Written Programs : Respiratory: Respiratory Protection Program, Opt.2

Respiratory Protection Program

This sample policy statement is provided only as a guide to assist in complying with 29 CFR 1910.134, OSHA's Respiratory Protection Program standard. It is not intended to supersede the requirements detailed in the standards. Review the standard for particular requirements which are applicable to your specific situation. Employers will need to delete or add information relevant to your particular facility in order to develop an effective, comprehensive plan.

This sample covers situations where employees are not required to wear respiratory protection, but may elect to voluntarily wear respirators other than a dust mask. Note that this option requires the employer to comply with specific provisions of the standard and use Appendix B2, C & D.

This material and safety and health consultation services are provided at no cost to owners, proprietors, and managers of small businesses by the Illinois Onsite Safety & Health Consultation Program, Industrial Services Division, Department of Commerce and Community Affairs under a program funded largely by the Occupational Safety and Health Administration (OSHA), an agency of the U.S. Department of Labor.

ONSITE SAFETY & HEALTH CONSULTATION PROGRAM
Illinois Department of Commerce & Economic Opportunity
Industrial Services Division
100 West Randolph, Suites 3-400
Chicago, Illinois 60601
Phone: 312-814-2337 Fax: 312-814-7238 TDD: 800-419-0667

RESPIRATORY PROTECTION PROGRAM
Voluntary Use of Respirators

We designed this program to protect employee health though we have decided that respirators are not required. The respirator program administrator is responsible for overseeing this program. We require employees who voluntarily use respirators other than filtering face pieces (dust masks) to do the following:

1. The employee will contact the program administrator to initiate a medical evaluation.

2. We will not pay for respirators that employees voluntarily choose to wear. We will cover the costs associated with medical evaluations and the employee's time necessary to clean, disinfect, maintain and store the respirator.

3. Our designated physician or licensed health care provider (PLHCP) is insert name. The PLHCP will do medical evaluations using a medical questionnaire or an initial medical examination that obtains the same information as the medical questionnaire (required information located in Appendix C).

This evaluation will be administered confidentially, at no cost to the employee, during the employee's normal working hours or at a time and place convenient to the employee and in a manner that employees understand. The employee will have an opportunity to discuss the questionnaire and examination results with the health care provider (PLHCP).

4. The program administrator will provide the health care provider with the following supplemental information (optional forms located in Appendix E):

  • The type and weight of the respirator to be used by the employee;
  • The duration and frequency of respirator use (including use for rescue and escape);
  • The expected physical work effort;
  • Additional protective clothing and equipment to be worn;
  • Temperature and humidity extremes that may be encountered.
  • A copy of this written respiratory protection program.
  • A copy of the respiratory protection standard (29 CFR 1910.134).

5. An additional medical evaluation may be necessary as determined by the health care provider.

6. The program administrator will receive and keep on file the health care provider's written opinion on the employee's ability to use the respirator.

7. Respirators will be cleaned and disinfected according to the manufacturer's recommendation or those found in Appendix B-2.

8. All respirators will be stored to protect them from damage, contamination, dust, sunlight, extreme temperatures, excessive moisture and damaging chemicals and they will be packed or stored to prevent deformation of the facepiece and exhalation valve.

9. The program administrator will provide a copy of Appendix D of the OSHA Respirator Standard 29 CFR 1910.134 to the employee.

10. Employees are required to read Appendix D and follow the guidelines established in this policy. The program administrator and other management personnel will ensure through supervision that the policy is followed.