he horizon. There is, according t o legend, a boiling pot of gold at one end. People look, but no one ever finds it . When a m an looks for som et hing beyond reach, his friends say he is looking for t he pot of gold at t he end of t he rainbow. ( 6) Grim ace. The t est subj ect shall grim ace by sm iling or frowning ( This applies only t o QNFT t est ing; it is not perform ed for QLFT) ( 7) Bending over. The t est subj ect shall bend at t he waist as if he/ she were t o t ouch his/ her t oes. Jogging in place shall be subst it ut ed for t his

exercise in t hose t est environm ent s such as shroud t ype QNFT or QLFT unit s t hat do not perm it bending over at t he waist . ( 8) Norm al breat hing. Sam e as exercise ( 1) ( b) Each t est exercise shall be perform ed for one m inut e except for t he grim ace exercise which shall be perform ed for 15 seconds. The t est subj ect shall be quest ioned by t he t est conduct or regarding t he com fort of t he respirat or upon com plet ion of t he prot ocol. I f it has becom e unaccept able, anot her m odel of respirat or shall be t ried. The respirat or shall not be adj ust ed once t he fit t est exercises begin. Any adj ust m ent voids t he t est , and t he fit t est m ust be repeat ed. B. Qualit at ive Fit Test ( QLFT) Prot ocols 1. General ( a) The em ployer shall ensure t hat persons adm inist ering QLFT are able t o prepare t est solut ions, calibrat e equipm ent and perform t est s properly, recognize invalid t est s, and ensure t hat t est equipm ent is in proper working

order. ( b) The em ployer shall ensure t hat QLFT equipm ent is kept clean and well m aint ained so as t o operat e wit hin t he param et ers for which it was designed. 2. I soam yl Acet at e Prot ocol N ot e : This prot ocol is not appropriat e t o use for t he fit t est ing of part iculat e respirat ors. I f used t o fit t est part iculat e respirat ors, t he respirat or m ust be equipped wit h an organic vapor filt er. ( a) Odor Threshold Screening Odor t hreshold screening, perform ed wit hout wearing a respirat or, is int ended t o det erm ine if t he individual t est ed can det ect t he odor of isoam yl acet at e at low levels. ( 1) Three 1 lit er glass j ars wit h m et al lids are required. ( 2) Odor- free wat er ( e.g, dist illed or spring wat er) at approxim at ely 25 deg C ( 77 deg F) shall be used for t he solut ions. ( 3) The isoam yl acet at e ( I AA) ( also known at isopent yl acet at e) st ock solut ion is prepared by adding 1 m l of pure I AA t o 800 m l of odor- free

wat er in a 1 lit er j ar, closing t he lid and shaking for 30 seconds. A new solut ion shall be prepared at least weekly 99 Source: http://www.doksinet ( 4) The screening t est shall be conduct ed in a room separat e from t he room used for act ual fit t est ing. The t wo room s shall be well- vent ilat ed t o prevent t he odor of I AA from becom ing evident in t he general room air where t est ing t akes place. ( 5) The odor t est solut ion is prepared in a second j ar by placing 0.4 m l of t he st ock solut ion int o 500 m l of odor- free wat er using a clean dropper or pipet t e. The solut ion shall be shaken for 30 seconds and allowed t o st and for t wo t o t hree m inut es so t hat t he I AA concent rat ion above t he liquid m ay reach equilibrium . This solut ion shall be used for only one day ( 6) A t est blank shall be prepared in a t hird j ar by adding 500 cc of odor- free wat er. ( 7) The odor t est and t est blank j ar lids shall be labeled ( e.g, 1 and 2) for j ar

ident ificat ion Labels shall be placed on t he lids so t hat t hey can be peeled off periodically and swit ched t o m aint ain t he int egrit y of t he t est . ( 8) The following inst ruct ion shall be t yped on a card and placed on t he t able in front of t he t wo t est j ars ( i.e, 1 and 2) : "The purpose of t his t est is t o det erm ine if you can sm ell banana oil at a low concent rat ion. The t wo b ot t les in front of you cont ain wat er One of t hese bot t les also cont ains a sm all am ount of banana oil. Be sure t he covers are on t ight , t hen shake each bot t le for t wo seconds. Unscrew t he lid of each bot t le, one at a t im e, and sniff at t he m out h of t he bot t le. I ndicat e t o t he t est conduct or which bot t le cont ains banana oil." ( 9) The m ixt ures used in t he I AA odor det ect ion t est shall be prepared in an area separat e from where t he t est is perform ed, in order t o prevent olfact ory fat igue in t he subj ect . ( 10) I f t he t

est subj ect is unable t o correct ly ident ify t he j ar cont aining t he odor t est solut ion, t he I AA qualit at ive fit t est shall not be perform ed. ( 11) I f t he t est subj ect correct ly ident ifies t he j ar cont aining t he odor t est solut ion, t he t est subj ect m ay proceed t o respirat or select ion and fit t est ing. ( b) I soam yl Acet at e Fit Test ( 1) The fit t est cham ber shall be a clear 55- gallon drum liner suspended invert ed over a 2foot diam et er fram e so t hat t he t op of t he cham ber is about 6 inches above t he t est subj ect s head. I f no drum liner is available, a sim ilar cham ber shall be const ruct ed using plast ic sheet ing. The inside t op cent er of t he cham ber shall have a sm all hook at t ached ( 2) Each respirat or used for t he fit t ing and fit t est ing shall be eq uipped wit h organic vapor cart ridges or offer prot ect ion against organic vapors. ( 3) Aft er select ing, donning, and properly adj ust ing a respirat or, t he t est

subj ect shall wear it t o t he fit t est ing room . This room shall be separat e from t he room used for odor t hreshold screening and respirat or select ion, and shall be well- vent ilat ed, as by an exhaust fan or lab hood, t o prevent general room cont am inat ion. ( 4) A copy of t he t est exercises and any prepared t ext from which t he subj ect is t o read shall be t aped t o t he inside of t he t est cham ber. ( 5) Upon ent ering t he t est cham ber, t he t est subj ect shall be given a 6 -inch by 5- inch piece of paper t owel, or ot her porous, absorbent , single-ply m at erial, folded in half and wet t ed wit h 0.75 m l of pure I AA The t est subj ect shall hang t he wet t owel on t he hook at t he t op of t he cham ber. An I AA t est swab or am pule m ay be subst it ut ed for t he I AA wet t ed paper t owel provided it has been dem onst rat ed t hat t he alt ernat ive I AA source will generat e an I AA t est at m osphere wit h a concent rat ion equivalent t o t hat generat

ed by t he paper t owel m et hod. ( 6) Allow t wo m inut es for t he I AA t est concent rat ion t o st abilize before st art ing t he fit t est exercises. This would be an appropriat e t im e t o t alk wit h t he t est subj ect ; t o explain t he fit 100 Source: http://www.doksinet t est , t he im port ance of his/ her cooperat ion, and t he purpose for t he t est exercises; or t o dem onst rat e som e of t he exercises. ( 7) I f at any t im e during t he t est , t he subj ect det ect s t he banana-like odor of I AA, t he t est is failed. The subj ect shall quickly exit from t he t est cham ber and leave t he t est area t o avoid olfact ory fat igue. ( 8) I f t he t est is failed, t he subj ect shall ret urn t o t he select ion room and rem ove t he respirat or. The t est subj ect shall repeat t he odor sensit ivit y t est , select and put on anot her respirat or, ret urn t o t he t est area and again begin t he fit t est procedure described in ( b) ( 1) t hrough ( 7) above. The

process cont inues unt il a respirat or t hat fit s well has been found Should t he odor sensit ivit y t est be failed, t he subj ect shall wait at least 5 m inut es before ret est ing. Odor sensit ivit y will usually have ret urned by t his t im e ( 9) I f t he subj ect passes t he t est , t he efficiency of t he t est procedure shall be dem onst rat ed by having t he subj ect break t he respirat or face seal and t ake a breat h before exit ing t he cham ber. ( 10) When t he t est subj ect leaves t he cham ber, t he subj ect shall rem ove t he sat urat ed t owel and ret urn it t o t he person conduct ing t he t est , so t hat t here is no significant I AA concent rat ion buildup in t he cham ber during subsequent t est s. The used t owels shall be kept in a self - sealing plast ic bag t o keep t he t est area from being cont am inat ed. 3. Saccharin Solut ion Aerosol Prot ocol The ent ire screening and t est ing procedure shall be explained t o t he t est subj ect prior t o t he

conduct of t he screening t est . ( a) Tast e t hreshold screening. The saccharin t ast e t hreshold screening, perform ed wit hout wearing a respirat or, is int ended t o det erm ine whet her t he individual being t est ed can det ect t he t ast e of saccharin. ( 1) During t hreshold screening as well as during fit t est ing, subj ect s shall wear an enclosure about t he head and shoulders t hat is approxim at ely 12 inches in diam et er by 14 inches t all wit h at least t he front port ion clear and t hat allows free m ovem ent s of t he head when a respirat or is worn. An enclosure subst ant ially sim ilar t o t he 3M hood assem bly, part s # FT 14 and # FT 15 com bined, is adequat e. ( 2) The t est enclosure shall have a 3/ 4- inch ( 1.9 cm ) hole in front of t he t est subj ect s nose and m out h area t o accom m odat e t he nebulizer nozzle. ( 3) The t est subj ect shall don t he t est enclosure. Throughout t he t hreshold screening t est , t he t est subj ect shall breat he t

hrough his/ her slight ly open m out h wit h t ongue ext ended. The subj ect is in st ruct ed t o report when he/ she det ect s a sweet t ast e. ( 4) Using a DeVilbiss Model 40 I nhalat ion Medicat ion Nebulizer or equivalent , t he t est conduct or shall spray t he t hreshold check solut ion int o t he enclosure. The nozzle is direct ed away from t he nose and m out h of t he person. This nebulizer shall be clearly m arked t o dist inguish it from t he fit t est solut ion nebulizer. ( 5) The t hreshold check solut ion is prepared by dissolving 0.83 gram of sodium saccharin USP in 100 m l of warm wat er. I t can be prepared by put t ing 1 m l of t he fit t est solut ion ( see ( b) ( 5) below) in 100 m l of dist illed wat er. ( 6) To produce t he aerosol, t he nebulizer bulb is firm ly squeezed so t hat it collapses com plet ely, t hen released and allowed t o fully expand. ( 7) Ten squeezes are repeat ed rapidly and t hen t he t est subj ect is asked whet her t he saccharin can be t

