OSHA requirements are set by statute, standards and regulations. Our interpretation letters explain these requirements and how they apply to particular circumstances, but they cannot create additional employer obligations. This letter constitutes OSHA's interpretation of the requirements discussed. Note that our enforcement guidance may be affected by changes to OSHA rules. Also, from time to time we update our guidance in response to new information. To keep apprised of such developments, you can consult OSHA's website at https://www.osha.gov.

October 16, 1998

Ms. Laila Freidmann, RN, COHN-S
Concentra Health Services
400 North Beach
Fort Worth, Texas 76111

Dear Ms. Freidmann:

This letter is in response to your requests of May 19th and July 14th; we apologize for the delay in responding to your requests. You asked several questions concerning the Occupational Safety and Health Administration's (OSHA) Respiratory Protection standard, 29 CFR 1910.134. Specifically, you asked about Appendix C, the Respirator Medical Evaluation Questionnaire (Questionnaire).

In your first letter, you asked if OSHA plans to make Part B of the Questionnaire mandatory, and, if not, how can a physician or other licensed health care professional (PLHCP) obtain the information in Part B. OSHA does not plan to make Part B of the Questionnaire mandatory. The PLHCP, moreover, has total discretion to add none, any, or all of the optional questions to the Questionnaire, or to add other questions to the Questionnaire that the PLHCP believes are necessary to perform the medical evaluation. In addition, the PLHCP has discretion regarding when Part B (but not Part A) is administered (e.g., after fit testing).

You also stated that the Questionnaire's numbering system is "challenging," and asked if the questions can be renumbered. OSHA's response is that a PLHCP or an employer can renumber the Questionnaire to suit their needs.

In your second letter, you expressed concerns regarding the follow-up medical examinations specified in 29 CFR 1910.134(e)(3)(ii). You asked if this paragraph requires the PLHCP to provide a "hands-on" medical examination to an employee who gives a positive response to questions 1 through 8 in Section 2, Part A of the Questionnaire, or when the employee's initial medical examination demonstrates the need for a follow-up medical examination. Again, the PLHCP has total discretion in determining the scope and form of the follow-up medical examination. A positive response to the Questionnaire, for example, does not automatically require a face-to-face visit with the PLHCP or a hands-on medical examination. The PLHCP may conduct a hands-on medical examination, perform additional diagnostic tests, or clarify medical issues in a telephone consultation with the employee. Therefore, while PLHCPs are free to administer a hands-on medical examination after reviewing responses to the Questionnaire, and prior to making a referral or obtaining a consultation, they are not required to do so by the standard.

With regard to your question about supplemental information on the medical-evaluation provisions of the standard, there are several documents currently available that provide this information. A document titled "Questions and Answers on the Respiratory Protection Standard" contains over 70 pages of questions and answers on the entire standard, including the medical-evaluation provisions. The OSHA Compliance Directive, CPL 2-0.120, titled "Inspection Procedures for the Respiratory Protection Standard," also provides information on the entire standard. In addition, the "Small Entity Compliance Guide" is available. All of these documents can be accessed on OSHA's Web site at www.osha.gov.; you may also obtain printed copies of these documents from OSHA's Publications Office by telephoning (202) 219-4667.

Thank you for your interest in occupational safety and health. If you have any further questions, please telephone our Office of Health Compliance Assistance, at (202) 219-8036.


Richard E. Fairfax
Acting Director
Directorate of Compliance Programs