Clinic RPP Template
- Clinic RPP Template Home
- Scope and Application
- Identifying Work Hazards
- Respirator Selection
- Medical Evaluations
- Fit Testing
- Proper Respirator Use
- Cleaning and Disinfecting
- Inspecting, Maintenance and Repairs
- Respirator Training
- Evaluating/Updating Program
- Roles and Responsibilities
- Documentation and Record-keeping
Documentation and Record-keeping:
Clinic Respiratory Protection Program Template
- A written copy of this program can be found in ________________________ (example: policy and procedure manual).
- _______________________ (example: RPA, Clinic Supervisor, employer’s name, human resources person) maintains the medical information for all employees covered under the respiratory program.
- The completed medical forms and documented medical recommendations are confidential and will remain with/in _______________________ (example: RPA, the health care provider conducting the evaluation, Clinic Supervisor, employer’s name, human resources person).
- All relevant medical information must be maintained for the duration of the employment of the individual plus thirty years.
Download a print version of this template:
Clinic Respiratory Protection Program Template (PDF: 39KB/6 pages)
Download an editable version of this template:
Clinic Respiratory Protection Program Template (Word: 73KB/6 pages)
If you have questions or comments about this page, use our IDEPC Comment Form or call 651-201-5414 for the MDH Infectious Disease Epidemiology, Prevention and Control Division.