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Respiratory Protection Plan

May 4, 2009Reviewed 2012; 2014

VDH Respiratory Protection Plan May 4, 2009

1.0 Background

The Federal Occupational Safety and Health Administration (OSHA) has established a series of standards pertaining to Personal Protective Equipment, published in Title 29 of the Code of Federal Regulations (CFR), Part 1910, Subpart I. The General Requirements section (29 CFR 1910.132) states that the “employer shall assess the workplace to determine if hazards are present, or are likely to be present, which necessitate the use of personal protective equipment (PPE). If such hazards are present, or likely to be present, the employer shall select and have each affected employee use the types of PPE that will protect the affected employee from the hazards identified in the hazard assessment” [Ref.1]. One of the subsequent sections under this regulation is the Respiratory Protection Standard (29 CFR 1910.134), first adopted in 1971, with the latest revision becoming effective on October 5, 1998. This Standard states that an employer shall provide respirators to its employees when such equipment is necessary to protect the health of the employee, and the respirators chosen will be applicable and suitable for the purpose intended. For example, an employer may need to provide respirators to its employees who (1) are potentially exposed to harmful levels of respiratory hazards such as gases, vapors, dust, mists, fumes, sprays, and other airborne particles; or (2) work in situations where the level of oxygen is insufficient or potentially insufficient. When such hazards or potential hazards exist in the workplace, the employer shall be responsible for the establishment and maintenance of a respiratory protection program, to include a written program [Ref.2].

2.0 Purpose

As part of the overall respiratory protection program, this plan provides written guidance and procedures that are intended to help ensure that at-risk employees of ________Health District -or- VDH Division of __________ are protected from exposure to existing and potential respiratory hazards. This written plan is designed to comply with the requirements of the OSHA Respiratory Protection Standard (29 CFR 1910.134) [Ref.2].

3.0 Scope and Application

This program applies to all employees of ________Health District -or- VDH Division of __________ who are required to wear respirators during normal work operations and during certain non-routine or emergency work operations, while performing duties within the scope of their job description. Types of employees affected by this plan include, but are not limited to, physicians, public health nurses, epidemiologists, environmental health specialists, medical examiners, death investigators, and autopsy technicians. Examples of duties that are covered by this plan include, but are not limited to: medical examination and treatment of certain patients, investigation of infectious disease cases or outbreaks, death investigations and fatality management of events involving certain hazardous materials, and autopsies with the potential for aerosolized infectious or chemical agents. The classes and models of respirators available at VDH, as well as the operations for which they will be used, are listed in Table 1 below. The specific respirators chosen for ________Health District -or- VDH Division of __________ are indicated by the checked boxes.

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Table 1: RESPIRATORS USED AT VDHRespirator Operation

N95 Filtering Facepiece Respirators, variety of models

Clinical investigation of, or exposure to, infectious diseases requiring airborne precautions.

N100 Filtering Facepiece Respirators, 3M model 8293

Clinical investigation of, or exposure to, infectious diseases requiring airborne precautions.

Powered Air Purifying Respirator (PAPR), 3M Breathe Easy system with headcover

Alternative respirator for individuals unable to pass fit-testing for tight-fitting respirators, and who are involved in the clinical investigation of, or who may have exposure to, infectious diseases requiring airborne precautions.

Powered Air Purifying Respirator (PAPR), 3M Breathe Easy 10 system with hood

Emergency response to a scene involving a potentially hazardous environment.

Air Purifying Respirator (APR), MSA Millennium Mask with CBRN cartridge


Self-Contained Breathing Apparatus (SCBA), Scott AirPak 4.5


Employees participating in the respiratory protection program do so at no cost to them. The expense associated with training, medical evaluations and respiratory protection equipment will be the responsibility of the employer.

4.0 Policies and Responsibilities

Summary: The Occupational Safety and Health Administration (OSHA) requires the use of respiratory protection to protect the health of employees during any potential worksite exposures. Each health district and office director is required by OSHA (29 CFR 1910.134) to have a written Respiratory Protection Plan that addresses when and how respiratory protection should be used. The Respiratory Protection Plan should be readily available for review by all employees.

Policy:

1. Each VDH Health District and Office shall develop a Respiratory Protection Plan for their work unit. Each work unit’s respiratory protection plan shall be based on the attached Respiratory Protection Plan template and include the following primary elements:

A written program document covering the major elements of the OSHA Respiratory Protection Standard;

A designated Respiratory Program Administrator; Hazard identification and evaluation of respiratory hazards in the workplace;

Within VDH, and considering likely potential exposures in a clinical setting, the N95 and the N100 are interchangeable. Either one will provide adequate protection from clinical infectious diseases requiring airborne precautions, as long as the respirator fits properly and it is used properly. Where there is any likelihood that the N95/N100 is inadequate, a product with a higher assigned protection factor should be substituted for the disposable particulate respirators.

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Medical evaluations of employees required to use respirators; Fit testing procedures for tight-fitting respirators; Procedures for proper use of respirators in routine and reasonably foreseeable emergency

situations; Procedures and schedules for reuse, storage, inspection, and disposal of respirators; Training of employees in the respiratory hazards to which they are potentially exposed during

routine and emergency situations; Training of employees in the proper use of respirators, including donning and doffing procedures,

maintenance procedures, and limitations of their use; Procedures for regularly evaluating the effectiveness of the program.

2. The VDH District Health and Office Directors will determine the number of employees in their district/office who need to use a respirator, and who specifically (using position & working title) will participate in the respiratory protection plan. These employees will be selected based on the director’s assessment of the number of employees needed to respond to infectious cases of active tuberculosis, suspected cases of tuberculosis whose infectious status is not yet known, or to a biologic event or outbreak requiring respiratory protective equipment. It is the responsibility of the director to assure that enough employees have been fit tested to be able to respond to routine or outbreak situations.

3. No employee will be required to wear respirator protection unless it is part of the essential tasks of that position/role.

4. All employees who are required to be fit tested for a respiratory protective device will receive an initial medical evaluation, and annual fit testing for the respirator that they will use (see attached Respiratory Protection Plan). The cost of this evaluation will be covered by the employee’s respective work site (cost center).

5. An annual medical evaluation or review of employee health status is not required. At a minimum, the employer must provide additional medical evaluations if:

Employee reports medical signs or symptoms related to the ability to use a respirator. Physician or other licensed health care professional, supervisor, or program administrator informs

the employer that an employee needs to be reevaluated. Information from the respirator program, including observations made during fit testing and

program evaluation, indicates a need. Change occurs in workplace conditions that may substantially increase the physiological burden

on an employee.The cost of additional medical evaluations will be covered by the employee’s respective work site (cost center).

6. The medical evaluation can be performed in-house using a VDH clinician or using a contract healthcare provider. If an outside provider is not used, the health department clinician assigned to perform the medical evaluation cannot be in the employee’s direct chain of command.

