Douglas County                   

 

 

 

SECTION 1.  WRITTEN RESPIRATORY PROTECTION PROGRAM

 

 

 

Introduction

 

This written program establishes policies and procedures for the effective use of respirators to protect Douglas County employees from airborne contaminate exposures. These procedures are mandatory.  This written program is based upon the respirator requirements under Oregon Occupational Safety and Health Administration’s rules 1910.134 - Respiratory Protection.

 

Responsibilities

 

Department	Supply the required respirator, replacement parts, cartridges, filters, and appropriate cleaning solutions.
Supervisors/Safety Manager	Provide training in the maintenance and use of the respirators and will audit work sites for compliance with the requirements for the use of respirators.  Supervisors are also responsible to ensure employees wear appropriate respiratory protection.
Employees	Wear an approved respirator, properly fitted at all times while performing an operation defined as hazardous.

 

Selection of Respirators

 

Only the National Institute of Occupational Safety and Health (NIOSH) approved respirators have been selected for use.  The following Respiratory Protection Selection Guide shows the type of respirator in relationship to the chemical/operations and condition of use.

                                              

These respirators have been chosen based on the type of hazard and the type of protection given by the selected respiratory equipment. Different sizes and styles of respirators are available.  The specific selection will be based on the fit testing protocols to determine the best style for each employee to ensure proper fit and comfort.

 

The use life of each respirator or cartridges will vary depending on the job duties and actual time in use.  Each respirator will have some limitations, thus manufacturer instructions and recommendations must be referred to.  Air purifying respirators (disposable mask, half or full face piece cartridge respirators) cannot be used in confined spaces where the environment may have less than 19.5% oxygen or in fumigation operations.

 

  

TABLE 1 - RESPIRATORY PROTECTION SELECTION GUIDE

TASK	HAZARD	TYPE OF REQUIRED RESPIRATOR
Abrasive Blasting	Dust/toxic metals	Silica Abrasive: Air line with abrasive blasting helmet/hood
Welding & Cutting cartridge	Fumes, gases	Half-face piece respirator with fume or air-line respirator
Spray Painting (organic solvents paints)	Vapors/Mists	Half-face piece with organic cartridge and paint spray mist over filter or Airline system depending on type of paint. Note: if lead based paint must use a combination HEPA and organic vapor cartridge.
Road Dust/Construction Surfacing Activities	Dust	Depending on levels from total or toxic dust disposable respirator, half-mask face piece respirator with dust filter or HEPA cartridge.
Asphalt Fumes	Hydrocarbon Fumes	Fume cartridge half-mask and/or organic vapor cartridge (non-cancer form)
Herbicides/Pesticides  Mixing or,   If specifically required on MSDS’s	Depends on formulation Dust Mists/Vapors	CURRENT MATERIALS DO NOT REQUIRE RESPIRATORS Note: Check MSDS of new Herbicides
Sweepers and other construction or lawn maintenance equipment (i.e. mowers)	Dust	Depending on levels from total or toxic dust disposable respirator and half-face piece dust/mist or HEPA cartridge.
Vehicle Exhaust (i.e. in tunnels, sand sheds, or poor ventilated shops) complex mixtures)	Carbon monoxide (CO) Diesel emissions ( CO, oxides of nitrogen and	Airline respirators or special approved gas masks with end-of-service life indicators.
Confined space entry	Toxic Atmosphere O2 deficiency Possible IDHL	If IDLH environment a minimum of 5 min. escape cylinder is required to be worn in conjunction with the airline
Emergency Fire Response	Toxic Atmosphere	Self-Contained Breathing Apparatus (SCBA)                   O2 deficiency, dust Smoke, Possible IDHL

 

 

TASK	HAZARD	TYPE OF REQUIRED RESPIRATOR
Striper Painting (organic solvents paints)	Vapors/Mists	Half or full face piece with organic cartridge and paint spray mist over filter or airline system depending on type of paint. Note: if lead based paint must use a combination HEPA and organic vapor cartridge at a minimum.