ast ed. I f t he t est subj ect report s t ast ing t he sweet t ast e during t he t en squeezes, t he screening t est is com plet ed. The t ast e t hreshold is not ed as t en regardless of t he num ber of squeezes act ually com plet ed. 101 Source: http://www.doksinet ( 8) I f t he first response is negat ive, t en m ore squeezes are repeat ed rapidly and t he t est subj ect is again asked whet her t he saccharin is t ast ed. I f t he t est subj ect report s t ast ing t he sweet t ast e during t he second t en squeezes, t he screening t est is com plet ed. The t ast e t hreshold is not ed as t went y regardless of t he num ber of squeezes act ually com plet ed. ( 9) I f t he second response is negat ive, t en m ore squeezes are repeat ed rapidly and t he t est subj ect is again asked whet her t he saccharin is t ast ed. I f t he t est subj ect report s t ast ing t he sweet t ast e during t he t hird set of t en squeezes, t he screening t est is com plet ed. The t ast e t hreshold

is not ed as t hirt y regardless of t he num ber of squeezes act ually com plet ed. ( 10) The t est conduct or will t ake not e of t he num ber of squeezes required t o solicit a t ast e response. ( 11) I f t he saccharin is not t ast ed aft er 30 squeezes ( st ep 10) , t he t est subj ect is unable t o t ast e saccharin and m ay not perform t he saccharin fit t est . N ot e t o pa r a gr a ph 3 . ( a ) : I f t he t est subj ect eat s or drinks som et hing sweet before t he screening t est , he/ she m ay be unable t o t ast e t he weak saccharin solut ion. ( 12) I f a t ast e response is elicit ed, t he t est subj ect shall be asked t o t ake not e of t he t ast e for reference in t he fit t est . ( 13) Correct use of t he nebulizer m eans t hat approxim at ely 1 m l of liquid is used at a t im e in t he nebulizer body. ( 14) The nebulizer shall be t horoughly rinsed in wat er, shaken dry, and refilled at least each m orning and aft ernoon or at least every four hours. ( b) Saccharin

solut ion aerosol fit t est procedure. ( 1) The t est subj ect m ay not eat , drink ( except plain wat er) , sm oke, or chew gum for 15 m inut es before t he t est . ( 2) The fit t est uses t he sam e enclosure described in 3. ( a) above ( 3) The t est subj ect shall don t he enclosure while wearing t he respirat or select ed in sect ion I . A of t his appendix The respirat or shall be properly adj ust ed and equipped wit h a part iculat e filt er( s) . ( 4) A second DeVilbiss Model 40 I nhalat ion Medicat ion Nebulizer or equivalent is used t o spray t he fit t est solut ion int o t he enclosure. This nebulizer shall be clearly m arked t o dist inguish it from t he screening t est solut ion nebulizer. ( 5) The fit t est solut ion is prepared by adding 83 gram s of sodium saccharin t o 100 m l of warm wat er. ( 6) As before, t he t est subj ect shall breat he t hrough t he slight ly open m out h wit h t ongue ext ended, and report if he/ she t ast es t he sweet t ast e of saccharin. (

7) The nebulizer is insert ed int o t he hole in t he front of t he enclosure and an init ial concent rat ion of saccharin fit t est solut ion is sprayed int o t he enclosure using t he sam e num ber of squeezes ( eit her 10, 20 or 30 squeezes) based on t he num ber of squeezes required t o elicit a t ast e response as not ed during t he screening t est . A m inim um of 10 squeezes is required. ( 8) Aft er generat ing t he aerosol, t he t est subj ect shall be inst ruct ed t o perform t he exercises in sect ion I . A 14 of t his appendix ( 9) Every 30 seconds t he aerosol concent rat ion shall be replenished using one half t he 102 Source: http://www.doksinet original num ber of squeezes used init ially ( e.g, 5, 10 or 15) ( 10) The t est subj ect shall indicat e t o t he t est conduct or if at any t im e during t he fit t est t he t ast e of saccharin is det ect ed. I f t he t est subj ect does not report t ast ing t he saccharin, t he t est is passed. ( 11) I f t he t ast e of

saccharin is det ect ed, t he fit is deem ed unsat isfact ory and t he t est is failed. A different respirat or shall be t ried and t he ent ire t est procedure is repeat ed ( t ast e t hreshold screening and fit t est ing) . ( 12) Since t he nebulizer has a t endency t o clog during use, t he t est operat or m ust m ake periodic checks of t he nebulizer t o ensure t hat it is not clogged. I f clogging is found at t he end of t he t est session, t he t est is invalid. 4. Bit rex TM ( Denat onium Benzoat e) Solut ion Aerosol Qualit at ive Fit Test Prot ocol The Bit rex TM ( Denat onium benzoat e) solut ion aerosol QLFT prot ocol uses t he published saccharin t est prot ocol because t hat prot ocol is widely accept ed. Bit rex is rout inely used as a t ast e aversion agent in household liquids which children should not be drinking and is endorsed by t he Am erican Medical Associat ion, t he Nat ional Safet y Council, and t he Am erican Associat ion of Poison Cont rol Cent ers. The ent

ire screening and t est ing procedure shall be explained t o t he t est subj ect prior t o t he conduct of t he screening t est . ( a) Tast e Threshold Screening. The Bit rex t ast e t hreshold screening, perform ed wit hout wearing a respirat or, is int ended t o det erm ine whet her t he individual being t est ed can det ect t he t ast e of Bit rex. ( 1) During t hreshold screening as well as during fit t est ing, subj ect s shall wear an enclosure about t he head and shoulders t hat is approxim at ely 12 inches ( 30.5 cm ) in diam et er by 14 inches ( 35.6 cm ) t all The front port ion of t he enclosure shall be clear from t he respirat or and allow free m ovem ent of t he head when a respirat or is worn. An enclosure subst ant ially sim ilar t o t he 3M hood assem bly, part s # FT 14 and # FT 15 com bined, is adequat e. ( 2) The t est enclosure shall have a 3/ 4 inch ( 1.9 cm ) hole in front of t he t est subj ect s nose and m out h area t o accom m odat e t he nebulizer nozzle.

( 3) The t est subj ect shall don t he t est enclosure. Throughout t he t hreshold screening t est , t he t est subj ect shall breat he t hrough his or her slight ly open m out h wit h t ongue ext ended. The subj ect is inst ruct ed t o report when he/ she det ect s a bit t er t ast e ( 4) Using a DeVilbiss Model 40 I nhalat ion Medicat ion Nebulizer or equivalent , t he t est conduct or shall spray t he Threshold Check Solut ion int o t he enclosure. This Nebulizer shall be clearly m arked t o dist inguish it from t he fit t est solut ion nebulizer. ( 5) The Threshold Check Solut ion is prepared by adding 13.5 m illigram s of Bit rex t o 100 m l of 5% salt ( NaCl) solut ion in dist illed wat er. ( 6) To produce t he aerosol, t he nebulizer bulb is firm ly squeezed so t hat t he bulb collapses com plet ely, and is t hen released and allowed t o fully expand. ( 7) An init ial t en squeezes are repeat ed rapidly and t hen t he t est subj ect is asked whet her t he Bit rex can be t ast

ed. I f t he t est subj ect report s t ast ing t he bit t er t ast e during t he t en squeezes, t he screening t est is com plet ed. The t ast e t hreshold is not ed as t en regardless of t he num ber of squeezes act ually com plet ed. ( 8) I f t he first response is negat ive, t en m ore squeezes are repeat ed rapidly and t he t est subj ect is again asked whet her t he Bit rex is t ast ed. I f t he t est subj ect report s t ast ing t he bit t er t ast e during t he second t en squeezes, t he screening t est is com plet ed. The t ast e t hreshold is not ed as t went y regardless of t he num ber of squeezes act ually com plet ed. 103 Source: http://www.doksinet ( 9) I f t he second response is negat ive, t en m ore squeezes are repeat ed rapidly and t he t est subj ect is again asked whet her t he Bit rex is t ast ed. I f t he t est subj ect report s t ast ing t he bit t er t ast e during t he t hird set of t en squeezes, t he screening t est is com plet ed. The t ast e t hreshold

is not ed as t hirt y regardless of t he num ber of squeezes act ually com plet ed. ( 10) The t est conduct or will t ake not e of t he num ber of squeezes required t o solicit a t ast e response. ( 11) I f t he Bit rex is not t ast ed aft er 30 squeezes ( st ep 10) , t he t est subj ect is unable t o t ast e Bit rex and m ay not perform t he Bit rex fit t est . ( 12) I f a t ast e response is elicit ed, t he t est subj ect shall be asked t o t ake not e of t he t ast e for reference in t he fit t est . ( 13) Correct use of t he nebulizer m eans t hat approxim at ely 1 m l of liquid is used at a t im e in t he nebulizer body. ( 14) The nebulizer shall be t horoughly rinsed in wat er, shaken t o dry, and refilled at least each m orning and aft ernoon or at least every four hours. ( b) Bit rex Solut ion Aerosol Fit Test Procedure. ( 1) The t est subj ect m ay not eat , drink ( except plain wat er) , sm oke, or chew gum for 15 m inut es before t he t est . ( 2) The fit t est uses t he sam

e enclosure as t hat described in 4. ( a) above ( 3) The t est subj ect shall don t he enclosure while wearing t he respirat or select ed according t o sect ion I . A of t his appendix The respirat or shall be properly adj ust ed and equipped wit h any t ype part iculat e filt er( s) . ( 4) A second DeVilbiss Model 40 I nhalat ion Medicat ion Nebulizer or equivalent is used t o spray t he fit t est solut ion int o t he enclosure. This nebulizer shall be clearly m arked t o dist inguish it from t he screening t est solut ion nebulizer. ( 5) The fit t est solut ion is prepared by adding 337.5 m g of Bit rex t o 200 m l of a 5% salt ( NaCl) solut ion in warm wat er. ( 6) As before, t he t est subj ect shall breat he t hrough his or her slight ly open m ou t h wit h t ongue ext ended, and be inst ruct ed t o report if he/ she t ast es t he bit t er t ast e of Bit rex. ( 7) The nebulizer is insert ed int o t he hole in t he front of t he enclosure and an init ial concent rat ion of t he fit