7. Each district shall maintain an up-to-date list of employee’s who have been fit tested.

8. The Respiratory Protective Plan template is attached. Changes cannot be made to this document other than to identify the locality/office and include elements specific to district/office operations.

4.1 Employer Responsibilities

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The employer (________Health District -or- VDH Division of __________) has overall responsibility for development and implementation of a Respiratory Protection Program, with worksite-specific procedures. The employer shall include in the program the elements listed in 4.0 Policy and Responsibilities.

The employer must provide all respirators, medical evaluations, fit testing, and training at no cost to the employees. The medical records must be kept in a secure location. The employer will be responsible for the assignment of a suitably trained respiratory program administrator.

4.2 Program Administrator Responsibilities

__________________ has been appointed as the Program Administrator for the ________Health District -or- VDH Division of __________ and will be responsible for implementing this Respiratory Protection Program. He/she serves as the first contact for employees concerned with respiratory protection. The Program Administrator’s duties include:

Assessing hazards in the workplace in order to identify those work areas, processes, and tasks that require workers to wear respirators;

Selecting appropriate respirators based on the hazard assessment; Coordinating the medical surveillance program, as outlined in Section 7 below; Implementing the fit testing program; Developing procedures for proper respirator use – for both routine and emergency

situations; Monitoring respirator use to ensure that respirators are used in accordance with their

certification. Coordinating and/or conducting worker training, at least annually, to include training

on potential respiratory hazards and proper respirator use; Ensuring proper maintenance of respiratory protection equipment, to include

cleaning, disinfecting, storing, inspecting, repairing, and discarding; Maintaining records as required by OSHA (see Section 14 below); Evaluating the program for compliance and overall effectiveness; Updating the written program, as needed.

4.3 Employee Responsibilities

Each employee of the ________Health District -or- VDH Division of __________ who is required to use a respirator has the responsibility to:

Attend all required respiratory protection training; Wear his/her respirator when and where required and in accordance with the training

provided.

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Perform a user seal check each time a tight-fitting respirator is donned, in accordance with Appendix F;

Care for and maintain her/his respirators as instructed; Inform the Program Administrator if the respirator no longer fits well or if there have

been changes in facial features (e.g., surgery, scars, beard growth) or general physique (e.g., significant weight gain or loss);

Inform the Program Administrator of any changes in personal medical condition and any new medical signs/symptoms that may affect the ability to wear a respirator;

Inform the Program Administrator of any respiratory hazards that he or she feels are not adequately addressed in the performance of work duties and of any other concerns that he or she may have regarding the program.

5 Respirator Selection Procedures

The employer or Program Administrator will select the appropriate respirators to be used by personnel based on the respiratory hazards to which the worker is exposed and workplace and user factors that affect respirator performance and reliability. Only respirators, filters, cartridges and canisters that have been certified by the National Institute for Occupational Safety and Health (NIOSH) will be selected. The selection is based upon the physical and chemical properties of the air contaminant and the concentration levels likely to be encountered by the employee. The employer or Program Administrator will conduct a hazard assessment for each operation where an airborne contaminant may be present in routine operations or during an emergency, and will update the hazard assessment following significant changes in the work environment. The hazard assessment will include:

Identification and development of a list of hazardous substances that employees may encounter;

Review of work processes to determine where potential exposures to these hazardous substances may occur;

Exposure monitoring, if possible, to quantify potential hazardous exposures.

The employer shall select respirators from a sufficient number of respirator models and sizes so that the respirator is acceptable to, and correctly fits, the user.

6 Voluntary Respirator Use

The Program Administrator will provide all employees who voluntarily choose to wear a respirator with a copy of Appendix I, which provides details of the requirements for voluntary use of respirators by employees. Employees voluntarily choosing to wear a respirator must comply with the procedures for Medical Surveillance, Respirator Use, and Cleaning, Maintenance and Storage. 7 Medical Surveillance

Employees who are either required to wear respirators, or who choose to voluntarily don respirator protection, must complete a medical evaluation prior to their initial fit-testing and

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before being permitted to wear a respirator on the job. The employer shall identify a physician or other licensed health care professional (PLHCP) to perform medical evaluations using a medical questionnaire comparable to that in Appendix A of this plan or an initial medical examination that obtains the same information as the medical questionnaire. Employees are not permitted to wear a respirator until the designated PLHCP has signed the medical recommendation form indicating that they are medically qualified. Any employee refusing the medical evaluation will not be allowed to work in an area or operation requiring respirator use.

Procedures for medical surveillance of employees using respirators are as follows:

The Program Administrator will provide a copy of the medical questionnaire to all identified employees. The medical questionnaire and examinations shall be administered confidentially during the employee's normal working hours or at a time and place convenient to the employee.

The employee will complete and sign the medical questionnaire according to the directions given and will submit the completed form to a designated PLHCP.

The PLHCP will review the completed medical questionnaire or will conduct a medical examination obtaining the same information as in the questionnaire. The PLHCP must then make a medical determination and a written recommendation as to the employee’s ability to use a respirator (see Appendix B for an example of a recommendation form).

The employer shall ensure that a follow-up medical examination is provided for an employee who gives a positive response to any question among questions 1 through 8 of Appendix A, or whose initial medical evaluation demonstrates the need for a follow-up medical examination. The follow-up medical examination shall include any medical tests, consultations, or diagnostic procedures that the PLHCP deems necessary to make a final determination.

In addition, the employer will provide for an additional medical evaluation for any of the following reasons:

o an employee reports medical signs or symptoms that are related to his or her ability to use a respirator;

o the PLHCP, supervisor, or respirator program administrator informs the employer that an employee needs to be reevaluated;

o information from the respiratory protection program, including observations made during fit testing and program evaluation, indicates a need for employee reevaluation; or

o a change occurs in workplace conditions (e.g., physical work effort, protective clothing, or ambient temperature) that may result in a substantial increase in the physiological burden placed on an employee.

All medical examinations and questionnaires are to remain confidential and be maintained in a secure location.

8 Fit Testing

Before any employee is required to use a respirator with a negative or positive pressure tight-fitting facepiece, the employee must be fit tested with the same make, model, style, and size respirator that will be used. This applies to all tight-fitting respirators, including air purifying

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and SCBA. Employees volunteering to don a respirator may ask to be fit tested. The fit-testing procedures that will be used are attached as Appendix C. The Bitrex® solution aerosol protocol is the preferred method, with the Saccharin solution aerosol protocol used as a backup; regardless of which protocol is attempted initially, if the test subject fails to detect the initial sensitivity solution, then the alternate fit-test solution will be used. Upon completion of the test, whether successful or unsuccessful, the person conducting the fit-test shall fill out the Fit-Test Evaluation Form (Appendix D) and return the completed form to the Program Administrator. Fit-testing shall be conducted prior to initial use of the respirator, whenever a different respirator facepiece (size, style, model, or make) is used, and at least annually thereafter.