 

NOTES:

	Lead based paints require air-line supply for paint or abrasive blasting
	All types of respirator selected must be NIOSH/MSHA approved for the hazard
	For tasks involving airborne contaminants which are not listed, contact supervisor or safety manager before beginning work
	See: Appendix 1 for Explanation on Cartridge and Filter selection   Appendix 2 on Compressed Air Quality for airline or self-contained breathing apparatus   Appendix 3 on Assigned Protection Factors

 

Availability and Use of Respirators

 

When required to wear a respirator, each employee shall wear an approved respirator selected for the hazard the person is exposed to.  The respirator must be properly worn and fitted at all times while performing job operations defined as hazardous.

 

Each employee that needs a respirator will be issued one by the supervisor or safety manager with proper replacement parts, cartridges and filters, and cleaning materials.  The supervisor is responsible to see that employees are provided respirators when they are required by this policy.

 

 

DOUGLAS COUNTY HAS VARIOUS RESPIRATORS AVAILABLE FOR USE.  THE SPECIFIC RESPIRATORS FOR EACH DEPARTMENT VARY.  THE TYPES INCLUDE:

 

	Dust and mist disposable mask
	Half-face respirator with filters and chemical cartridges.
	Full-face respirator with filters and chemical cartridges.
	Air-supplied respirators include air lines and self-contained breathing apparatus (SCBA).

           

Supervisors are responsible to see that the proper replacement parts, cartridges and filters are available and will be issued as requested by the employee.

 

Each employee shall wear a properly fitted respirator while performing an operation defined as hazardous in TABLE 1.  Employees must wear a respirator when in the immediate area where another employee is performing a hazardous operation.  To aid in defining this area it will normally be within 10 feet for more than five minutes.  This definition would not apply in cases where regulated areas are established for lead or asbestos or other chemical exposures.

 

Respirator requiring a tight face fit shall not be worn when conditions prevent a good face seal.  Such conditions may be:

 

	The growth of a beard and/or sideburns
	A skull cap that projects under the face piece
	Temple pieces on glasses

 

The selection of respirators that are not listed in TABLE 1 should be based on information from the chemical material safety data sheet (MSDS), safety equipment supplier and safety manager.

 

Availability of Respirators for Comfort - BUT not Required

Respirators are available to employees for comfort and not under mandatory overexposure situations.  In these cases the following must be required to meet Oregon OSHA basic regulations:

 

	Ensure the employee is medically able to use the respirator.
	Select respirators to match the type of contaminate.
	Instruct employee on how to wear and maintain the respirator.
	Regardless of the use reason for the respirator, they must be maintained in a clean and sanitary manner and properly stored

 

The County requires that any employee using a respirator voluntarily be medically able to use that respirator, and that the respirator is cleaned, stored, and maintained so that its use does not present a health hazard to the employee.  The County will not require detailed fit testing for employees who only wear respirators for comfort and not as a health hazard safety device.  As a result it is critical that supervisors and the safety manager evaluate all situations where respirators are being worn to determine the level of program need.

 

**Exception: Employees voluntarily using filtering face pieces (dust masks) for their own comfort where no particulate air contaminate exceeds permissible exposure levels, will be exempt from the provisions of this program.

 

Training of Employees

 

Each respirator user will be trained on how to use and maintain the respirator based on this program.  The training will be given by supervisor, safety manager or knowledgeable person.  Refresher training will be done every year or when employee changes type of respirator or as otherwise needed to ensure that the respirator program is followed and understood.

 

A record will be kept of those employees who have been trained.  Each user must understand and apply the contents of this respirator program to the daily use, care and storage of the equipment.

 

To insure the availability of this program, copies are located in each unit.  Employees will be informed where copies are available.

 

Fitting of Respirators

 

Prior to fit-testing an employee must undergo a medical evaluation, provided by the County, to determine the employee’s ability to use a respirator.  Employees not capable of wearing a negative pressure respirator will not be assigned job tasks requiring respirator use.

 

Proper fitting of respirators is essential if employees are to receive the necessary protection from the airborne contaminate hazards. Air which passes around the face piece of the respirator, rather than through it, is not being filtered.  In order to ensure that a good face seal can be achieved, the respirator needs to be carefully fitted.

 

The following procedures will be followed to fit the initial wearer and then to be used each time the respirator is used: (NOTE: See SECTION 3. for details on fit testing).

