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
Clinic Respiratory Protection Program Template
- Persons assigned to tasks that require respiratory protection must be physically able to perform the tasks while wearing a respirator.
- ____________________ (example: occupational health physician, personal physician) will determine individual medical clearance by a medical questionnaire and/or medical exam. Employees refusing a medical evaluation will not be allowed to work in conditions requiring respirator use.
- Re-evaluation will be conducted under these circumstances:
- Employee reports physical symptoms that are related to the ability to use a respirator. (wheezing, shortness of breath, chest pain, etc.)
- It is identified that an employee is having a medical problem during respirator use.
- The health care professional performing the evaluation determines an employee needs to be re-evaluated and the frequency of the evaluation.
- A change occurs in the workplace conditions that may result in an increased physiological burden on the employee.
- Employee facial size/shape/structure has changed significantly.
Next: Fit Testing
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.