9 Respirator Users and General Use Procedures

Appendix E contains a list of employees participating in the respiratory protection program at ________Health District -or- VDH Division of __________. The names listed in the document signify that they have successfully completed the required medical evaluation, respirator training, and fit-testing as described in this plan and in accordance with 29 CFR 1910.134. Participating employees shall be instructed in and shall follow the following general use procedures:

9.1 Employees will use their respirators under conditions specified by this program, and in accordance with the training they receive on the use of each particular model. In addition, the respirator shall not be used in a manner for which it is not certified by NIOSH or by its manufacturer.

9.2 All employees shall conduct a user seal check each time that they wear their respirator in accordance with procedures in Appendix F.

9.3 Employees must clean their respirators and change their filters and cartridges/canisters when required and as outlined in Section 10 below.

9.4 Employees are not permitted to wear tight-fitting respirators if they have any condition (e.g., facial scars, facial hair, glasses, or missing dentures) that would prevent them from achieving a good seal. Powered Air Purifying Respirators may be provided in these cases, at the discretion of the Program Administrator and employer, and with the appropriate medical recommendation from the PLHCP.

9.5 For any malfunction of a respirator (e.g., a breakthrough, facepiece leakage, or improperly working valve), the respirator wearer should inform their Program Administrator that the respirator is no longer performing properly.

9.6 All employees wearing a supplied air respirator will operate using the buddy system. Buddies shall assist workers who experience a malfunction.

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10 Maintenance and Care of Respirators

10.1 Cleaning

The employer shall provide each respirator user with a respirator that is clean, sanitary, and in good working order. With the exception of disposable particulate respirators, the employer shall ensure that respirators are cleaned and disinfected using the procedures in Appendix G of this plan, or follow procedures recommended by the respirator manufacturer, provided that such procedures are of equivalent effectiveness. The respirators shall be cleaned and disinfected at the following intervals:

Respirators issued for the exclusive use of an employee shall be cleaned and disinfected as often as necessary to be maintained in a sanitary condition;

Respirators issued to more than one employee shall be cleaned and disinfected before being worn by different individuals;

Respirators maintained for emergency use shall be cleaned and disinfected after each use; and

Respirators used in fit testing and training shall be cleaned and disinfected after each use.

The Program Administrator will ensure that an adequate supply of appropriate cleanser and disinfectant is continuously available. If supplies are low, employees should contact the Program Administrator.

10.2 Inspection and Maintenance

Respirators are to be properly maintained at all times in order to ensure that they function properly and adequately protect the employee. Maintenance involves a thorough visual inspection for cleanliness and defects. Worn or deteriorated parts will be replaced prior to use. No components will be replaced or repairs made beyond those recommended by the manufacturer.

All routine-use respirators shall be inspected by the employee before each use and during cleaning. All respirators maintained for use in emergency situations shall be inspected at least monthly and in accordance with the manufacturer's recommendations, and shall be checked for proper function before and after each use

Inspections shall be conducted utilizing the form in Appendix H. In addition, the following checklist will be used to help guide the inspection:

Facepieceo Cracks, tears, or holes.o Facemask distortiono Cracked or loose lenses/faceshield

Headstraps

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o Breaks or tearso Broken buckles

Valveso Residue or dirto Cracks or tears in valve material

Filters/Cartridgeso Approval designationo Gasketso Cracks or dents in housingo Proper cartridge for hazard

Batterieso Ensure the batteries to the PAPR are properly charged according to manufacture’s

recommendations.

Where applicable, SCBAs shall be inspected monthly. Air cylinders shall be maintained in a fully charged state and shall be recharged when the pressure falls to 90% of the manufacturer’s recommended pressure level. The employer shall ensure that the regulator and warning devices function properly.

10.3 Storage

Respirators must be stored in a clean, dry area, in accordance with the manufacturer’s recommendations. Storage shall not be in an area where the surfaces of the respirator are potentially exposed to air contaminants. After cleaning and inspection, each employee will store his/her own respirators in a clean bag labeled with his/her name.

The Program Administrator will store replenishment supply of respirators and respirator components in the original manufacturer’s packaging if available.

10.4 Change Schedules

Filtering facepiece respirators are generally disposed of immediately following each exposure with a biological agent or infectious disease. Exceptions to this rule may be made by the employer in certain circumstances (e.g., when an insufficient supply of respirators exists during an emergency response situation).

Employees wearing an APR or PAPR with a High Efficiency Particulate Air (HEPA) filter, or a combination HEPA filter/cartridge, for protection against a biological agent shall change the filter/cartridge on their respirator when the filter/cartridge reaches its established expiration date or when they first begin to experience difficulty breathing (resistance) while wearing the respirator, whichever comes first.

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Employees wearing an APR, PAPR, or SCBA at the scene of an emergency response shall change their cartridges in accordance with the change schedule established by the Incident Commander or Haz-Mat officer at the scene.

11 Breathing Air Quality and Use

11.1 The employer shall ensure that workers who are wearing atmosphere-supplying respirators are supplied with breathing air of high purity. Atmosphere-supplying respirators are used to provide breathing air from a source independent of the ambient atmosphere. There are two types of such respirators: self-contained breathing apparatus (SCBA) units and supplied-air respirators (SARs). SCBAs are respirators for which air is supplied from a tank (a cylinder of compressed air); for this type of respirator, the source of the breathing air is designed to be transported by or with the equipment user. SARs (also known as airline respirators) receive air from a connecting hose; the source of air is either a pressurized cylinder or an air compressor.

11.2 Compressed breathing air shall meet at least the requirements for Grade D breathing air described in ANSI/Compressed Gas Association Commodity Specification for Air, G-7.1-1989, to include:

Oxygen content (v/v) of 19.5-23.5%; Hydrocarbon (condensed) content of 5 mg per cubic meter of air, or less; Carbon monoxide (CO) content of 10 ppm or less; Carbon dioxide content of 1,000 ppm or less; and Lack of noticeable odor.

11.3 Employees covered under this plan shall not use compressed or liquid oxygen as a source of respirable gas in the performance of their duties; cylinders and respirators shall never contain oxygen concentrations greater than 23.5%.

11.4 The employer shall ensure that cylinders used to supply breathing air to respirators meet the following requirements:

Cylinders are tested and maintained as prescribed in the Shipping Container Specification Regulations of the Department of Transportation (49 CFR part 173 and part 178);

Cylinders of purchased breathing air have a certificate of analysis from the supplier that the breathing air meets the requirements for Grade D breathing air; and

The moisture content in the cylinder does not exceed a dew point of neg. 50 deg.F (neg. 45.6 deg.C) at 1 atmosphere pressure.