1.	The respirator straps must be worn in the correct place as shown in the manufacturer's instructions.  Adjust the head bands until they are tight yet comfortable.
2.	To adjust the face piece properly, position the chin firmly in the chin cup and manually shift the face piece until the most comfortable position is located.  Make the final adjustments on the headbands and do not break the nose seal.
3.	No beards or facial hair are allowed which interfere with the face fit.  This may include long sideburns, beards and other conditions which would prevent a good seal; also temple pieces on glasses or a skull cap that projects under the face piece.
4.	A positive and negative pressure test needs to be performed every time a respirator is worn.   The negative pressure test is performed on a half or full face piece respirator designed for filters or chemical cartridges.  The test consists of covering the air inlet lightly and inhaling slightly.  If a leak exists, the air can be felt as it enters.  The common leak areas are around the nose and chin.   The positive pressure test is performed by blocking the exhalation valve and exhaling lightly.  Again, air leakage can be felt if a leak is evident.  If such leaks are found, the respirator is to be adjusted and retested.
5.	For the initial fitting of a respirator, a more elaborate test will be conducted on each new employee or each time a new type of respirator is used.  The banana oil odor test is primarily uses.  A knowledgeable person will conduct the fit testing and may decide at times to use the irritant smoke test.
		Banana oil (isoamyl acetate) test which can be used to check the respirator fit when using organic vapor cartridges by determining if the wearer can detect the odor of bananas.
		Irritant smoke test can be used with particulate filters by determining if the wearer can detect the irritation of the smoke.

           

            If a fit cannot be achieved, then a different size or style face piece needs to be fitted.

 

 

 

Maintenance of Respirators

 

Respirators are to be cleaned after each daily use with alcohol preps and placed dry in a clean container or plastic bag for storage.  More thorough cleaning is needed for dirty respirators or those shared.  This involves performing the following procedures:

 

1.	Remove the cartridges or filters from the face piece.  The filters and cartridges must not be washed.
2.	Immerse the piece in a warm water solution of commercial disinfectant liquid. The respirator should be scrubbed gently with a cloth or soft brush.  Make sure that all foreign material is removed from all the surfaces of the rubber exhalation valve and plastic exhalation valve seats and face seal.   NOTE: The inhalation, exhalation valves, valve cover, and cartridges will be replaced during the quarterly cleaning.
3.	After washing and disinfecting the respirator, rinse in clean warm water and allow the respirator to dry before storing.
4.	After the respirator is dry, store it in a clean container. Respirators should not be stored where chemicals are used or stored.  Respirators should not be hung from nails on the walls or in chemical storage areas. The respirators must be stored in a normal position which means that they should not be stretched or stored under objects which could cause the face-piece to become warped.

 

Any respirator malfunction shall be reported to the supervisor who can evaluate the problem and ensure that proper replacement parts or a new respirator is supplied to the employee.

 

Each person assigned a respirator shall be responsible to maintain the equipment and routinely inspect the respirator before and after use for worn or dirty parts.  WORN PARTS WILL BE REPLACED IMMEDIATELY.

 

Respirators will be periodically evaluated by the supervisor or safety manager to assure that the equipment is in proper working order condition and kept clean.

 

Routine inspection shall include an evaluation of:

	Regulatory and warning devices are functional
	Tightness of the connections
	Condition of the face piece
	Condition of the headbands
	Condition of the cartridges (for respirators using cartridges)
	Condition of the valves, and
	Pliability and deterioration of the face piece material

 

A written record of the inspections will be kept by the supervisor.  (see form Section 2. D).

 

 

 

 

 

 

 

Respirator Program Evaluation

 

It is important that both the respirator wearer as well as the supervisor and/or safety manager evaluate respirator use and program effectiveness.  It is critical that the appropriate respirator be worn correctly.

 

If an employee notices any of the following they should immediately leave the area and replace the respirator if:

 

1.	Breathing becomes difficult.
2.	Dizziness or other distress occurs (see supervisor).
3.	Sense irritation, smell or taste contaminants.
4.	The respirator becomes damaged.

 

The overall program will be evaluated by the safety manager.  This includes:

1.	Frequent unscheduled observation of employee respirator usage during job operations     requiring protection to confirm proper respirator use.
2.	Observation and discussion of the respirator program with new employees and those who are not following proper protocols.
3.	Periodic discussions of respiratory use procedures during safety and management meetings.