t est solut ion is sprayed int o t he enclosure using t he sam e num ber of squeezes ( eit her 10, 20 or 30 squeezes) based on t he num ber of squeezes required t o elicit a t ast e response as not ed during t he screening t est . ( 8) Aft er generat ing t he aerosol, t he t est subj ect shall be inst ruct ed t o perform the exercises in sect ion I . A 14 of t his appendix ( 9) Every 30 seconds t he aerosol concent rat ion shall be replenished using one half t he num ber of squeezes used init ially ( e.g, 5, 10 or 15) ( 10) The t est subj ect shall indicat e t o t he t est conduct or if at any t im e during t he fit t est t he t ast e of Bit rex is det ect ed. I f t he t est subj ect does not report t ast ing t he Bit rex, t he t est is passed. ( 11) I f t he t ast e of Bit rex is det ect ed, t he fit is deem ed unsat isfact ory and t he t est is failed. A different respirat or shall be t ried and t he ent ire t est procedure is repeat ed ( t ast e t hreshold screening and fit t est

ing) . 104 Source: http://www.doksinet 5. I rrit ant Sm oke ( St annic Chloride) Prot ocol This qualit at ive fit t est uses a persons response t o t he irrit at ing chem icals released in t he "sm oke" produced by a st annic chloride vent ilat ion sm oke t ube t o det ect leakage int o t he respirat or. ( a) General Requirem ent s and Precaut ions ( 1) The respirat or t o be t est ed shall be equipped wit h high efficiency part iculat e air ( HEPA) or P100 series filt er( s) . ( 2) Only st annic chloride sm oke t ubes shall be used for t his prot ocol. ( 3) No form of t est enclosure or hood for t he t est subj ect shall be used. ( 4) The sm oke can be irrit at ing t o t he eyes, lungs, and nasal passages. The t est conduct or shall t ake precaut ions t o m inim ize t he t est subj ect s exposure t o irrit ant sm oke. Sensit ivit y varies, and cert ain individuals m ay respond t o a great er degree t o irrit ant sm oke. Care shall be t aken when perform ing t he sensit

ivit y screening checks t hat det erm ine whet her t he t est subj ect can det ect irrit ant sm oke t o use only t he m inim um am ount of sm oke necessary t o elicit a response from t he t est subj ect . ( 5) The fit t est shall be perform ed in an area wit h adequat e vent ilat ion t o prevent exposure of t he person conduct ing t he fit t est or t he build- up of irrit ant sm oke in t he general at m osphere. ( b) Sensit ivit y Screening Check The person t o be t est ed m ust dem onst rat e his or her abilit y t o det ect a weak concent rat ion of t he irrit ant sm oke. ( 1) The t est operat or sh all break bot h ends of a vent ilat ion sm oke t ube cont aining st annic chloride, and at t ach one end of t he sm oke t ube t o a low flow air pum p set t o deliver 200 m illilit ers per m inut e, or an aspirat or squeeze bulb. The t est operat or shall cover t he ot her end of t he sm oke t ube wit h a short piece of t ubing t o prevent pot ent ial inj ury from t he j agged end of t he

sm oke t ube. ( 2) The t est operat or shall advise t he t est subj ect t hat t he sm oke can be irrit at ing t o t he eyes, lungs, and nasal passages and inst ruct t he subj ect t o keep his/ her eyes closed while t he t est is perform ed. ( 3) The t est subj ect shall be allowed t o sm ell a weak concent rat ion of t he irrit ant sm oke before t he respirat or is donned t o becom e fam iliar wit h it s irrit at ing propert ies and t o det erm ine if he/ she can det ect t he irrit at ing propert ies of t he sm oke. The t est operat or shall carefully direct a sm all am ount of t he irrit ant sm oke in t he t est subj ect s direct ion t o det erm ine t hat he/ she can det ect it . ( c) I rrit ant Sm oke Fit Test Procedure ( 1) The person being fit t est ed shall don t he respirat or wit hout assist ance, and perform t he required user seal check( s) . ( 2) The t est subj ect shall be inst ruct ed t o keep his/ her eyes closed. ( 3) The t est operat or shall direct t he st ream of irrit

ant sm oke from t he sm oke t ube t oward t he faceseal area of t he t est subj ect , using t he low flow pum p or t he squeeze bulb. The t est operat or shall begin at least 12 inches from t he facepiece and m ove t he sm oke st ream around t he whole perim et er of t he m ask. The operat or shall gradually m ake t wo m ore passes around t he perim et er of t he m ask, m oving t o wit hin six inches of t he respirat or. ( 4) I f t he person being t est ed has not had an involunt ary response and/ or det ect ed t he irrit ant sm oke, proceed wit h t he t est exercises. ( 5) The exercises ident ified in sect ion I .A 14 of t his appendix shall be perform ed by t he 105 Source: http://www.doksinet t est subj ect while t he respirat or seal is being cont inually challenged by t he sm oke, direct ed around t he perim et er of t he respirat or at a dist ance of six inches. ( 6) I f t he person being fit t est ed report s det ect ing t he irrit ant sm oke at any t im e, t he t est is

failed. The person being ret est ed m ust repeat t he ent ire sensit ivit y check and fit t est procedure. ( 7) Each t est subj ect passing t he irrit ant sm oke t est wit hout evidence of a response ( involunt ary cough, irrit at ion) shall be given a second sensit ivit y screening check, wit h t he sm oke from t he sam e sm oke t ube used during t he fit t est , once t he respirat or has been rem oved, t o det erm ine whet her he/ she st ill react s t o t he sm oke. Failure t o evoke a response shall void t he fit t est . ( 8) I f a response is produced during t his second sensit ivit y check, t hen t he fit t est is passed. C. Quant it at ive Fit Test ( QN FT) Prot ocols The following quant it at ive fit t est ing procedures have been dem onst rat ed t o be accept able: Quant it at ive fit t est ing using a non -hazardous t est aerosol ( such as corn oil, polyet hylene glycol 400 [ PEG 400] , di- 2-et hyl hexyl sebacat e [ DEHS] , or sodium chloride) generat ed in a t est cham ber,

and em ploying inst rum ent at ion t o quant ify t he fit of t he respirat or; Quant it at ive fit t est ing using am bient aerosol as t he t est agent and appropriat e inst rum ent at ion ( condensat ion nuclei count er) t o quant ify t he respirat or fit ; Quant it at ive fit t est ing using cont rolled negat ive pressure and appropriat e inst rum ent at ion t o m easure t he volum et ric leak rat e of a facepiece t o quant ify t he respirat or fit . 1. General ( a) The em ployer shall ensure t hat persons adm inist ering QNFT are able t o calibrat e equipm ent and perform t est s properly, recognize invalid t est s, calculat e fit fact ors properly and ensure t hat t est equipm ent is in proper working order. ( b) The em ployer shall ensure t hat QNFT equipm ent is kept clean, and is m aint ained and calibrat ed according t o t he m anufact urers inst ruct ions so as t o operat e at t he param et ers for which it was designed. 2. Generat ed Aerosol Quant it at ive Fit Test ing Prot

ocol ( a) Apparat us. ( 1) I nst rum ent at ion. Aerosol generat ion, dilut ion, and m easurem ent syst em s using part iculat es ( corn oil, polyet hylene glycol 400 [ PEG 400] , di- 2- et hyl hexyl sebacat e [ DEHS] or sodium chloride) as t est aerosols shall be used for quant it at ive fit t est ing. ( 2) Test cham ber. The t est cham ber shall be large enough t o perm it all t est subj ect s t o perform freely all required exercises wit hout dist urbing t he t est agent concent rat ion or t he m easurem ent apparat us. The t est cham ber shall be equipped and const ruct ed so t hat t he t est agent is effect ively isolat ed from t he am bient air, yet uniform in concent rat ion t hroughout t he cham ber. ( 3) When t est ing air- purifying respirat ors, t he norm al filt er or cart ridge elem ent shall be replaced wit h a high efficiency part iculat e air ( HEPA) or P100 series filt er supplied by t he sam e m anufact urer. ( 4) The sam pling inst rum ent shall be select ed so t hat

a com put er record or st rip chart record m ay be m ade of t he t est showing t he rise and fall of t he t est agent concent rat ion wit h each inspirat ion and expirat ion at fit fact ors of at least 2,000. I nt egrat ors or com put ers t hat int egrat e t he am ount of t est agent penet rat ion leakage int o t he respirat or for each exercise m ay be used provided a record of t he readings is m ade. ( 5) The com binat ion of subst it ut e air- purifying elem ent s, t est agent and t est agent concent rat ion shall be such t hat t he t est subj ect is not exposed in excess of an est ablished 106 Source: http://www.doksinet exposure lim it for t he t est agent at any t im e during t he t est ing process, based upon t he lengt h of t he exposure and t he exposure lim it durat ion. ( 6) The sam pling port on t he t est specim en respirat or shall be placed and const ruct ed so t hat no leakage occurs around t he port ( e.g, where t he respirat or is probed) , a free air flow is

allowed int o t he sam pling line at all t im es, and t here is no int erference wit h t he fit or perform ance of t he respirat or. The in-m ask sam pling device ( probe) shall be designed and used so t hat t he air sam ple is drawn from t he breat hing zone of t he t est subj ect , m idway bet ween t he nose and m out h and wit h t he probe ext ending int o t he facepiece cavit y at least 1/ 4 inch. ( 7) The t est set up shall perm it t he person adm inist ering t he t est t o observe t he t est subj ect inside t he cham ber during t he t est . ( 8) The equipm ent generat ing t he t est at m osphere shall m aint ain t he concent rat ion of t est agent const ant t o wit hin a 10 percent variat ion for t he durat ion of t he t est . ( 9) The t im e lag ( int erval bet ween an event and t he recording of t he event on t he st rip chart or com put er or int egrat or) shall be kept t o a m inim um . There shall be a clear associat ion bet ween t he occurrence of an event and it s being