11.5 The employer will not acquire or maintain any compressors used to supply breathing air to respirators. Those employees using SCBA respirators shall have their cylinders filled using a compressor from an agency or source external to VDH (e.g., the Virginia State Police in the case of OCME employees). The employer shall verify that such

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external agency or other source is in compliance with Section (i-5) of the Respiratory Protection Standard [29 CFR 1910.134(i)(5)] regarding their compressors.

11.6 The employer shall use breathing gas containers marked in accordance with the NIOSH respirator certification standard, 42 CFR part 84.

12 Employee Training

No employee will be permitted to work with a respirator until he or she has received training in respiratory protection. The training will be provided or coordinated by the Program Administrator and will cover the following topics:

A discussion of appropriate regulatory guidelines, including federal (OSHA) and state (VOSH) standards

Explanation of potential work-related respiratory hazards and the risks associated with not wearing respiratory protection;

Elements of the Respiratory Protection Program, including employee responsibilities; Selection of respiratory protection and who is authorized to modify the selection; Medical surveillance program and the Respirator Fitting Form; Function, capabilities, and limitations of the selected respiratory protection; Explanation of the operation of the respiratory protection, including how to don, check

the fit, and wear the respirator properly; Respirator maintenance including cleaning, inspection, and storage; Recognition and handling of emergency situations; Medical signs and symptoms that might limit the effective use of respirators.

Training shall be administered annually, and when the following situations occur:

Changes in the workplace or the type of respirator render previous training obsolete; Inadequacies in the employee's knowledge or use of the respirator indicate that the

employee has not retained the requisite understanding or skill; or Any other situation arises in which retraining appears necessary to ensure safe respirator

use.

13 Program Evaluation

The Program Administrator shall conduct periodic evaluations of the workplace and operating conditions to ensure that the provisions of this program are being properly implemented. The evaluation will include regular consultations with employees who use respirators, review of sampling results (if applicable), and review of records. The Program Administrator, with approval of the employer, shall make any necessary changes to the program based on the results of these periodic evaluations and shall update the written program in accordance with any revisions recommended or mandated by OSHA or VOSH.

14 Documentation and Recordkeeping

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For each employee assigned a respirator, the following records will be maintained in the noted secure locations:

Medical records, including the initial medical questionnaire and any follow-up medical evaluations/examinations, are confidential and will be kept by the PLHCP and any referral healthcare providers.

The medical recommendation (Appendix B, Part 2), after completion by the PLHCP, will be kept by the Program Administrator.

Training records will be kept by the Program Administrator. Fit testing records (i.e., the most current fit-test evaluation form for each respirator used

by an employee) will be kept by the Program Administrator.

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APPENDIX A: MEDICAL QUESTIONNAIRE

PART 1. PERSONAL INFORMATION

Date: _________ Name: ________________________________ (first) (middle) (last)

SS#:________________

Age: _____ Sex (circle one): Male Female Height: ____ ft. ___in. Weight: _____lbs.

Job Title: Department:

A phone number where you can be reached by the healthcare professional who reviews this questionnaire: _______________ The best time to phone you at this number: _____________

Has your employer told you how to contact the health care professional who will review this questionnaire (circle one): Yes/NoType of respirator(s) you will be using (if known): _______________________________Have you worn a respirator in the past? (circle one): Yes/NoIf "yes," what type(s):

PART 2. HEALTH QUESTIONS:

Questions 1 through 9 below must be answered by every employee who has been selected to use any type of respirator. Please circle "yes" or "no" to the following.

1. Do you currently smoke tobacco, or have you smoked tobacco in the last month? Yes/No

2. Have you ever had any of the following conditions?a. Seizures (fits): Yes/Nob. Diabetes (sugar disease): Yes/Noc. Allergic reactions that interfere with your breathing: Yes/Nod. Claustrophobia (fear of closed-in places): Yes/Noe. Trouble smelling odors: Yes/No

3. Have you ever had any of the following pulmonary or lung problems?a. Asbestosis: Yes/Nob. Asthma: Yes/Noc. Chronic bronchitis: Yes/Nod. Emphysema: Yes/Noe. Pneumonia: Yes/Nof. Tuberculosis: Yes/Nog. Silicosis: Yes/Noh. Pneumothorax (collapsed lung): Yes/Noi. Lung cancer: Yes/Noj. Broken ribs: Yes/Nok. Any chest injuries or surgeries: Yes/Nol. Any other lung problem that you've been told about: Yes/No

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4. Do you currently have any of the following symptoms of pulmonary or lung illness?a. Shortness of breath: Yes/Nob. Shortness of breath when walking fast on level ground or walking up a slight hill or incline: Yes/Noc. Shortness of breath when walking with other people at an ordinary pace on level ground: Yes/Nod. Have to stop for breath when walking at your own pace on level ground: Yes/Noe. Shortness of breath when washing or dressing yourself: Yes/Nof. Shortness of breath that interferes with your job: Yes/Nog. Coughing that produces phlegm (thick sputum) not associated with a cold: Yes/Noh. Coughing that wakes you early in the morning: Yes/Noi. Coughing that occurs mostly when you are lying down: Yes/Noj. Coughing up blood in the last month: Yes/Nok. Wheezing: Yes/Nol. Wheezing that interferes with your job: Yes/Nom. Chest pain when you breathe deeply: Yes/Non. Any other symptoms that you think may be related to lung problems: Yes/No

5. Have you ever had any of the following cardiovascular or heart problems?a. Heart attack: Yes/Nob. Stroke: Yes/Noc. Angina: Yes/Nod. Heart failure: Yes/Noe. Swelling in your legs or feet (not caused by walking): Yes/Nof. Heart arrhythmia (heart beating irregularly): Yes/Nog. High blood pressure: Yes/Noh. Any other heart problem that you've been told about: Yes/No

6. Have you ever had any of the following cardiovascular or heart symptoms?a. Frequent pain or tightness in your chest: Yes/Nob. Pain or tightness in your chest during physical activity: Yes/Noc. Pain or tightness in your chest that interferes with your job: Yes/No d. In the past two years, have you noticed your heart skipping or missing a beat: Yes/Noe. Heartburn or indigestion that is not related to eating: Yes/Nof. Any other symptoms you think may be related to heart or circulation problems: Yes/No

7. Do you currently take medication for any of the following problems?a. Breathing or lung problems: Yes/Nob. Heart trouble: Yes/Noc. Blood pressure: Yes/Nod. Seizures (fits): Yes/Noe. Other ___________________________________________

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8. If you've used a respirator, have you ever had any of the following problems? (If you've never used a respirator, check here and go to question 9)

a. Eye irritation: Yes/Nob. Skin allergies or rashes: Yes/Noc. Anxiety: Yes/Nod. General weakness or fatigue: Yes/Noe. Any other problem that interferes with your use of a respirator: Yes/No

9. Would you like to talk to the healthcare professional who will review this questionnaire about your answers to this questionnaire? Yes/No

Questions 10-15 below are mandatory for employees using a full-facepiece respirator or a self-contained breathing apparatus (SCBA). For all others, answering these questions is voluntary.