                

 

The safety manager will use the program checklist at least annually to determine the overall effectiveness of the program and needed updates.  If deficiencies are found then additional employee training will be given and more frequency evaluations will be made.

 

Medical Evaluations to Determine Suitability for Respirator Use

 

Purpose           Medical certification of an employee is required for respirator use by OSHA rules 1910.1018 (h)(3)(iv) which state that if an employee has demonstrated difficulty in breathing during the fitting test or during use of respirators, he or she shall be examined by a physician trained in pulmonary medicine to determine whether the employee can wear a respirator while performing the required duty.  The purpose of a          medical evaluation is twofold:

 

1.	To determine if an individual is medically fit to wear a respirator, provided appropriate health and safety precautions have been taken in the work environment.
2.	To determine if an individual needs work restrictions, given the job that he or she is required to do.

 

NOTE:  Job descriptions or job capacity evaluations need to be available to the physician doing the evaluation.

 

 

 

 

Oregon OSHA rules 1910.134(e)(1) state that  ”The employer shall provide a medical evaluation to determine the employee's ability to use a respirator, before the employee is fit tested or required to use the respirator in the workplace.”  In addition, some specific OSHA standards for chemical substances or occupations may also contain requirements for medical examinations.  Both standards require that a physician should determine what health and physical conditions are pertinent, and that the respirator wearers' medical status should be reviewed periodically.

 

In addition, some specific OSHA standards for chemical substances or occupations may also contain requirements for medical examinations.  Both types of standards require that a physician should determine what health and physical conditions are pertinent, and that the respirator wearers' medical status could be reviewed periodically.

 

Oregon OSHA applies this standard when the air contaminates level or conditions could result in overexposure to the permissible exposure limit.  Thus if filtering face pieces (dust masks) are provided for comfort mandatory medical screening would not be required.

 

Pre-placement medical examinations should screen out those who are physically or psychologically unfit to wear respirators.  As another part of this examination, medical tests pertinent to the respiratory hazards that workers may encounter should be made to get baseline data against which to assess physiological changes in respirator wearers.

 

The medical fitness program requires having employees medically evaluated to ensure they are able to safely wear respiratory equipment.  The medical fitness evaluation process involves:

 

 

Step #1	Notification to the supervisor that an employee needs to wear a respirator. (Form A - Respirator Assignment and Fit Testing Form).
Step #2	Health care provider gives the health questionnaire and arranges for employee assessment.
Step #3	Supervisor and/or safety manager is notified by the health care provider whether or not the employee can wear a respirator.

           

 

	If pass, then supervisor or safety manager fits the employee in the appropriate respirator.  The Selection and Fit form is completed and the employee receives a copy of the form which includes use and maintenance instructions.
	If fail, the employee’s letter will have specific instructions for further medical evaluation.
	Additional evaluations and/or testing will be scheduled.
	Upon completion of additional evaluations and/or testing, Health care provider will notify the Department and employee of a pass status.
	If testing indicates additional medical intervention, Health care provider will contact the Department Head and Human Resources Department.

 

 

 

 

           

 

Medical           Currently, basic standards are available to determine fitness for respirator use.

Protocols         It is the responsibility of the evaluating physician to remain updated on changes in the ANSI and NIOSH guidelines.  The ANSI and NIOSH guidelines also address the frequency of medical fitness determinations. (See Section 5 References: for NIOSH recommended medical protocols.)

 

The decision to certify an employee for respirator use depends on many factors; IE:  the individual's medical history, physical examination, and test results (lung function tests, EKG, stress tests).  Thus the following recommended medical examinations and tests are guidelines for the evaluating physician.

 

It is recognized that different types of respirators create different levels of demands on wearers.  For example, wearing a half mask may be less demanding on a worker's physical capacity than a self-contained breathing apparatus (SCBA).  For this reason, and depending on the employee's job duties, the examining physician may decide on further medical evaluation based on the medical questionnaire and physical evaluation that are part of this standard protocol.