recorded. ( 10) The sam pling line t ubing for t he t est cham ber at m osphere and for t he respirat or sam pling port shall be of equal diam et er and of t he sam e m at erial. The lengt h of t he t wo lines shall be equal. ( 11) The exhaust flow from t he t est cham ber shall pass t hrough an appropriat e filt er ( i.e, high efficiency part iculat e filt er) before release. ( 12) When sodium chloride aerosol is used, t he relat ive hum idit y inside t he t est cham ber shall not exceed 50 percent . ( 13) The lim it at ions of inst rum ent det ect ion shall be t aken int o account when det erm ining t he fit fact or. ( 14) Test respirat ors shall be m aint ained in proper working order and be inspect ed regularly for deficiencies such as cracks or m issing valves and gasket s. ( b) Procedural Requirem ent s. ( 1) When perform ing t he init ial user seal check using a posit ive or negat ive pressure check, t he sam pling line shall be crim ped closed in order t o avoid air pressure

leakage during eit her of t hese pressure checks. ( 2) The use of an abbreviat ed screening QLFT t est is opt ional. Such a t est m ay be ut ilized in order t o quickly ident ify poor fit t ing respirat ors t hat passed t he posit ive and/ or negat ive pressure t est and reduce t he am ount of QNFT t im e. The use of t he CNC QNFT inst rum ent in t he count m ode is anot her opt ional m et hod t o obt ain a quick est im at e of fit and elim inat e poor fit t ing respirat ors before going on t o perform a full QNFT. ( 3) A reasonably st able t est agent concent rat ion shall be m easured in t he t est cham ber prior t o t est ing. For canopy or shower curt ain t ypes of t est unit s, t he det erm inat ion of t he t est agent s st abilit y m ay be est ablished aft er t he t est subj ect has ent ered t he t est environm ent . ( 4) I m m ediat ely aft er t he subj ect ent ers t he t est cham ber, t he t est agent concent rat ion inside t he respirat or shall be m easured t o ensure t hat t

he peak penet rat ion does not exceed 5 percent for a half m ask or 1 percent for a full facepiece respirat or. ( 5) A st able t est agent concent rat ion shall be obt ained prior t o t he act ual st art of t est ing. 107 Source: http://www.doksinet ( 6) Respirat or rest raining st raps shall not be over-t ight ened for t est ing. The st raps shall be adj ust ed by t he wearer wit hout assist ance from ot her persons t o give a reasonably com fort able fit t ypical of norm al use. The respirat or sh all not be adj ust ed once t he fit t est exercises begin. ( 7) The t est shall be t erm inat ed whenever any single peak penet rat ion exceeds 5 percent for half m asks and 1 percent for full facepiece respirat ors. The t est subj ect shall be refit t ed and ret est ed. ( 8) Calculat ion of fit fact ors. ( i) The fit fact or shall be det erm ined for t he quant it at ive fit t est by t aking t he rat io of t he average cham ber concent rat ion t o t he concent rat ion m easured inside

t he respirat or for each t est exercise except t he grim ace exercise. ( ii) The average t est cham ber concent rat ion shall be calculat ed as t he arit hm et ic average of t he concent rat ion m easured before and aft er each t est ( i.e, 7 exercises) or t he arit hm et ic average of t he concent rat ion m easured before and aft er each exercise or t he t rue average m easured cont inuously during t he respirat or sam ple. ( iii) The concent rat ion of t he challenge agent inside t he respirat or shall be det erm ined by one of t he following m et hods: ( A) Average peak penet rat ion m et hod m eans t he m et h od of det erm ining t est agent penet rat ion int o t he respirat or ut ilizing a st rip chart recorder, int egrat or, or com put er. The agent penet rat ion is det erm ined by an average of t he peak height s on t he graph or by com put er int egrat ion, for each exercise except t he grim ace exercise. I nt egrat ors or com put ers t hat calculat e t he act ual t est agent

penet rat ion int o t he respirat or for each exercise will also be considered t o m eet t he requirem ent s of t he average peak penet rat ion m et hod. ( B) Maxim um peak penet rat ion m et hod m eans t he m et hod of det erm ining t est agent penet rat ion in t he respirat or as det erm ined by st rip chart recordings of t he t est . The highest peak penet rat ion for a given exercise is t aken t o be represent at ive of average penet rat ion int o t he respirat or for t hat exercise. ( C) I nt egrat ion by calculat ion of t he area under t he individual peak for each exercise except t he grim ace exercise. This includes com put erized int egrat ion ( D) The calculat ion of t he overall fit fact or using individual exercise fit fact ors involves first convert ing t he exercise fit fact ors t o penet rat ion values, det erm ining t he average, and t hen convert ing t hat result back t o a fit fact or. This procedure is described in t he following equat ion: Where ff1 , ff 2 , ff3 ,

et c. are t he fit fact ors for exercises 1, 2, 3, et c ( 9) The t est subj ect shall not be perm it t ed t o wear a half m ask or quart er facepiece respirat or unless a m inim um fit fact or of 100 is obt ained, or a full facepiece respirat or unless a m inim um fit fact or of 500 is obt ained. ( 10) Filt ers used for quant it at ive fit t est ing shall be replaced whenever increased breat hing resist ance is encount ered, or when t he t est agent has alt ered t he int egrit y of t he filt er m edia. 108 Source: http://www.doksinet 3. Am bient aerosol condensat ion nuclei count er ( CNC) quant it at ive fit t est ing prot ocol The am bient aerosol condensat ion nuclei count er ( CNC) quant it at ive fit t est ing ( Port acount TM ) prot ocol quant it at ively fit t est s respirat ors wit h t he use of a probe. The probed respirat or is only used for quant it at ive fit t est s. A probed respirat or has a special sam pling device, inst alled on t he respirat or, t hat allows t he

probe t o sam ple t he air from inside t he m ask. A probed respirat or is required for each m ake, st yle, m odel, and size t hat t he em ployer uses and can be obt ained from t he respirat or m anufact urer or dist ribut or. The CNC inst rum ent m anufact urer, TSI I nc., also provides probe at t achm ent s ( TSI sam pling adapt ers) t hat perm it fit t est ing in an em ployees own respirat or. A m inim um fit fact or pass level of at least 100 is necessary for a half-m ask respirat or and a m inim um fit fact or pass level of at least 500 is required for a full facepiece negat ive pressure respirat or. The ent ire screening and t est ing procedure shall be explained t o t he t est subj ect prior t o t he conduct of t he screening t est . ( a) Port acount Fit Test Requirem ent s. ( 1) Check t he respirat or t o m ake sure t he sam pling probe and line are properly at t ached t o t he facepiece and t hat t he respirat or is fit t ed wit h a part iculat e filt er capable of prevent ing

significant penet rat ion by t he am bient part icles used for t he fit t est ( e.g, NI OSH 42 CFR 84 series 100, series 99, or series 95 part iculat e filt er) per m anufact urers inst ruct ion. ( 2) I nst ruct t he person t o be t est ed t o don t he respirat or for five m inut es before t he fit t est st art s. This purges t he am bient part icles t rapped inside t he respirat or and perm it s t he wearer t o m ake cert ain t he respirat or is com fort able. This individual shall already have been t rained on how t o wear t he respirat or properly. ( 3) Check t he following condit ions for t he adequacy of t he respirat or fit : Chin properly placed; Adequat e st rap t ension, not overly t ight ened; Fit across nose bridge; Respirat or of proper size t o span dist ance from nose t o chin; Tendency of t he respirat or t o slip; Self observat ion in a m irror t o evaluat e fit and respirat or posit ion. ( 4) Have t he person wearing t he respirat or do a user seal check. I f leakage

is det ect ed, det erm ine t he cause. I f leakage is from a poorly fit t ing facepiece, t ry anot her size of t he sam e m odel respirat or, or anot her m odel of respirat or. ( 5) Follow t he m anufact urers inst ruct ions for operat ing t he Port acount and proceed wit h t he t est . ( 6) The t est subj ect shall be inst ruct ed t o perform t he exercises in sect ion I . A 14 of t his appendix. ( 7) Aft er t he t est exercises, t he t est subj ect shall be quest ioned by t he t est conduct or regarding t he com fort of t he respirat or upon com plet ion of t he prot ocol. I f it has becom e unaccept able, anot her m odel of respirat or shall be t ried. ( b) Port acount Test I nst rum ent . ( 1) The Port acount will aut om at ically st op and calculat e t he overall fit fact or for t he ent ire set of exercises. The overall fit fact or is what count s The Pass or Fail m essage will indicat e whet her or not t he t est was successful. I f t he t est was a Pass, t he fit t est is over

( 2) Since t he pass or fail crit erion of t he Port acount is user program m able, t he t est operat or shall ensure t hat t he pass or fail crit erion m eet t he requirem ent s for m inim um respirat or perform ance in t his Appendix. ( 3) A record of t he t est needs t o be kept on file, assum ing t he fit t est was successful. The record m ust cont ain t he t est subj ect s nam e; overall fit fact or; m ake, m odel, st yle, and size of respirat or used; and dat e t est ed. 4. Cont rolled negat ive pressure ( CNP) quant it at ive fit t est ing prot ocol The CNP prot ocol provides an alt ernat ive t o aerosol fit t est m et hods. The CNP fit t est 109 Source: http://www.doksinet m et hod t echnology is based on exhaust ing air from a t em porarily sealed respirat or facepiece t o generat e and t hen m aint ain a const ant negat ive pressure inside t he facepiece. The rat e of air exhaust is cont rolled so t hat a const ant negat ive pressure is m aint ained in t he respirat or

during t he fit t est . The level of pressure is select ed t o replicat e t he m ean inspirat ory pressure t hat causes leakage int o t he respirat or under norm al use condit ions. Wit h pressure held const ant , air flow out of t he respirat or is equal t o air flow int o t he respirat or. Therefore, m easurem ent of t he exhaust st ream t hat is required t o hold t he pressure in t he t em porarily sealed respirat or const ant yields a direct m easure of leakage air flow int o t he respirat or. The CNP fit t est m et hod m easures leak rat es t hrough t he facepiece as a m et hod for det erm ining t he facepiece fit for negat ive pressure respirat ors. The CNP inst rum ent m anufact urer Occupat ional Healt h Dynam ics of Birm ingham , Alabam a also provides at t achm ent s ( sam pling m anifolds) t hat replace t he filt er cart ridges t o perm it fit t est ing in an em ployees own respirat or. To perform t he t est , t he t est subj ect closes his or her m out h and holds his/ her