10. Have you ever lost vision in either eye (temporarily or permanently)? Yes/No

11. Do you currently have any of the following vision problems?a. Wear contact lenses: Yes/Nob. Wear glasses: Yes/Noc. Color blind: Yes/Noe. Any other eye or vision problem: Yes/No

12. Have you ever had an injury to your ears, including a broken eardrum? Yes/No

13. Do you currently have any of the following hearing problems?a. Difficulty hearing: Yes/Nob. Wear a hearing aid: Yes/Noc. Any other hearing or ear problem: Yes/No

14. Have you ever had a back injury: Yes/No

15. Do you currently have any of the following musculoskeletal problems?a. Weakness in any of your arms, hands, legs, or feet: Yes/No b. Back pain: Yes/Noc. Difficulty fully moving your arms and legs: Yes/Nod. Pain or stiffness when you lean forward or backward at the waist: Yes/Noe. Difficulties fully moving your head up or down: Yes/Nof. Difficulty fully moving your head side to side: Yes/Nog. Difficulty bending at your knees: Yes/Noh. Difficulty squatting to the ground: Yes/Noi. Difficulty climbing a flight of stairs or a ladder carrying more than 25 lbs: Yes/Noj. Any other muscle or skeletal problem that interferes with using a respirator: Yes/No

16. Do you have any other health conditions or issues you would like the healthcare professional who will be reviewing this questionnaire to know about? Yes/No

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APPENDIX A: MEDICAL QUESTIONNAIRE

PART B: OPTIONAL

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 will review the

questionnaire.

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: Yes/No

If “yes,” do you have feelings of dizziness, shortness of breath, pounding in your chest, or other symptoms when you’re working under these conditions: Yes/No

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 knowthem:_______________________________________________________________________________________________________________________________________

3. Have you ever worked with any of the materials, or under any of the conditions, listed below:

Asbestos: Yes/No Silica (e.g., in sandblasting): Yes/No Tungsten/cobalt (e.g., grinding or welding this material): Yes/No Beryllium: Yes/No Aluminum: Yes/No Coal (for example, mining): Yes/No Iron: Yes/No Tin: Yes/No Dusty environments: Yes/No Any other hazardous exposures: Yes/No

If “yes,” describe these exposures:__________________________________________ ______________________________________________________________________

4. List any second jobs or side businesses you have:______________________________________________________________________________________________________________

5. List your previous occupations:_____________________________________________________________________________________________________________________________

6. List your current and previous hobbies:_______________________________________________________________________________________________________________________

7. Have you been in the military services? Yes/No

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If “yes,” were you exposed to biological or chemical agents (either in training or combat): Yes/No

8. Have you ever worked on a HAZMAT team? Yes/No

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 over-the-counter medications): Yes/No

If “yes,” name the medications if you know them:______________________________ ______________________________________________________________________

10.Will you be using any of the following items with your respirator(s)? HEPA Filters: Yes/No Canisters (for example, gas masks): Yes/No Cartridges: Yes/No

11. How often are you expected to use the respirator(s) (circle “yes” or “no” for all answers that apply to you)?:

Escape only (no rescue): Yes/No Emergency rescue only: Yes/No Less than 5 hours per week: Yes/No Less than 2 hours per day: Yes/No 2 to 4 hours per day: Yes/No Over 4 hours per day: Yes/No

12. During the period you are using the respirator(s), is your work effort:

Light (less than 200 kcal per hour): Yes/NoIf “yes,” how long does this period last during the average shift: __hrs. __mins.

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.) or controlling machines.

Moderate (200 to 350 kcal per hour): Yes/NoIf “yes,” how long does this period last during the average shift: __hrs.___mins.

Examples of moderate work effort are sitting while nailing or filing; driving a truck or bus in urban traffic; standing while drilling, nailing, performing assemblywork, 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 (about 100 lbs.) on a level surface.

Heavy (above 350 kcal per hour): Yes/NoIf “yes,” how long does this period last during the average shift: ___hrs.__mins.

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.).

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13.Will you be wearing protective clothing and/or equipment (other than the respirator) when you’re using your respirator: Yes/No

If “yes,” describe this protective clothing and/or equipment:__________________________________________________________________________________________

14.Will you be working under hot conditions (temperature exceeding 77 deg. F): Yes/No

15.Will you be working under humid conditions: Yes/No

16. Describe the work you’ll be doing while you’re using your respirator(s)__________________________________________________________________________________________

17. Describe any special or hazardous conditions you might encounter when you’re using your respirator(s) (for example, confined spaces, lifethreatening gases):__________________________________________________________________________________________________________________________________________________

18. Provide the following information, if you know it, for each toxic substance that you’ll be exposed to when you’re using your respirator(s):

Name of the first toxic sustance:_________________________________________ 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 you’ll be exposed to while using your

respirator: __________________________________________________________

19. Describe any special responsibilities you’ll have while using your respirator(s) that may affect the safety and well-being of others (for example, rescue, security):____________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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APPENDIX B: MEDICAL RECOMMENDATION

PART 1. WORKING ENVIRONMENT(to be completed by Program Administrator)

Employee Name: _____________________________________

Workload: Light* Moderate* Heavy/Strenuous*Light: <200 kcal per hr; sitting while writing, typing, drafting; performing light assembly work; walking level carrying up to 10 lbs.Moderate: 200-350 kcal per hr; frequent lifting up to 25 lbs.; infrequent lifting up to 50 lbs.; walking level carrying 25 lbs. Heavy: >350 kcal per hr; frequent lifting of 50 lbs.; infrequent lifting of 100 lbs.; walking level carrying 50 lbs.; walking uphill @ 2mph.

Usage: Frequent (>5hrs/week) Occasional (<5hrs/wk) Rare (<5hrs/month)(or emergency use only)

Will the user be working under hot conditions (i.e., temperature exceeding 77o F)? Yes/NoWill the user be working under high humidity conditions? Yes/NoOther protective gear to be worn with respirator:______________________________________Hazards to be protected against (e.g., biologicals, dusts, mists, sprays, fumes, gases, vapors): _____________________________________________________________________________

Type of respirator(s) to be assigned: _____ Filtering Face Piece respirator_____ Half-face air purifying respirator_____ Full-face air purifying respirator_____ SCBA or Airline respirator_____ PAPR (loose fitting hood or headcover)_____ PAPR (tight-fitting)

Special Considerations: __________________________________________________________ ______________________________________________________________________________

PART 2. MEDICAL RECOMMENDATION(to be completed by a licensed healthcare professional)

This person can wear a respirator of the type(s) described above, without restrictions.