 

It is important to note that the current Oregon OSHA respirator regulations on medical examinations leave the actual decision as to the type and detail of the examination up to the evaluating physician.  The ANSI standard and NIOSH decision logic only provide recommendations.  The final decision needs to be made by the evaluating physician.

 

Additional medical tests may be needed depending upon the medical findings.  These test could include: chest X-ray, an EKG or a stress test.

 

Medical              Medical testing frequency is not addressed in the current OSHA respiratory Testing protection rules; however, NIOSH provides the following recommendation. This Frequency is an area that the evaluating physician will also need to be consulted.  The

                        following is the NIOSH suggested frequency of medical fitness determinations for respirator users.                                                                                                                                                                     

 

                                              RECOMMENDED MEDICAL FITNESS TESTING FREQUENCY

 

WORKER AGE (years)	<35	34-45	>45
Most work conditions     requiring a respirator	Every 5 years	Every 2 years	Every 1-2 years
Strenuous work conditions   with SCBA	Every 3 yrs	Every 18 months	Annually

                                                                                            

NOTE:  Interim testing would be needed if changes in health status occur.

 

Reporting       Several factors are involved to ensure that adequate reporting and record keeping is done. Confidentiality of medical results is most important.  For this reason, the Medical Evaluation Report Form Section 2. C. has been devised that could be used by the evaluating physician to report the decision back to the employer.  It should not list any medical diagnoses or conditions.

                 

                        The employee should receive notification from the evaluating physician as to the results   of the tests.

 

Retention        It should also be stressed, that the preservation of medical records is according Medical            to OSHA 1910.1020 (d) Preservation of Records (General Safety and Health Provisions).            This requires that the records be retained for 30 years plus   employment             duration.  The   medical records may be kept by the evaluating physician or in a confidential file in their         Personnel File if the employees agree to the transfer of their records.

  

If an employee works for one year or less, the County may give the employee their records and not retain them.  If they are not given to the employee, then the 30 years retention time is in effect per the OSHA requirements.

 

 

APPENDIX 1

 

RESPIRATORY CARTRIDGE / FILTER SELECTION

EXPLANATION

 

 

The following tables indicate potential chemical exposures in relationship to respiratory selection for various operations.  The selection for emergency use will always be Self-contained Breathing Apparatus (SCBA) Respirators unless the Incident Commander gives other directions based on an assessment of the emergency release or spill.

 

The respirator selection charts are based on the County’s data as to what potential chemical exposures can occur and level of the employee exposures, OSHA, NIOSH, and manufacturer’s requirements. 

 

The color code system used for respirator cartridges and canisters is based on ANSI K13.1973 Identification of Air Purifying Respirator Canisters & Cartridges.

 

COLOR CODE FOR CARTRIDGE/S/CANISTERS

 

Contaminant	Color Assigned
Acid Gas	White
Organic Vapors	Black
Ammonia Gas	Green
Acid Gas and Organic Vapor	Yellow
Radioactive or Highly Toxic Particulates/Fumes HEPA filter	Purple (Magenta)
Dust, Fumes & Mists	Red or gray with a red stripe
Other Vapors & Gases not listed	Brown

 

NOTES:

        A purple stripe shall be used to identify radioactive materials in combination with any vapor or gas cartridge.

  An orange stripe shall be used to identify dusts, fumes, and mist in combination with any vapor or as cartridge.

  Where labels only are colored to conform with this table, the canister or cartridge body shall be gray or a metal canister or cartridge body be left in its natural metallic color.

       The user shall refer to the wording of the label to determine the type and degree of protection the canister or cartridge will afford.

   

TYPE OF RESPIRATORY/ SYSTEM		NIOSH APPROVAL #
Supplied Air: SCBA		TC-13F
Supplied Air Respirator:  Air Line  Abrasive Blasting Unit		TC-19C TC-19CE
Gas Masks		TC-14G
Powered Air Purifying Respirators (PAPRs) Note: the specific cartridges and filters would have separate approval		TC-14G
Particulate Respirators: includes: HEPA, dust/mist, and dust/ mist/fume		TC-21
Chemical Cartridges		TC-23C
	Ammonia use  300 ppm
	Chlorine use  10 ppm
	Hydrogen Chloride use  50 ppm
	Combination Cl2, HCL & sulfur dioxide for use same as above and SO2  50 ppm
	Organic Vapor use in general it is 1000 ppm based on protection factor of 10
	Paints with organic vapor & over filter 1000 ppm

  

Note other approved cartridges include:

 Chlorine dioxide

 Formaldehyde

 Hydrogen fluoride

 Hydrogen Sulfide

 Mercury

 Pesticide

 

It is important to note that the listed respirators are not for emergency or high exposure situations.  Air-purifying respirators are not to be used in conditions which are immediately dangerous to life or health (IDLH).