breat h, aft er which an air pum p rem oves air from t he respirat or facepiece at a pre-select ed const ant pressure. The facepiece fit is expressed as t he leak rat e t hrough t he facepiece, expressed as m illilit ers per m inut e. The qualit y and validit y of t he CNP fit t est s are det erm ined by t he degree t o which t he in -m ask pressure t racks t he t est pressure during t he syst em m easurem ent t im e of approxim at ely five seconds. I nst ant aneous feedback in t he form of a real- t im e pressure t race of t he in-m ask pressure is provided and used t o det erm ine t est validit y and qualit y. A m inim um fit fact or pass level of 100 is necessary for a half- m ask respirat or and a m inim um fit fact or of at least 500 is required for a full facepiece respirat or. The ent ire screening and t est ing procedure shall be explained t o t he t est subj ect prior t o t he conduct of t he screening t est . ( a) CNP Fit Test Requirem ent s. ( 1) The inst rum ent shall have

a non- adj ust able t est pressure of 15.0 m m wat er pressure ( 2) The CNP syst em default s select ed for t est pressure shall be set at - - 15 m m of wat er ( 0.58 inches of wat er) and t he m odeled inspirat ory flow rat e shall be 538 lit ers per m inut e for perform ing fit t est s. ( N ot e: CNP syst em s have built- in capabilit y t o conduct fit t est ing t hat is specific t o unique work rat e, m ask, and gender sit uat ions t hat m ight apply in a specific workplace. Use of syst em default values, which were select ed t o represent respirat or wear wit h m edium cart ridge resist ance at a low- m oderat e work rat e, will allow int er-t est com parison of t he respirat or fit .) ( 3) The individual who conduct s t he CNP fit t est ing shall be t horoughly t rained t o perform t he t est . ( 4) The respirat or filt er or cart ridge needs t o be replaced wit h t he CNP t est m anifold. The inhalat ion valve downst ream from t he m anifold eit her needs t o be t em porarily rem

oved or propped open. ( 5) The em ployer m ust t rain t he t est subj ect t o hold his or her breat h for at least 10 seconds. ( 6) The t est subj ect m ust don t he t est respirat or wit hout any assist ance from t he t est adm inist rat or who is conduct ing t he CNP fit t est . The respirat or m ust not be adj ust ed once t he fit- t est exercises begin. Any adj ust m ent voids t he t est , and t he t est subj ect m ust repeat t he fit t est . ( 7) The QNFT prot ocol shall be followed according t o sect ion I . C 1 of t his appendix wit h an except ion for t he CNP t est exercises. ( b) CNP Test Exercises. ( 1) Norm al breat hing. I n a norm al st anding posit ion, wit hout t alking, t he subj ect shall breat he norm ally for 1 m inut e. Aft er t he norm al breat hing exercise, t he subj ect needs t o hold head st raight ahead and hold his or her breat h for 10 seconds during t he t est m easurem ent . 110 Source: http://www.doksinet ( 2) Deep breat hing. I n a norm al st anding

posit ion, t he subj ect shall breat he slowly and deeply for 1 m inut e, being careful not t o hypervent ilat e. Aft er t he deep breat hing exercise, t he subj ect shall hold his or her head st raight ahead and hold his or h er breat h for 10 seconds during t est m easurem ent . ( 3) Turning head side t o side. St anding in place, t he subj ect shall slowly t urn his or her head from side t o side bet ween t he ext rem e posit ions on each side for 1 m inut e. The head shall be held at each ext rem e m om ent arily so t he subj ect can inhale at each side. Aft er t he t urning head side t o side exercise, t he subj ect needs t o hold head full left and hold his or her breat h for 10 seconds during t est m easurem ent . Next , t he subj ect needs t o hold head full right and hold his or her breat h for 10 seconds during t est m easurem ent . ( 4) Moving head up and down. St anding in place, t he subj ect shall slowly m ove his or her head up and down for 1 m inut e. The subj ect shall

be inst ruct ed t o inhale in t he up posit ion ( i.e, when looking t oward t he ceiling) Aft er t he m oving head up and down exercise, t he subj ect shall hold his or her head full up and hold his or her breat h for 10 seconds during t est m easurem ent . Next , t he subj ect shall hold his or her head full down and hold his or her breat h for 10 seconds during t est m easurem ent . ( 5) Talking. The subj ect shall t alk out loud slowly and loud enough so as t o be heard clearly by t he t est conduct or. The subj ect can read from a prepared t ext such as t he Rainbow Passage, cou nt backward from 100, or recit e a m em orized poem or song for 1 m inut e. Aft er t he t alking exercise, t he subj ect shall hold his or her head st raight ahead and hold his or her breat h for 10 seconds during t he t est m easurem ent . ( 6) Grim ace. The t est subj ect shall grim ace by sm iling or frowning for 15 seconds ( 7) Bending Over. The t est subj ect shall bend at t he waist as if he or she

were t o t ouch his or her t oes for 1 m inut e. Jogging in place shall be subst it ut ed for t his exercise in t hose t est environm ent s such as shroud- t ype QNFT unit s t hat prohibit bending at t he waist . Aft er t he bending over exercise, t he subj ect shall hold his or her head st raight ahead and hold his or her breat h for 10 seconds during t he t est m easurem ent . ( 8) Norm al Breat hing. The t est subj ect shall rem ove and re-don t he respirat or wit hin a onem inut e period Then, in a norm al st anding posit ion, wit hout t alking, t he subj ect shall breat he norm ally for 1 m inut e. Aft er t he norm al breat hing exercise, t he subj ect shall hold his or her head st raight ahead and hold his or her breat h for 10 seconds during t he t est m easurem ent . Aft er t he t est exercises, t he t est subj ect shall be quest ioned by t he t est conduct or regarding t he com fort of t he respirat or upon com plet ion of t he prot ocol. I f it has becom e unaccept able, anot

her m odel of a respirat or shall be t ried. ( c) CNP Test I nst rum ent . ( 1) The t est inst rum ent m ust have an effect ive audio-warning device, or a visual- warning device in t he form of a screen t racing, t hat indicat es when t he t est subj ect fails t o hold his or her breat h during t he t est . The t est m ust be t erm inat ed and rest art ed from t he beginning when t he t est subj ect fails t o hold his or her breat h during t he t est . The t est subj ect t hen m ay be refit t ed and ret est ed. ( 2) A record of t he t est shall be kept on file, assum ing t he fit t est was successful. The record m ust cont ain t he t est subj ect s nam e; overall fit fact or; m ake, m odel, st yle and size of respirat or used; and dat e t est ed. 5. Cont rolled negat ive pressure ( CNP) REDON quant it at iv e fit t est ing prot ocol ( a) When adm inist ering t his prot ocol t o t est subj ect s, em ployers m ust com ply wit h t he requirem ent s specified in paragraphs ( a) and ( c) of

Part I .C4 of t his appendix ( "Cont rolled negat ive pressure ( CNP) quant it at ive fit t est ing prot ocol") , as well as use t he t est exercises described below in paragraph ( b) of t his prot ocol inst ead of t he t est exercises specified in paragraph ( b) of Part I .C4 of t his appendix 111 Source: http://www.doksinet ( b) Em ployers m ust ensure t hat each t est subj ect being fit t est ed using t his prot ocol follows t he exercise and m easurem ent procedures, including t he order of adm inist rat ion, described below in Table A- 1 of t his appendix. Ta ble A-1 . - - CN P REDON Quant it at ive Fit Test ing Prot ocol Exercises ( 1) Exercise procedure Measurem ent procedure Facing Forward St and and breat he norm ally, wit hout t alking, for 30 seconds. Face forward, while holding breat h for 10 seconds. Bending Over Bend at t he waist , as if going t o t ouch his or her t oes, for 30 seconds. Face parallel t o t he floor, while holding breat h for 10

seconds Head Shaking For about t hree seconds, shake head back and fort h vigorously several t im es while shout ing. Face forward, while holding breat h for 10 seconds. REDON 1 Rem ove t he respirat or m ask, loosen all facepiece st raps, and t hen redon t he respirat or m ask. Face forward, while holding breat h for 10 seconds. REDON 2 Rem ove t he respirat or m ask, loosen all facepiece st raps, and t hen redon t he respirat or m ask again. Face forward, while holding breat h for 10 seconds. 1 Exercises are list ed in t he order in which t hey are t o be adm inist ered. ( c) Aft er com plet ing t he t est exercises, t he t est adm inist rat or m ust quest ion each t est subj ect regarding t he com fort of t he respirat or. When a t est subj ect st at es t hat t he respirat or is unaccept able, t he em ployer m ust ensure t hat t he t est adm inist rat or repeat s t he prot ocol using anot her respirat or m odel. ( d) Em ployers m ust det erm ine t he overall fit fact or

for each t est subj ect by calculat ing t he harm onic m ean of t he fit t est ing exercises as follows: Where: N = The num ber of exercises; FF1 = The fit fact or for t he first exercise; FF2 = The fit fact or for t he second exercise; and FFN = The fit fact or for t he nt h exercise. Pa rt I I . N ew Fit Test Prot ocols A. Any person m ay subm it t o OSHA an applicat ion for approval of a new fit t est prot ocol I f t he applicat ion m eet s t he following crit eria, OSHA will init iat e a rulem aking proceeding under sect ion 6( b) ( 7) of t he OSH Act t o det erm ine whet her t o list t he new prot ocol as an approved prot ocol in t his Appendix A. B. The applicat ion m ust include a det ailed descript ion of t he proposed new fit t est prot ocol This applicat ion m ust be support ed by eit her: 1. A t est report prepared by an independent governm ent research laborat ory ( eg, Lawrence Liverm ore Nat ional Laborat ory, Los Alam os Nat ional Laborat ory, t he Nat ional I nst it

ut e for St andards and Technology) st at ing t hat t he laborat ory has t est ed t he prot ocol and had found it t o be accurat e and reliable; or 2. An art icle t hat has been published in a peer- reviewed indust rial hygiene j ournal describing t he prot ocol and explaining how t est dat a support t he prot ocols accuracy and 112 Source: http://www.doksinet reliabilit y. C. I f OSHA det erm ines t hat addit ional inform at ion is required before t he Agency com m ences a rulem aking proceeding under t his sect ion, OSHA will so not ify t he applicant and afford t he applicant t he opport unit y t o subm it t he supplem ent al inform at ion. I nit iat ion of a rulem aking proceeding will be deferred unt il OSHA has received and evaluat ed t he supplem ent al inform at ion. [ 63 FR 20098, April 23, 199 8; 69 FR 46993, August 4, 2004 Appendix B- 1 t o § 1 9 1 0 .1 3 4 : User Seal Check Procedures ( M andat ory) The individual who uses a t ight- fit t ing respirat or is t o perform