This person can wear a respirator subject to the following restrictions or limitations:________________________________________________________________________________________________________________________________________

This person cannot use a respirator of the type(s) described above. (If a negative-pressure respirator cannot be used, can the person use a PAPR? Yes/No)

A follow-up medical evaluation is required. Employee has been referred to:____________________________________________________________________

I have provided the employee named above with a copy of this recommendation.

__________________/_________________ __________________PLHCP (Name) (Signature) Date

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APPENDIX C: FIT-TESTING PROCEDURES

C.1 GENERAL PROCEDURES

1. Prior to the commencement of the fit test, the test subject shall be given a description of the fit test and the test subject’s 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 ten minutes before the start of the fit test.

2. The fit test shall be performed while the test subject is wearing any applicable safety equipment that may be worn during the actual respirator use, which could interfere with respirator fit.

3. 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.

4. 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 subject’s formal training on respirator use, because it is only a review.

5. 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.

6. 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.

7. The more acceptable facepieces are noted in case the one selected proves unacceptable; the most comfortable mask is donned and worn at least ten minutes to assess comfort. 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.

8. Assessment of comfort shall include reviewing 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 noseb) Room for eye protectionc) Room to talkd) Position of mask on face and cheeks

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9. The following criteria shall be used to help determine the adequacy of the respirator fit:

a) Chin properly placedb) Adequate strap tension, not overly tightenedc) Fit across nose bridged) Respirator of proper size to span distance from nose to chine) Tendency of respirator to slipf) Self-observation in mirror to evaluate fit and respirator position

10. The test subject shall conduct a user seal check using negative and positive pressure seal checks as demonstrated by the program administrator. Before conducting the negative or 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 will be selected if the test subject fails the user seal check tests.

11. 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 that interferes with a satisfactory fit shall be altered or removed.

12. If a test subject exhibits difficulty in breathing during the tests, he/she 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 his or her duties.

13. 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.

C.2 BITREX® SOLUTION AEROSOL PROTOCOL

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The Bitrex® (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 conducted to assure that the person being fit tested can detect the taste of the Bitrex solution at very low levels. The sensitivity test solution is a 100 to 1 dilution of the fit test solution.

NOTE:The test subject must not eat, drink (except plain water), smoke, or chew gum for 15 minutes before the fit testing procedure.

For threshold screening and fit-testing, employees shall use an enclosure about the head and shoulders that is approximately 12 inches in diameter by 14 inches tall with at least the front portion clear and that allows free movement of the head when a respirator is worn. An enclosure hood assembly, which comes with most fit testing kits, is adequate. The test enclosure shall have a three-quarter inch hole in front of the test subject's nose and mouth area to accommodate the nebulizer nozzle. The test subject shall don the test enclosure. For the threshold screening test, he shall breathe through his open mouth with tongue extended. 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. The threshold check solution is prepared by dissolving 13.5 milligrams of Bitrex in 100 ml of a 5% salt (NaCl) solution in distilled water.To produce the aerosol, the nebulizer bulb is firmly squeezed so that it collapses completely then released and allowed to fully expand. Ten squeezes are repeated rapidly and then the test subject is asked whether the Bitrex can be tasted. If the first response is negative, ten more squeezes are repeated rapidly and the test subject is again asked whether the Bitrex is tasted. If the second response is negative, ten more squeezes are repeated rapidly and the test subject is again asked whether the Bitrex is tasted. The test conductor will take note of the number of squeezes required to elicit a taste response. If the Bitrex is not tasted after 30 squeezes (Step 10), the test subject may not perform the Bitrex fit test and shall use an alternate test.

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If a taste response is elicited, the test subject shall be asked to take note of the taste for reference in the fit test. Correct use of the nebulizer means that approximately 1 cc of liquid is used at a time in the nebulizer body. 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. Respirator Selection

Respirators shall be selected as described above in section C1 (General Procedures), and each respirator shall be equipped with a particular filter or cartridge as determined by the program administrator.

C. Fit Test Procedures

1. Note: The test subject may not eat, drink (except plain water), smoke or chew gum for 15 minutes before the test.

2. Each test subject shall wear his respirator for at least 10 minutes before starting the fit test.

3. The test subject shall don the enclosure while wearing the respirator selected in section above. This respirator shall be properly adjusted and equipped with a particular filter cartridge.

4. A second DeVilbiss Model 40 Inhalation Medication nebulizer 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 or equivalent.

5. The fit test solution is prepared by dissolving 337.5 mg of Bitrex in 200 cc of a 5% salt (NaCl) solution in warm water.

6. As before, the test subject shall breathe through the open mouth with tongue extended.

7. The nebulizer is inserted into the hole in front of the enclosure and the fit test solution is sprayed into the enclosure using the same technique as for the taste threshold screening and the same number of squeezes required to elicit a taste response in the screening.

8. After generation of the aerosol, the test subject shall be instructed to perform the following exercises for one minute each: a. Normal breathing. In a normal standing position, without talking,

breathe normally.b. Deep breathing. In a normal standing position, breathe slowly and

regularly taking caution not to hyperventilate. Be certain breaths are deep and regular.

c. Turning head from side-to-side. Standing in place, turn head from side to side. Be certain movement is complete. Alert the test subject not to bump the respirator on the shoulders. Have the test subject inhale when his head is at either side.

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d. Nodding head up-and-down. Nod head up and down, being certain motions are complete and made about every second. Alert the test subject not to bump the respirator on the chest. Have the test subject inhale when his head is in the fully up position.

e. Talking. Talk aloud and slowly for several minutes. The following paragraph is called the Rainbow Passage. Reading it will result in a wide range of facial movements, and thus be useful to satisfy this requirement. Alternative passages which serve the same purpose, or counting backwards from 100, may also be used.

Rainbow PassageWhen 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.

f. Bending over. The subject shall bend over at the waist as if he/she were going to touch his/her toes.

g. Normal breathing. In a normal standing position, without talking, breathe normally.

9. Every 30 seconds, the aerosol concentration shall be replenished using one-half the number of squeezes as initially.

10. The test subject shall so indicate to the test conductor if, at any time during the fit-test, the taste of Bitrex is detected.

11. If the Bitrex is detected, then the fit is deemed unsatisfactory and the test is failed. A different respirator shall be tried and the entire test procedure is repeated (including taste threshold and fit testing).

12. Successful completion of the test protocol shall allow the use of the tested respirator in contaminated atmospheres up to 10 times the PEL. In other words this protocol may be used to assign protection factors no higher than ten.