 

Questions about the appropriate respirator should be directed to the supervisor and/or safety manager.

 

APPENDIX 2

 

COMPRESSED AIR QUALITY FOR SUPPLIED AIR SYSTEMS

 

 

High quality breathing air (not oxygen) is required when supplied air respirators or SCBA's are used.  The Oregon OSHA codes (Oregon Administrative Rules Chapter 437, Division 2) require that at least Grade D quality breathing air be supplied.  The specifications for Grade D breathing air are found in Compressed Gas Association Commodity Specification G-7.1-1989.

 

Cylinders of breathing air or compressors may be used.  If compressors are used, it is preferable to use a carbon-vane pump designed especially for supplied air respirator use.  Such pumps are electric or air-driven, oil-free, and are equipped with inlet and outlet filters.  They do not produce carbon monoxide, oil vapor, or oil mist, as other compressors may.

 

If oil lubricated compressors are used, high temperature alarms, CO monitors and special airline filters are required.

 

Fittings and couplings for air lines must be incompatible with outlets for other gas systems to prevent inadvertent servicing of airlines with irrespirable gases or oxygen.

 

It is crucial that air compressors or pumps be placed in locations where the air is clean and breathable at all times.  Compressors and pumps DO NOT remove carbon monoxide, toxic chemicals, or other air contaminants (other than large-size particulates which are filtered out at the inlet filter.  Inlet and outlet filters, as well as other special filters with which some systems may be equipped, must be replaced periodically.

 

 

APPENDIX 3

 

ADDITIONAL SELECTION CRITERIA - ASSIGNED PROTECTION FACTORS

 

 

type of respirator used by NIOSH and the maximum concentration the specific type of respirator can be used for is determined by:

 

 Upper limit of exposure for type of respirator = Protection Factor x Employees airborne concentration

 

EXAMPLE:

 

  Employee’s wood dust exposure level was 10 mg/m3 and the OR-OSHA   permissible exposure limit (PEL) is 5 mg/m3  - what is the upper limit of exposure that a disposable respirator can handle?

 

-       5 mg/m3  x 5 (protection factor) = 25 mg/m3

 

The issue as to what level of protection from a contaminate can be achieved by a particular type of respirator has been established by general guidelines established by NIOSH (National Institute of Occupational Safety and Health).  County employees are required to use respirators with the appropriate protection factors.  Protection factor is a numerical number based on the ability of a respirator to maintain exposure levels below the permissible exposure limits.  

 

The following is the overall guideline for the commonly used respirators by Douglas County employees.  The protection factor number is set by the

  Employee’s exposed to toluene during painting at 150 parts per million (ppm) the PEL is 100            ppm - what is the upper limit of exposure that a half-mask with organic vapor cartridge can handle?

 

                 - 100 ppm x 10 (protection factor) = 1,000 ppm

 

When there are questions about the exposure levels please contact the safety manager.

 

Assigned factors are in the following table:

 

ASSIGNED PROTECTION FACTOR	TYPE OF RESPIRATOR
5	Single use - disposable mask or quarter face piece mask.
10	Any air-purifying half-mask respiratory including the new half-piece disposable equipped with any type of particulate or chemical cartridges (note some chemical cartridge may have approval for less than 10 times the permissible exposure limit)
25	Any powered air-purifying respirator (PAPR) equipped with a hood or helmet and any type of particulate filter.   Any supplied-air respiratory equipped with a hood or helmet operated in a continuous flow mode.
50	Any air-purifying full face piece respirator equipped with HEPA filters.   Any PAPR equipped with tight-fitting face piece and HEPA filters.   Any supplied-air respirator equipped with a tight-fitting face piece and operated in a continuous flow mode.
1,000	Any supplied-air respirator equipped with a half-mask and operated in a pressure demand or other positive pressure modes.
10,000	Any supplied-air full face piece respirator in pressure demand used in combinations with an auxiliary self-contained breathing apparatus operated in a pressure demand or other positive pressure mode cylinder of at least 5 minutes for escape.   Any self-contained respirator equipped with full face piece and operated in a pressure demand or the other positive pressure mode.