a user seal check t o ensure t hat an adequat e seal is achieved each t im e t he respirat or is put on. Eit her t he posit ive and negat ive pressure checks list ed in t his appendix, or t he respirat or m anufact urers recom m ended user seal check m et hod shall be used. User seal checks are not subst it ut es for qualit at ive or quant it at ive fit t est s. I . Facepiece Posit ive and/ or Negat ive Pressure Checks A. Posit ive pressure check Close off t he exhalat ion valve and exhale gent ly int o t he facepiece. The face fit is considered sat isfact ory if a slight posit ive pressure can be built up inside t he facepiece wit hout any evidence of out ward leakage of air at t he seal. For m ost respirat ors t his m et hod of leak t est ing requires t he wearer t o first rem ove t he exhalat ion valve cover before closing off t he exhalat ion valve and t hen carefully replacing it aft er t he t est . B. Negat ive pressure check Close off t he inlet opening of t he canist er or cart

ridge( s) by covering wit h t he palm of t he hand( s) or by replacing t he filt er seal( s) , inhale gent ly so t hat t he facepiece collapses slight ly, and hold t he breat h for t en seconds. Th e design of t he inlet opening of som e cart ridges cannot be effect ively covered wit h t he palm of t he hand. The t est can be perform ed by covering t he inlet opening of t he cart ridge wit h a t hin lat ex or nit rile glove. I f t he facepiece rem ains in it s slight ly collapsed condit ion and no inward leakage of air is det ect ed, t he t ight ness of t he respirat or is considered sat isfact ory. I I . Manufact urers Recom m ended User Seal Check Procedures The respirat or m anufact urers recom m ended procedures for perform ing a user seal check m ay be used inst ead of t he posit ive and/ or negat ive pressure check procedures provided t hat t he em ployer dem onst rat es t hat t he m anufact urers procedures are equally effect ive. [ 63 FR 1152, Jan. 8, 1998 Appendix C t o Sec. 1

9 1 0 1 3 4 : OSHA Respirat or M edical Evaluat ion Quest ionnaire ( M a nda t or y) To t he em ployer: Answers t o quest ions in Sect ion 1, and t o quest ion 9 in Sect ion 2 of Part A, do not require a m edical exam inat ion. To t he em ployee: Can you read ( circle one) : Yes/ No Your em ployer m ust allow you t o answer t his quest ionnaire during norm al working hours, or at a t im e and place t hat is convenient t o you. To m aint ain your confident ialit y, your em ployer or supervisor m ust not look at or review your answers, and your em ployer m ust 113 Source: http://www.doksinet t ell you how t o d eliver or send t his quest ionnaire t o t he healt h care professional who will review it . Part A. Sect ion 1 ( Mandat ory) The following inform at ion m ust be provided by every em ployee who has been select ed t o use any t ype of respirat or ( please print ) . 1. Todays dat e: 2. Your nam e:

3. Your age ( t o nearest year) : 4. Sex ( circle one) : Male/ Fem ale 5. Your height : ft in 6. Your weight : lbs 7. Your j ob t it le: 8. A phone num ber where you can be reached by t he healt h care professional who reviews t his quest ionnaire ( include t he Area Code) : 9. The best t im e t o phone you at t his num ber: 10. Has your em ployer t old you how t o cont act t he healt h care professional who will review t his quest ionnaire ( circle one) : Yes/ No 11. Check t he t ype of respirat or you will use ( you can check m ore t han one cat egory) : a. N, R, or P disposable respirat or ( filt er-m ask, non- cart ridge t ype only) b. Ot her t ype ( for exam ple, half- or full- facepiece t ype, powered - air purifying, supplied - air, self- cont ained breat hing

apparat us) . 12. Have you worn a respirat or ( circle one) : Yes/ No I f "yes," what t ype( s) : Part A. Sect ion 2 ( Mandat ory) Quest ions 1 t hrough 9 below m ust be answered by every em ployee who has been select ed t o use any t ype of respirat or ( please circle "yes" or "no") . 1. Do you cur r e nt ly sm oke t obacco, or have you sm oked t obacco in t he last m ont h: Yes/ No 2. Have you ever ha d any of t he following condit ions? a. b. c. d. e. Seizures ( fit s) : Yes/ No Diabet es ( sugar disease) : Yes/ No Allergic react ions t hat int erfere wit h your breat hing: Yes/ No Claust rophobia ( fear of closed- in places) : Yes/ No Trouble sm elling odors: Yes/ No 3. Have you ever ha d any of t he following pulm onary or lung problem s? a. Asbest osis: Yes/ No b . Ast hm a: Yes/ No 114 Source: http://www.doksinet c. d. e. f. g.

h. i. j. k. l. Chronic bronchit is: Yes/ No Em physem a: Yes/ No Pneum onia: Yes/ No Tuberculosis: Yes/ No Silicosis: Yes/ No Pneum ot horax ( collapsed lung) : Yes/ No Lung cancer: Yes/ No Broken ribs: Yes/ No Any chest inj uries or surgeries: Yes/ No Any ot her lung problem t hat youve been t old about : Yes/ No 4. Do you cur r e nt ly have any of t he following sym pt om s of pulm onary or lung illness? a. Short ness of breat h: Yes/ No b . Short ness of breat h when walking fast on level ground or walking up a slight hill or incline: Yes/ No c. Short ness of breat h when walking wit h ot her people at an ordinary pace on level ground: Yes/ No d . Have t o st op for breat h when walking at your own pace on level ground: Yes/ No e. Short ness of breat h when washing or dressing yourself: Yes/ No f. Short ness of breat h t hat int erferes wit h your j ob: Yes/ No g . Coughing t hat produces phlegm ( t hick sput um ) : Yes/ No h. Coughing t hat wakes you early in t he m orning: Yes/

No i. Coughing t hat occurs m ost ly when you are lying down: Yes/ No j . Coughing up blood in t he last m ont h: Yes/ No k. Wheezing: Yes/ No l. Wheezing t hat int erferes wit h your j ob: Yes/ No m . Chest pain when you breat he deeply: Yes/ No n. Any ot her sym pt om s t hat you t hink m ay be relat ed t o lung problem s: Yes/ No 5. Have you ever ha d any of t he following cardiovascular or heart problem s? a. b. c. d. e. f. g. h. Heart at t ack: Yes/ No St roke: Yes/ No Angina: Yes/ No Heart failure: Yes/ No Swelling in your legs or feet ( not caused by walking) : Yes/ No Heart arrhyt hm ia ( heart beat ing irregularly) : Yes/ No High blood pressure: Yes/ No Any ot her heart problem t hat youve been t old about : Yes/ No 6. Have you ever ha d any of t he following cardiovascular or heart sym pt om s? a. b. c. d. Frequent pain or t ight ness in your chest : Yes/ No Pain or t ight ness in your chest during physical act ivit y: Yes/ No Pain or t ight ness in your chest t hat int

erferes wit h your j ob: Yes/ No I n t he past t wo years, have you not iced your heart skipping or m issing a beat : Yes/ No e. Heart burn or indigest ion t hat is not relat ed t o eat ing: Yes/ No f. Any ot her sym pt om s t hat you t hink m ay be relat ed t o heart or circulat ion problem s: Yes/ No 7. Do you cur r e nt ly t ake m edicat ion for any of t he following problem s? a. Breat hing or lung problem s: Yes/ No b . Heart t rouble: Yes/ No c. Blood pressure: Yes/ No 115 Source: http://www.doksinet d . Seizures ( fit s) : Yes/ No 8. I f youve used a respirat or, have you ever ha d any of t he following problem s? ( I f youve never used a respirat or, check t he following space and go t o quest ion 9: ) a. b. c. d. e. Eye irrit at ion: Yes/ No Skin allergies or rashes: Yes/ No Anxiet y: Yes/ No General weakness or fat igue: Yes/ No Any ot her problem t hat int erferes wit h your use of a respirat or: Yes/ No 9. Would you like t o t alk t o t he healt h care professional

who will review t his quest ionnaire about your answers t o t his quest ionnaire: Yes/ No Quest ions 10 t o 15 below m ust be answered by every em ployee who has been select ed t o use eit her a full- facepiece respirat or or a self- cont ained breat hing apparat us ( SCBA) . For em ployees who have been select ed t o use ot her t ypes of respirat ors, answering t hese quest ions is volunt ary. 10. Have you ever lost vision in eit her eye ( t em porarily or perm anent ly) : Yes/ No 11. Do you cur r e nt ly have any of t he following vision problem s? a. b. c. d. Wear cont act lenses: Yes/ No Wear glasses: Yes/ No Color blind: Yes/ No Any ot her eye or vision problem : Yes/ No 12. Have you ever ha d an inj ury t o your ears, including a broken ear drum : Yes/ No 13. Do you cur r e nt ly have any of t he following hearing problem s? a. Difficult y hearing: Yes/ No b . Wear a hearing aid: Yes/ No c. Any ot her hearing or ear problem : Yes/ No 14. Have you ever ha d a back inj ury: Yes/

No 15. Do you cur r e nt ly have any of t he following m usculoskelet al problem s? a. b. c. d. e. f. g. h. i. j. Weakness in any of your arm s, hands, legs, or feet : Yes/ No Back pain: Yes/ No Difficult y fully m oving your arm s and legs: Yes/ No Pain or st iffness when you lean forward or backward at t he waist : Yes/ No Difficult y fully m oving your head up or down: Yes/ No Difficult y fully m oving your head side t o side: Yes/ No Difficult y bending at your knees: Yes/ No Difficult y squat t ing t o t he ground: Yes/ No Clim bing a flight of st airs or a ladder carrying m ore t han 25 lbs: Yes/ No Any ot her m uscle or skelet al problem t hat int erferes wit h using a respirat or: Yes/ No Part B Any of t he following quest ions, and ot her quest ions not list ed, m ay be added t o t he quest ionnaire at t he discret ion of t he healt h care professional who will review t he quest ionnaire. 116 Source: http://www.doksinet 1. I n your present j ob, are you working at high

alt it udes ( over 5,000 feet ) or in a place t hat has lower t han norm al am ount s of oxygen: Yes/ No I f " y es," do you have feelings of dizziness, short ness of breat h, pounding in your chest , or ot her sym pt om s when youre working under t hese condit ions: Yes/ No 2. At work or at hom e, have you ever been exposed t o hazardous solvent s, hazardous airborne chem icals ( e.g, gases, fum es, or dust ) , or have you com e int o skin cont act wit h hazardous chem icals: Yes/ No I f "yes," nam e t he chem icals if you know t hem : 3. Have you ever worked wit h any of t he m at erials, or under any of t he condit ions, list ed below: a. b. c. d. e. f. g. h. i. j. Asbest os: Yes/ No Silica ( e .g, in sandblast ing) : Yes/ No Tungst en/ cobalt ( e.g, grinding or welding t his m at erial) : Yes/