D. Cleaning/Refilling

Immediately after completing the test, pour the unused solutions back into respective bottles. Rinse the nebulizers with warm water to prevent clogging. Wipe out the inside of the hood with a damp cloth or paper towel to remove any deposited Test Solution. The Nebulizers must be thoroughly rinsed in water, shaken dry and refilled at least each morning and afternoon or at least every (4) hours.

C.3 SACCHARIN SOLUTION AEROSOL PROTOCOL

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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 saccharin taste threshold screening, performed without wearing a respirator, is conducted to assure that the person being fit tested can detect the taste of the saccharin solution at very low levels. The sensitivity test solution is a 100 to 1 dilution of the fit test solution.

NOTE:The test subject must not eat, drink (except plain water), smoke, or chew gum for 15 minutes before the fit testing procedure.

1. For threshold screening and fit-testing, employees shall use an enclosure about the head and shoulders that is approximately 12 inches in diameter by 14 inches tall with at least the front portion clear and that allows free movement of the head when a respirator is worn. An enclosure hood assembly, which comes with most fit testing kits, is adequate.

2. The test enclosure shall have a three-quarter inch hole in front of the test subject's nose and mouth area to accommodate the nebulizer nozzle.

3. The test subject shall don the test enclosure. For the threshold screening test, he shall breathe through his open mouth with tongue extended.

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 dissolving 0.83 grams of sodium saccharin (USP) in water. This can be achieved by mixing 1 cc of the test solution (see C5 below) in 100 cc of 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.

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.

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.

10. The test conductor will take note of the number of squeezes required to elicit a taste response.

11. If the saccharin is not tasted after 30 squeezes (Step 10), the test subject may not perform the saccharin fit test and shall use an alternate test if available.

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.

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13. Correct use of the nebulizer means that approximately 1 cc 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. Respirator Selection

Respirators shall be selected as described above in section C1 (General Procedures), and each respirator shall be equipped with a particular filter or cartridge as determined by the program administrator.

C. Fit Test Procedures

1. Note: The test subject may not eat, drink (except plain water), smoke or chew gum for 15 minutes before the test.

2. Each test subject shall wear his respirator for at least 10 minutes before starting the fit test.

3. The test subject shall don the enclosure while wearing the respirator selected in section above. This respirator shall be properly adjusted and equipped with a particular filter cartridge.

4. A second DeVilbiss Model 40 Inhalation Medication nebulizer 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 or equivalent.

5. The fit test solution is prepared by adding 83 grams of sodium saccharin to 100 cc of warm water.

6. As before, the test subject shall breathe through the open mouth with tongue extended.

7. The nebulizer is inserted into the hole in front of the enclosure and the fit test solution is sprayed into the enclosure using the same technique as for the taste threshold screening and the same number of squeezes required to elicit a taste response in the screening.

8. After generation of the aerosol, the test subject shall be instructed to perform the following exercises for one minute each: a. Normal breathing. In a normal standing position, without talking,

breathe normally.b. Deep breathing. In a normal standing position, breathe slowly and

regularly taking caution not to hyperventilate. Be certain breaths are deep and regular.

c. Turning head from side-to-side. Standing in place, turn head from side to side. Be certain movement is complete. Alert the test subject not to bump the respirator on the shoulders. Have the test subject inhale when his head is at either side.

d. Nodding head up-and-down. Nod head up and down, being certain motions are complete and made about every second. Alert the test subject

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not to bump the respirator on the chest. Have the test subject inhale when his head is in the fully up position.

e. Talking. Talk aloud and slowly for several minutes. The following paragraph is called the Rainbow Passage. Reading it will result in a wide range of facial movements, and thus be useful to satisfy this requirement. Alternative passages which serve the same purpose, or counting backwards from 100, may also be used.

Rainbow PassageWhen 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.

f. Bending over. The subject shall bend over at the waist as if he/she were going to touch his/her toes.

h. Normal breathing. In a normal standing position, without talking, breathe normally.

9. Every 30 seconds, the aerosol concentration shall be replenished using one-half the number of squeezes as initially.

10. The test subject shall so indicate to the test conductor if, at any time during the fit-test, the taste of saccharin is detected.

11. If the saccharin is detected, then the fit is deemed unsatisfactory and the test is failed. A different respirator shall be tried and the entire test procedure is repeated (including taste threshold and fit testing).

12. Successful completion of the test protocol shall allow the use of the tested respirator in contaminated atmospheres up to 10 times the PEL. In other words this protocol may be used to assign protection factors no higher than ten.

2. Cleaning/Refilling

Immediately after completing the test, pour the unused solutions back into respective bottles. Rinse the nebulizers with warm water to prevent clogging. Wipe out the inside of the hood with a damp cloth or paper towel to remove any deposited Test Solution. The Nebulizers must be thoroughly rinsed in water, shaken dry and refilled at least each morning and afternoon or at least every (4) hours.

APPENDIX D: FIT-TEST EVALUATION FORM

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(to be completed annually and retained by Program Administrator)

Name of User: ______________________________

Type of respirator to be tested: N95 filtering facepiece N100 filtering facepiece Air purifying respirator (APR) Atmosphere supplying respirator (SCBA or SAR) Other (describe: __________________________)

Manufacturer _______________ Model number __________ Size ______________

NIOSH Approval Number(s):________________________________________________

************************************************************************

Type of Fit Test: Qualitative (QLFT) Quantitative (QTFT)

Qualitative Fit Test Results:

Solution Used Sensitivity/Threshold(circle # of squeezes) Results of Fit Test

Bitrex® 10, 20, 30, or failed Passed / Failed

Saccharin 10, 20, 30, or failed Passed / Failed

Quantitative Fit Test Results:

Name of Fit Test Used Overall Fit Factor Results of Fit Test

(Attach results of QNFT)

Fitted by: _______________________________________Date:___________________test conductor’s signature

Additional Comments: ________________________________________________________________________________________________________________________________________________________________________________________________________________________APPENDIX E: LIST OF EMPLOYEES USING RESPIRATORS

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EMPLOYEES IN THE RESPIRATORY PROTECTION PROGRAM

Name Role Respirator Required:Make/Model/Size

Fit-Test Date(most recent)

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APPENDIX F: USER SEAL CHECK PROCEDURES

The individual who uses a tight-fitting respirator is to perform a user seal check each time the respirator is put on, in order to ensure that an adequate seal is achieved. Either the positive and negative pressure checks described below (steps 1 and 2), or the respirator manufacturer's recommended user seal check method shall be used. In the case of the N95 and N100 filtering facepiece respirator, the manufacturer’s recommended user seal check method shall be used. User seal checks are not substitutes for qualitative or quantitative fit tests.

