August 1, 2025

Robert K. McLellan, MD, MPH, FACOEM
Professor, Active Emeritus
Geisel School of Medicine
The Dartmouth Institute of Health Policy and Clinical Practice
74 College St
Vail Building, Room 715
Hanover, NH 03755

Philip Harber, MD, MPH, FACOEM
Adjunct Professor of Public Health
University of Arizona
Professor, Emeritus
University of California, Los Angeles

Dear Drs. McLellan and Harber:

Thank you for your letter to the U.S. Department of Labor, Occupational Safety and Health Administration (OSHA), regarding questions related to medical evaluations required by OSHA's Respiratory Protection standard, 29 CFR § 1910.134. This is a follow-up to the interim letter OSHA sent to you, dated November 9, 2023. This letter constitutes OSHA's interpretation only of the requirements herein and may not be applicable to any questions not delineated within your original correspondence. Your questions have been paraphrased, followed by our responses.

Background: OSHA's Respiratory Protection standard, per paragraph 29 CFR § 1910.134(e), requires a medical evaluation of workers before the required use of a respirator. The standard's paragraph (e)(5)(i) also directs employers to provide the following information to the physician or other licensed health care professional (PLHCP) before the PLHCP makes a recommendation concerning an employee's ability to use a respirator: type and weight of the respirator to be used, the duration and frequency of respirator use, the expected physical work effort, additional protective clothing and equipment to be worn, and the temperature and humidity extremes that may be encountered. Additionally, paragraph (e)(6)(i) requires the employer obtain a written recommendation regarding the employee's ability to use a respirator from the PLHCP.

In your letter, you state that the standard does not require the employer to provide other information about the employee's work while wearing a respirator that can affect the safety of the employee and potentially coworkers or the public, for example whether the employee operates dangerous machinery or works at heights while using the respirator.

You also state that during the medical evaluation, PLHCPs may become aware of conditions such as seizures, problems with equilibrium, or a myriad of other conditions that could affect the overall safety of the employee regardless of respirator use. You further state that the worker with these conditions may be able to use a respirator safely but may not be able to perform the job tasks safely and that employers often do not provide a comprehensive functional job description or hazardous exposure information when requesting a respirator medical evaluation.

Question 1: To what extent does OSHA's Respiratory Protection standard, at 29 CFR § 1910.134(e), require that the PLHCP's medical evaluation for respirator use include consideration of factors beyond respiratory protection that affect fitness to safely perform the expected job tasks while wearing a respirator?

Response: The purpose of a respiratory protection medical evaluation program is to ensure that any employee required to use a respirator can tolerate the physiological burden associated with such use, including: the burden imposed by the respirator itself (e.g., its weight and breathing resistance during both normal operation and under conditions of filter, canister, or cartridge overload); musculoskeletal stress (e.g., when the respirator to be worn is a self-contained breathing apparatus); limitations on auditory, visual, and odor sensations; and isolation from the workplace environment. See 63 FR 1152, 1208 (Jan. 8, 1998).

The PLHCP's recommendation concerning an employee's ability to use a respirator must take into consideration the information the employer provides pursuant to 29 CFR § 1910.134(e)(5). To the extent the workplace conditions identified in your letter (i.e., whether the employee operates dangerous machinery or works at heights while using the respirator) affect the physiological burden on the employee associated with respirator usage, they also may be taken into consideration by the PLHCP in determining the employee's ability to use a respirator. Additionally, as you note in your letter, a PLHCP's recommendation regarding an employee's ability to use a respirator may also include, “[a]ny limitations on respirator use related to the medical condition of the employee, or relating to the workplace conditions in which the respirator will be used….” 29 CFR § 1910.134(e)(6)(i)(A).

Finally, if a PLHCP determines that conditions of a work environment are unsafe or unhealthy, the clinician may bring the conditions to the employer's attention. However, the clinician should be careful to preserve patient confidentiality in discussions with employers (see OSHA's Clinicians Safety and Health Topics Page at https://www.osha.gov/clinicians#ethicsandconfidentiality). The PLHCP may also make a referral to a local OSHA Area Office (see https://www.osha.gov/contactus/bystate), when appropriate.

Question 2: Is there a reasonable expectation that the employer will provide functional job descriptions to include more than the narrowly specified information required by 29 CFR § 1910.134(e)(5)(i)?

Response: The Respiratory Protection standard does not prohibit the PLHCP from requesting the employer provide information beyond what the employer is required to provide pursuant to 29 CFR § 1910.134(e)(5)(i) if the PLHCP believes it is needed to make an informed medical determination on an employee's ability to wear a respirator. However, the only other information paragraph (e)(5) requires the employer to provide to the PLHCP, not previously mentioned above, as stated in paragraph (e)(5)(iii), is a copy of the employer's written respiratory protection program and a copy of the Respiratory Protection standard. The employer's written program must contain the elements outlined in paragraph (c) of the standard.

Thank you for your interest in occupational safety and health. I hope you find this information helpful. OSHA's requirements are set by statute, standards, and regulations. Letters of interpretation do not create new or additional requirements but rather explain these requirements and how they apply to particular circumstances. This letter constitutes OSHA's interpretation of the requirements discussed. From time to time, letters are affected when the agency updates a standard, a legal decision impacts a standard, or changes in technology affect the interpretation. To ensure that you are using the correct information and guidance, please consult OSHA's website at www.osha.gov. If you have further questions, please feel free to contact OSHA's Directorate of Enforcement Programs at (202) 693-2100.

Sincerely,

Erin P. Gilmore, Acting Director
Directorate of Enforcement Programs