No Beryllium : Yes/ No Alum inum : Yes/ No Coal ( for exam ple, m ining) : Yes/ No I ron: Yes/ No Tin: Yes/ No Dust y environm ent s: Yes/ No Any ot her hazardous exposures: Yes/ No I f "yes," describe t hese exposures: 4. List any second j obs or side businesses you have: 5. List your previous occupat ions: 6. List your current and previous hobbies: 7. Have you been in t he m ilit ary services? Yes/ No I f "yes," were you exposed t o biological or chem ical agent s ( eit her in t

raining or com bat ) : Yes/ No 8. Have you ever worked on a HAZMAT t eam ? Yes/ No 9. Ot her t han m edicat ions for breat hing and lung problem s, heart t rouble, blood pressure, and seizures m ent ioned earlier in t his quest ionnaire, are you t aking any ot her m edicat ions for any reason ( including over- t he-count er m edicat ions) : Yes/ No I f "yes," nam e t he m edicat ions if you know t hem : 10. Will you be using any of t he following it em s wit h your respirat or( s) ? 117 Source: http://www.doksinet a. HEPA Filt ers: Yes/ No b . Canist ers ( for exam ple, gas m asks) : Yes/ No c. Cart ridges: Yes/ No 11. How oft en are you expect ed t o use t he respirat or( s) ( circle "yes" or "no" for all answers t hat apply t o you) ?: a. b. c. d. e. f. Escape only ( no rescue) : Yes/ No Em ergency rescue only: Yes/ No Less t han 5 hours per w eek: Yes/ No Less t han 2 hours per day: Yes/ No 2 t o 4 hours per day: Yes/ No

Over 4 hours per day: Yes/ No 12. During t he period you are using t he respirat or( s) , is your work effort : a. Light ( less t han 200 kcal per hour) : Yes/ No I f "yes," how long does t his period last during t he average shift : hrs. m ins Exam ples of a light work effort are sit t ing while writ ing, t yping, draft ing, or perform ing light assem bly work; or st anding while operat ing a drill press ( 1 -3 lbs.) or cont rolling m achines. b . M ode r a t e ( 200 t o 350 kcal per hour) : Yes/ No I f " yes," how long does this period last during t he average shift : hrs. m ins Exam ples of m oderat e work effort are sit t ing while nailing or filing; driving a t ruck or bus in urban t raffic; st a nding while drilling, nailing, perform ing assem bly work, or t ransferring a m oderat e load ( about 35 lbs.) at t runk level; w a lk ing on a level surface about 2 m ph or down a 5-degree grade about 3 m ph; or pushing a

wheelbarrow wit h a heavy load ( about 100 lbs.) on a level surface c. H ea vy ( above 350 kcal per hour) : Yes/ No I f " y es," how long does t his period last during t he average shift : hrs. m ins Exam ples of heavy work are lift ing a heavy load ( about 50 lbs.) from t he floor t o your waist or shoulder; working on a loading dock; shoveling; st anding while bricklaying or chipping cast ings; w a lk ing up an 8- degree grade about 2 m ph; clim bing st airs wit h a heavy load ( about 50 lbs.) 13. Will you be wearing prot ect ive clot hing and/ or equipm ent ( ot her t han t he respirat or) when youre using your respirat or: Yes/ No I f "yes," describe t his prot ect ive clot hing and/ or equipm ent : 14. Will you be working under hot condit ions ( t em perat ure exceeding 77 deg F) : Yes/ No 15. Will you be working u nder hum id condit ions: Yes/ No 118

Source: http://www.doksinet 16. Describe t he work youll be doing while youre using your respirat or( s) : 17. Describe any special or hazardous condit ions you m ight encount er when youre using your respirat or( s) ( for exam ple, confined spaces, life- t hreat ening gases) : 18. Provide t he following inform at ion, if you know it , for each t oxic subst ance t hat youll be exposed t o when youre using your respirat or( s) : Nam e of t he first t oxic subst ance: Est im at ed m axim um exposure level per shift : Durat ion of exposure per shift : Nam e of t he second t oxic

subst ance: Est im at ed m axim um exposure level per shift : Durat ion of exposure per shift : Nam e of t he t hird t oxic subst ance: Est im at ed m axim um exposure level per shift : Durat ion of exposure per shift : The nam e of any ot her t oxic subst ances t hat youll be exposed t o while using your respirat or: 19. Describe any special responsibilit ies youll have while using your respirat or( s) t hat m ay affect t he safet y and well- being of ot hers ( for exam ple, rescue, securit y) :

[ 63 FR 1152, Jan. 8, 1998; 63 FR 20098, April 23, 1998 Appendix B- 2 t o § 1 9 1 0 .1 3 4 : Respirat or Cleaning Procedures ( M andat ory) These procedures are provided for em ployer use when cleaning respirat ors. They are general in nat ure, and t he em ployer as an alt ernat ive m ay use t he cleaning recom m endat ions provided by t he m anufact urer of t he respirat ors used by t heir em ployees, provided such procedures are as effect ive as t hose list ed here in Appendix B- 2. Equivalent effect iveness sim ply m eans t hat t he procedures used m ust accom plish t he obj ect ives set fort h in Appendix B- 2, i.e, m ust ensure t hat t he respirat or is properly cleaned and disinfect ed in a m anner t hat prevent s dam age t o t he respirat or and does not cause harm t o t he user. I . Procedures for Cleaning Respirat ors A. Rem ove filt ers, cart ridges, or canist ers Disassem ble facepieces by rem oving speaking diaphragm s, dem and and

pressure- dem and valve assem blies, hoses, or any com ponent s recom m ended by t he m anufact urer. Discard or repair any defect ive part s B. Wash com ponent s in warm ( 43 deg C [ 110 deg F] m axim um ) wat er wit h a m ild det ergent or wit h a cleaner recom m ended by t he m anufact urer. A st iff brist le ( not wire) brush m ay be used t o facilit at e t he rem oval of dirt . C. Rinse com ponent s t horoughly in clean, warm ( 43 deg C [ 110 deg F] m axim um ) , preferably running wat er. Drain 119 Source: http://www.doksinet D. When t he cleaner used does not cont ain a disinfect ing agent , respirat or com ponent s should be im m ersed for t wo m inut es in one of t he following: 1. Hypochlorit e solut ion ( 50 ppm of chlorine) m ade by adding approxim at ely one m illilit er of laundry bleach t o one lit er of wat er at 43 deg. C ( 110 deg F) ; or, 2. Aqueous solut ion of iodine ( 50 ppm iodine) m ade by adding approxim at ely 08 m illilit ers of t inct ure of iodine ( 6

-8 gram s am m onium and/ or pot assium iodide/ 100 cc of 45% alcohol) t o one lit er of wat er at 43 deg. C ( 110 deg F) ; or, 3. Ot her com m ercially available cleansers of equivalent disinfect ant qualit y when used as direct ed, if t heir use is recom m ended or approved by t he respirat or m anufact urer. E. Rinse com ponent s t horoughly in clean, warm ( 43 deg C [ 110 deg F] m axim um ) , preferably running wat er. Drain The im port ance of t horough rinsing cannot be overem phasized. Det ergent s or disinfect ant s t hat dry on facepieces m ay result in derm at it is I n addit ion, som e disinfect ant s m ay cause det eriorat ion of rubber or corrosion of m et al part s if not com plet ely rem oved. F. Com ponent s should be hand -dried wit h a clean lint -free clot h or air-dried G. Reassem ble facepiece, replacing filt ers, cart ridges, and canist ers where necessary H. Test t he respirat or t o ensure t hat all com ponen t s work properly [ 63 FR 1152, Jan. 8, 1998]

Appendix D t o Sec. 1 9 1 0 1 3 4 ( M a nda t ory) I nform a t ion for Em ployees Using Respira t ors W hen N ot Required Under t he St a nda rd Respirat ors are an effect ive m et hod of prot ect ion against designat ed hazards when properly select ed and worn. Respirat or use is encouraged, even when exposures are below t he exposure lim it , t o provide an addit ional level of com fort and prot ect ion for workers. However, if a respirat or is used im properly or not kept clean, t he respirat or it self can becom e a hazard t o t he worker. Som et im es, workers m ay wear respirat ors t o avoid exposures t o hazards, even if t he am ount of hazardous subst ance does not exceed t he lim it s set by OSHA st andards. I f your em ployer provides respirat ors for your volunt ary use, or if you provide your own respirat or, you need t o t ake cert ain precaut ions t o be sure t hat t he respirat or it self does not present a hazard. You should do t he following: 1. Read and heed all inst

ruct ions provided by t he m anufact urer on use, m aint enance, cleaning and care, and warnings regarding t he respirat ors lim it at ions. 2. Choose respirat ors cert ified for use t o prot ect against t he cont am inant of concern NI OSH, t he Nat ional I nst it ut e for Occupat ional Safet y and Healt h of t he U.S Depart m ent of Healt h and Hum an Services, cert ifies respirat ors. A label or st at em ent of cert ificat ion should appear on t he respirat or or respirat or packaging. I t will t ell you what t he respirat or is designed for and how m uch it will prot ect you. 3. Do not wear your respirat or int o at m ospheres cont aining cont am inant s for which your respirat or is not designed t o prot ect against . For exam ple, a respirat or designed t o filt er dust part icles will not prot ect you against gases, vapors, or very sm all solid part icles of fum es or sm oke. 120 Source: http://www.doksinet 4. Keep t rack of your respirat or so t hat you do not m ist akenly

use som eone elses respirat or. [ 63 FR 1152, Jan. 8, 1998; 63 FR 20098, April 23, 1998 121 Source: http://www.doksinet SECTION 11 APPENDICES 122 Source: http://www.doksinet Appendix A Respiratory Protection Guidance on Specific Airborne Infectious Agents 1. Guidance for Protecting Workers Against Avian Flu, US Department of Labor, Occupational Safety and Health, 2006. [http://wwwoshagov/dsg/guidance/avianfluhtml] 2. Understanding Respiratory Protection Against SARS, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, 2005. [http://www.cdcgov/niosh/npptl/topics/respirators/factsheets/respsarshtml] 3. Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health Care Settings, 2005. Centers for Disease Control and Prevention Selected sections: Introduction - pages 1-3, Respiratory Protection – pages 38-41, Nontraditional Facility-Based Settings, Emergency Medical Services – pages 25-26.