1. Positive pressure check. Close off the exhalation valve and exhale gently into the facepiece. The face fit is considered satisfactory if a slight positive pressure can be built up inside the facepiece without any evidence of outward leakage of air at the seal. For most respirators this method of leak testing requires the wearer to first remove the exhalation valve cover before closing off the exhalation valve and then carefully replacing it after the test.

2. Negative pressure check. Close off the inlet opening of the canister or cartridge(s) by covering with the palm of the hand(s) or by replacing the filter seal(s), inhale gently so that the facepiece collapses slightly, and hold the breath for ten seconds. The design of the inlet opening of some cartridges cannot be effectively covered with the palm of the hand. The test can be performed by covering the inlet opening of the cartridge with a thin latex or nitrile glove. If the facepiece remains in its slightly collapsed condition and no inward leakage of air is detected, the tightness of the respirator is considered satisfactory.

3. Manufacturer’s Recommended User Seal Check. As an alternative to using the positive and negative pressure check procedures described above, the respirator manufacturer’s recommended procedures for performing a user seal check may be used, provided that the employer demonstrates that the manufacturer’s procedures are equally effective.

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APPENDIX G: RESPIRATOR CLEANING PROCEDURES

These procedures are provided for employer use when cleaning respirators. They are general in nature, and the employer as an alternative may use the cleaning recommendations provided by the manufacturer of the respirators used by their employees, provided such procedures are as effective as those listed here. Equivalent effectiveness simply means that the procedures used must accomplish the same objectives of this Appendix, i.e., they must ensure that the respirator is properly cleaned and disinfected in a manner that prevents damage to the respirator and does not cause harm to the user.

Procedures for Cleaning Respirators:

1. Remove filters, cartridges, or canisters. Disassemble facepieces by removing speaking diaphragms, demand and pressure-demand valve assemblies, hoses, or any components recommended by the manufacturer. Discard or repair any defective parts.

2. Wash components in warm (43 deg.C [110 deg.F] maximum) water with a mild detergent or with a cleaner recommended by the manufacturer. A stiff bristle (not wire) brush may be used to facilitate the removal of dirt.

3. Rinse components thoroughly in clean, warm (43 deg.C [110 deg.F] maximum), preferably running water. Drain.

4. When the cleaner used does not contain a disinfecting agent, respirator components should be immersed for two minutes in one of the following:

a. Hypochlorite solution (50 ppm of chlorine) made by adding approximately one milliliter of laundry bleach to one liter of water at 43 deg.C (110 deg.F);

b. Aqueous solution of iodine (50 ppm iodine) made by adding approximately 0.8 milliliters of tincture of iodine (6-8 grams ammonium and/or potassium iodide/100 cc of 45% alcohol) to one liter of water at 43 deg.C (110 deg.F);

c. Other commercially available cleansers of equivalent disinfectant quality when used as directed, if their use is recommended or approved by the respirator manufacturer.

5. Rinse components thoroughly in clean, warm (43 deg.C [110 deg.F] maximum), preferably running water. Drain. The importance of thorough rinsing cannot be overemphasized. Detergents or disinfectants that dry on facepieces may result in dermatitis. In addition, some disinfectants may cause deterioration of rubber or corrosion of metal parts if not completely removed.

6. Components should be hand-dried with a clean lint-free cloth or air-dried.

7. Reassemble facepiece, replacing filters, cartridges, and canisters where necessary.

8. Test the respirator to ensure that all components work properly.

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APPENDIX H: RESPIRATOR INSPECTION FORM

User's Name: _____________________________ Make & Model of Respirator: ________________NIOSH/MSHA Approval:____________

HOOD/ FACEPIECE OK Defective N/A

Cleanliness

Flexibility

Lens

General Condition

HEADSTRAPS OK Defective N/A

Elasticity

Buckles and Attachments

General Condition

INHALATION AND EXHALATION VALVES OK Defective N/A

Valve Condition

Valve Cover

General Condition

AIR-PURIFYING ELEMENTS OK Defective N/A

Correct Cartridge, Filter or Canister for Hazard

Correct Installation

Gaskets Present

Cartridge or Filter Cleanliness

General Condition of Cartridge Holders

General Condition of Cartridge

STORAGE OK Defective N/A

General

Reviewed by: Date: ____________________________

Action taken: (1)________________________ Date: ________________ Initials: _____ (2)________________________ Date: ________________ Initials: _____

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APPENDIX I: INFORMATION FOR EMPLOYEES USING RESPIRATORS WHEN NOT REQUIRED UNDER THE OSHA STANDARD

Respirators are an effective method of protection against designated hazards when properly selected and worn. Respirator use is encouraged, even when exposures are below the exposure limit, to provide an additional level of comfort and protection for workers. However, if a respirator is used improperly or not kept clean, the respirator itself can become a hazard to the worker. Sometimes, workers may wear respirators to avoid exposures to hazards, even if theamount of hazardous substance does not exceed the limits set by OSHA standards. If your employer provides respirators for your voluntary use, or if you provide your own respirator, you need to take certain precautions to be sure that the respirator itself does not present a hazard.

You should do the following:

1. Read and heed all instructions provided by the manufacturer on use, maintenance, cleaning and care, and warnings regarding the respirators limitations.

2. Choose respirators certified for use to protect against the contaminant of concern. NIOSH, the National Institute for Occupational Safety and Health of the U.S. Department of Health and Human Services, certifies respirators. A label or statement of certification should appear on the respirator or respirator packaging. It will tell you what the respirator is designed for and how much it will protect you.

3. Do not wear your respirator into atmospheres containing contaminants for which your respirator is not designed to protect against. For example, a respirator designed to filter dust particles will not protect you against gases, vapors, or very small solid particles of fumes or smoke.

4. Keep track of your respirator so that you do not mistakenly use someone else's respirator.

[63 FR 1152, Jan. 8, 1998; 63 FR 20098, 20099, April 23, 1998; assembled at 69 FR 46993, Aug. 4, 2004, 71 FR 16672, April 3, 2006; 71 FR 50187, August 24, 2006]

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APPENDIX J: REFERENCES

(1) (29 CFR 1910.132): Occupational Safety and Health Standards, Subpart I – “Personal Protective Equipment,” section 1910.132 –”General Requirements”

(2) (29 CFR 1910.134): Occupational Safety and Health Standards, Subpart I – “Personal Protective Equipment,” section 1910.134 – “Respiratory Protection”

(3) VDH Recommendations on Protective Measures and Personal Protective Equipment, VDH PPE Committee, Draft, July 31, 2003.

(4) (29 CFR 1910.120): Occupational Safety and Health Standards, Subpart H – “Hazardous Materials,” section 1910.120 – “Hazardous waste operations and emergency response”

(5) NIOSH Guide to the Selection and Use of Particulate Respirators Certified Under 42 CFR 84. Available from National Institute for Occupational Safety and Health, www.cdc.gov/niosh/homepage.html

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