Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-842 - Respirators › Section 296-842-14005 - Provide medical evaluations

Current through Register Vol. 24-14, July 15, 2024
Exemption:
This section does
not
apply to
						  employees who
only
use:
1. Filtering-facepiece respirators
						  voluntarily. See WAC
						  296-842-11005 for
						  voluntary use requirements; or
2. Escape-only respirators that are
						  mouthpiece, loose-fitting, or hooded respirators.
IMPORTANT:
1. If an employee has been provided
			 with a medical evaluation addressing respirator use, as required by
			 another chapter, that evaluation will meet the requirements of this
			 section.
2. Using a
			 respirator can create physical risks for an employee each time it is
			 worn. The extent of these risks depends on these factors:
a. Type of respirator;
b. Environmental conditions at the
			 worksite;
c. Physical
			 demands of the work;
d.
			 Use of the protective clothing;
e. Employee's health status.
Follow the medical evaluation process, Steps 1
				through 7 in this section, to provide medical evaluations for
				employees at no cost to them.
Medical Evaluation Process
Step 1:
Identify employees who need
				medical evaluations AND determine the frequency of evaluations from
				Table 7. Include employees who:
(a) Are required to use
			 respirators; or
(b)
			 Voluntarily use respirators that are
not
filtering-facepiece respirators.
Note:
You may use a previous employer's medical
						  evaluation for an employee if you can:
1. Show the employee's previous work and use
						  conditions were substantially similar to yours; and
2. Obtain a copy of the licensed health care
						  professional's (LHCP's) written recommendation approving the
						  employee's use of the respirator chosen by you.
Step 2:
Identify a licensed health care
				professional (LHCP) to perform your medical evaluations.
Note:
If you select a different LHCP, you do not
						  need to have new medical evaluations done.
Step 3:
Make sure your LHCP has the
				following information
before
the evaluation is
				completed:
(a) Information
			 describing the respirators employees may use, including the weight
			 and type.
(b) How the
			 respirators will be used, including:
(i) How often the respirator will
			 be used, for example, daily, or once a month;
(ii) The duration of respirator
			 use, for example, a minimum of one hour, or up to twelve
			 hours;
(iii) The
			 employee's expected physical work effort;
(iv) Additional personal protective
			 clothing and equipment to be worn;
(v) Temperature and humidity
			 extremes expected during use.
(c) A copy of your written
			 respiratory protection program
and
this chapter.
Note:
1. You may choose to send the questionnaire
						  to the LHCP ahead of time, giving time to review it and add any
						  necessary questions.
2. The LHCP determines what questions to add
						  to the questionnaire, if any; however, questions in Parts 1-3 may not
						  be deleted or substantially altered.
Step 4:
Administer the medical
				questionnaire in WAC
				296-842-22005 to
				employees, OR provide them a medical exam that obtains the same
				information.
Note:
You may use online questionnaires if the
						  questions are the same and requirements of this section are
						  met.
(a) Administer the examination or
			 questionnaire at no cost to employees:
(i) During the employee's normal
			 working hours; or
(ii) At
			 a time and place convenient to the employee.
(b) Maintain employee
			 confidentiality during examination or questionnaire administration:
(i) Do
not
view
			 employee's answers on the questionnaire;
(ii) Do
not
act in a
			 manner that may be considered a breach of confidentiality.
Note:
Providing confidentiality is important for
						  securing successful medical evaluations. It helps make sure the LHCP
						  gets complete and dependable answers on the
						  questionnaire.
(c) Make sure employees understand
			 the content of the questionnaire.
(d) Provide the employee with an
			 opportunity to discuss the questionnaire or exam results with the
			 LHCP.
Step 5:
Provide follow-up evaluation for
				employees when:
(a) The LHCP
			 needs more information to make a final recommendation; or
(b) An employee gives any positive
			 response to questions 1-8 in Part 2 OR to questions 1-6 in Part 3 of
			 the DOSH medical evaluation questionnaire in WAC
			 296-842-22005.
Note:
Follow-up may include:
1. Employee consultation with the LHCP such
						  as a telephone conversation to evaluate positive questionnaire
						  responses;
2. Medical exams;
3. Medical tests or other diagnostic
						  procedures.
Step 6:
Obtain a written recommendation
				from the LHCP that contains only the following medical
				information:
(a) Whether or
			 not the employee is medically able to use the respirator;
(b) Any limitations of respirator
			 use for the employee;
(c)
			 What future medical evaluations, if any, are needed;
(d) A statement that the employee
			 has been provided a copy of the written recommendation.
Step 7:
Provide a powered, air-purifying
				respirator (PAPR) when the LHCP determines the employee should not
				wear a negative-pressure air-purifying respirator
AND
is
				able to wear a PAPR.
Reference:
See WAC
				296-842-13005 for
				requirements regarding selection of air-purifying respirators.
Note:
1. Yo u may discontinue medical evaluations
						  for an employee when the employee no longer uses a
						  respirator.
2. If you have staff conducting your medical
						  evaluations, they may keep completed questionnaires and findings as
						  confidential medical records, if they are maintained separately from
						  other records.
Use Table 7 to determine medical evaluation
				frequency.
Table 7 Evaluation Frequency
Type of Evaluation:
When required:
Initial medical evaluations
* Before respirators are fit-tested or used
						  in the workplace.
Subsequent medical evaluations
* If any of these occur:
- Your licensed health care professional
						  (LHCP) recommends them; for example, periodic evaluations at
						  specified intervals.
- A respirator program administrator or
						  supervisor informs you that an employee needs reevaluation.
- Medical signs or symptoms (such as
						  breathing difficulties) are:
* Observed during fit testing or program
						  evaluation; or
* Reported by the employee.
- Changes in worksite conditions such as
						  physical work effort, personal protective clothing, or temperature
						  that could substantially increase the employee's physiological
						  stress.