[http://www.cdcgov/mmwr/PDF/rr/rr5417pdf] For the most up-to-date information on respiratory protection guidance for specific infectious agents, consult the OSHA, CDC and NIOSH websites frequently: www.oshagov www.cdcgov www.cdcgov/niosh 123 Source: http://www.doksinet Appendix B PEOSH Respirator Medical Evaluation Questionnaire 124 Source: http://www.doksinet Mandatory Respirator Medical Evaluation Questionnaire OSHA/PEOSH Respiratory Protection Standard Can you read? 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. The following information must be provided by every employee who has been selected to use any type of respirator (please print). Part A.

Section 1 1. Todays date: 2. Your name: 3. Your age (to nearest year): 4. Sex (circle one): Male / Female 5. Your height: ft. in 6. Your weight: lbs. 7. Your job title: 8. Phone number(s): 9. The best time to phone: 10. Has your employer told you how to contact the health care professional who will review this questionnaire (circle one): Yes/No 11. Check the type of respirator you will use (you can check more than one category): a. N, R, or P disposable respirator (filter-mask, non- cartridge type only) b. Other type (for example, half- or full-facepiece type, powered-air purifying, supplied-air, self-contained breathing apparatus). 12. Have you worn a respirator (circle one): If "yes," what type(s): Yes No 125

Source: http://www.doksinet Part A. Section 2 ---- Please check "yes" or "no" YES NO 1. Do you currently smoke tobacco, or have you smoked tobacco in the last month: 2. Have you ever had any of the following conditions? Check YES or NO for each. a. Seizures (fits): b. Diabetes (sugar disease): c. Allergic reactions that interfere with breathing: d. Claustrophobia (fear of closed-in places): e. Trouble smelling odors: 3. Have you ever had any of the following pulmonary or lung problems? a. Asbestosis: b. Asthma: c. Chronic bronchitis: d. Emphysema: e. Pneumonia: f. Tuberculosis: g. Silicosis: h. Pneumothorax (collapsed lung): i. Lung cancer: j. Broken ribs: k. Any chest injuries or surgeries: l. Any other lung problem that youve been told about: 4. Do you currently have any of the following symptoms of pulmonary or lung illness? a. Shortness of breath: b. Shortness of breath when walking fast on level ground or walking up a slight hill or incline: 126 Source:

http://www.doksinet Part A. Section 2 (continued) YES NO c. Shortness of breath when walking with people at an ordinary pace on level ground d. Shortness of breath when washing and dressing yourself e. Shortness of breath that interferes with your job f. Coughing that produces phlegm (thick sputum) g. Coughing that wakes you early in the morning h. Coughing that mostly occurs when you are lying down i. Coughing up blood in the last month j. Wheezing k. Wheezing that interferes with your job l. Chest pain when you breathe deeply m. Any other symptoms that you think may be related to lung problems: 5. Have you ever had any of the following cardiovascular or heart problems? a. Heart attack b. Stroke c. Angina d. Heart failure e. Swelling in your legs or feet (not caused by walking) f. Heart arrhythmia g. High blood pressure h. Any other heart problems you’ve been told about 127 Source: http://www.doksinet YES NO 6. Have you ever had any of the following cardiovascular or heart

symptoms? a. Frequent pain or tightness in your chest: b. Pain or tightness in your chest during physical activity: c. Pain or tightness in your chest that interferes with your job: d. In the past two years, have you noticed your heart skipping or missing a beat: e. Heartburn or indigestion that is not related to eating: f. Any other symptoms that you think may be related to heart or circulation problems: 7. Do you currently take medication for any of the following problems? a. Breathing or lung problems: b. Heart trouble: c. Blood pressure: d. Seizures (fits): 8. Have you ever used a respirator? If NO, go to question 9. If YES, have you ever had any of the following problems? a. Eye irritation b. Skin allergies or rashes: c. Anxiety: d. General weakness or fatigue: e. Any other problem that interferes with your use of a respirator: 9. Would you like to talk to the health care professional who will review this questionnaire about your answers to this questionnaire? 128 Source:

http://www.doksinet Questions 10 to 15 below must be answered by every employee who has been selected to use either a full-facepiece respirator or a self-contained breathing apparatus (SCBA). For employees who have been selected to use other types of respirators, answering these questions is voluntary. YES NO 10. Have you ever lost vision in either eye (temporarily or permanently): 11. Do you currently have any of the following vision problems? a. Wear contact lenses: b. Wear glasses: c. Color blind: d. Any other eye or vision problem: 12. Have you ever had an injury to your ears, including a broken ear drum? 13. Do you currently have any of the following hearing problems? a. Difficulty hearing: b. Wear a hearing aid: c. Any other hearing or ear problem: 14. Have you ever had a back injury: Yes/No 15. Do you currently have any of the following musculoskeletal problems? a. Weakness in arms, hands, legs or feet b. Back pain: c. Difficulty fully moving your arms and legs: d.

Pain/stiffness when leaning forward or backward e. Difficulty fully moving your head up or down: f. Difficulty fully moving your head side to side: g. Difficulty bending at your knees: h. Difficulty squatting to the ground: i. Climbing a flight of stairs or a ladder carrying more than 25 lbs: j. Any other muscle or skeletal problem that interferes with using a respirator: 129 Source: http://www.doksinet Non-mandatory Section OSHA/PEOSH Respiratory Medical Evaluation Questionnaire 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 may review the questionnaire. YES NO 1. In your present job, are you working at high altitudes (over 5,000 feet) or in a place that has lower than normal amounts of oxygen? If "yes," do you have feelings of dizziness, shortness of breath, pounding in your chest, or other symptoms when youre working under these conditions? 2. At work or at home,

have you ever been exposed to hazardous solvents, hazardous airborne chemicals (e.g, gases, fumes, or dust), or have you come into skin contact with hazardous chemicals: Yes/No If "yes," name the chemicals if you know them: 3. Have you ever worked with any of the materials, or under any of the conditions, listed below: a. Asbestos: b. Silica (eg, in sandblasting): c. Tungsten/cobalt (eg, grinding or welding this material): d. Beryllium: e. Aluminum: f. Coal (for example, mining): g. Iron: h. Tin: i. Dusty environments: j. Any other hazardous exposures? If yes, describe these exposures: 130 Source: http://www.doksinet YES NO 4. Do you have any second jobs or side businesses? If YES, please list: 5. Have you had previous occupations? If YES, please list:

6. Do you currently have hobbies? Have you previously had hobbies? If YES, please list: 7. Have you been in the military services? If "YES," were you exposed to biological or chemical agents (either in training or combat)? 8. Have you ever worked on a HAZMAT team? 9. Other than medications for breathing and lung problems, heart trouble, blood pressure, and seizures mentioned earlier in this questionnaire, are you taking any other medications for any reason (including overthe-counter medications): If "yes," name the medications if you know them 131 Source: http://www.doksinet YES NO 10. Will you be using any of the following items with your respirator(s)? a. HEPA Filters: b. Canisters (for example, gas masks): c.

Cartridges: 11. How often are you expected to use the respirator(s) (circle "yes" or "no" for all answers that apply to you)?: a. Escape only (no rescue): b. Emergency rescue only: c. Less than 5 hours per week: d. Less than 2 hours per day: e. 2 to 4 hours per day: f. Over 4 hours per day: 12. During the period you are using the respirator(s), is your work effort: a. Light (less than 200 kcal per hour): (Examples of a light work effort are sitting while writing, typing, drafting, or performing light assembly work; or standing while operating a drill press (1-3 lbs.)) If "yes," how long does this period last during the average shift? hrs. mins b. Moderate (200 to 350 kcal per hour): (Examples of moderate work effort are sitting while nailing or filing; driving a truck or bus in urban traffic; standing while drilling, nailing, performing assembly work, or transferring a moderate load (about 35 lbs.) at trunk level; walking on a

level surface about 2 mph or down a 5-degree grade about 3 mph; or pushing a wheelbarrow with a heavy load. If "yes," how long does this period last during the average shift? hrs. mins c. Heavy (above 350 kcal per hour): (Examples of heavy work are lifting a heavy load (about 50 lbs.) from the floor to your waist or shoulder; working on a loading dock; shoveling; standing while bricklaying or chipping castings; walking up an 8-degree grade about 2 mph; climbing stairs with a heavy load (about 50 lbs.) If "yes," how long does this period last during the average shift? hrs. mins 132 Source: http://www.doksinet YES NO 13. Will you be wearing protective clothing and/or equipment (other than the respirator) when youre using your respirator: If "yes," describe this protective clothing and/or equipment: 14. Will you be working under

hot conditions temperature exceeding 77 deg F): 15. Will you be working under humid conditions: 16. Describe the work youll be doing while youre using your respirator(s): 17. Describe any special or hazardous conditions you might encounter when youre using your respirator(s) (for example, confined spaces, life-threatening gases): 18. Provide the following information, if you know it, for each toxic substance that youll be exposed to when youre using your respirator(s): Name of the first toxic substance: Estimated maximum exposure level per shift: Duration of exposure per shift: Name of the second toxic substance: Estimated maximum exposure level per shift:

Duration of exposure per shift: Name of the third toxic substance: Estimated maximum exposure level per shift: Duration of exposure per shift: The name of any other toxic substances that youll be exposed to while using your respirator: 19. Describe any special responsibilities youll have while using your respirator(s) that may affect the safety and well-being of others (for example, rescue, security): 133 Source: http://www.doksinet Appendix C NIOSH Guidance about Escape-Only Respirators What you Should Know in Deciding Whether to Buy Escape Hoods, Gas Masks or Other

Respirators for Preparedness at Home and Work U.S Centers for Disease Control and Prevention, NIOSH, 2005 http://www.cdcgov/niosh/npptl/topics/respirators/factsheets/respfacthtml 134 Source: http://www.doksinet 135