 

 

SECTION 2.  RESPIRATORY PROTECTION FORMS

 

The following forms are used to maintain records on our selection, fitting, medical evaluation and program surveillance.

 

Form A -	Respirator Assignment and Fit Record
	First part of the form is filled out by the assigning supervisor
	Second part of the form is completed by the person conducting the fit testing and training which may be supervisor, safety manager or knowledgeable person.
Form B -	Respirator Medical Evaluation Report
	This report is generated by the outside medical provider as to the fitness of the employee for wearing a respirator.
Form C -	Respiratory Protection Program Audit Checklist
	This checklist will be used by safety staff in evaluating the on-going respiratory protection program.

 

FORM A

 

Respirator Assignment And Fit Test Record

RESPIRATOR ASSIGNMENT & FIT RECORD

Date of FITNESS EXAM______________________           Date respirator issued:_____________

Type & Size of respirator issued ___________________________________________________

Respirator cartridges supplied _____________________________________________________

FIT TESTING

           Date: __________________________

           Positive/ Negative Fit Test: __________________________

           Isoamyl Acetate Vapor Test: __________________________

USER INSTRUCTIONS

           Donning and Doffing Methods                  

           Cleaning                                                  

           Maintenance                                            

           Problems with the respirator which require immediately leaving the area and replacing      respirator or seek assistance from YOUR SUPERVISOR or REGION SAFETY OFFICER:

                     Breathing becomes difficult                                                       

                     Dizziness or other distress                                                        

                     Sense irritation, smell or taste contaminants                             

 

1. The employee understands that a respirator must fit properly in order to be effective.  I have had my respirator tested for face-to face seal.  I have worn a respirator in normal air to familiarize myself with it, and have then worn it in a testing atmosphere.

 

2. I have received written & demonstrated practice instructions on wearing a respirator. I know how to adjust it & determine if it is fitting properly.  I am aware that I am in violation of safety code if wear the respirator with a beard, sideburns or skull cap.  I also understand that proper seal cannot be made over the temples of eye glasses.

 

3. I understand that I am responsible for the daily cleaning (or after each use) and proper storage of the respirator.

 

Employee Signature _________________________________________   Date _______________

 

Supervisor Signature ________________________________________   Date ________________

 

FORM B

 

 

Medical Evaluation Report

 

 

 

 

 

 

 

 

 

Physician (or other) Licensed Health Care Professional

 

Respirator Recommendation

 

Employer Name:                                                                                                       

 

 

                    The employee is able to use a respirator according to the supplemental information provided by employer.

 

                    The employees’ medical condition requires the following limitations regarding use of a respirator.

 

                                                                                                                                                       

 

                                                                                                                                                           

    The employee is unable to use a respirator until further medical evaluations are performed.

 

                   Physician:_________________________Facility:____________________________ 

 

                   Appointment Date:                                                      Time: _____________________ 

 

   “Authorization to Disclose Medical Records” (attached to employee’s copy)

 

                   The employee has been provided with a copy of the PLHCP Respirator Recommendations.

 

 

PLHCP Signature:                                                                                                                        

Date:                                                                                                                                             

 

            mailed to employer                    mailed to employee                        Occuhealth copy

 

           Completed by: ____________________________  Date: ___________________________

 

 

 

FORM C

 

 

Respiratory Program Evaluation Checklist

 

RESPIRATORY PROTECTION PROGRAM CHECKLIST

 

A.  PROGRAM ADMINISTRATION

 

____1.  Is there a written policy which assigns program responsibility, accountability, and authority? 

 

____2.  Is overall program responsibility given to one person who is knowledgeable and can coordinate all aspects of the

             program?

 

____3.  Can feasible engineering controls or work practices eliminate the need for respirators?

 

____4.  Are there written procedures/statements covering the various aspects of the respirator program, including:

 

           ______designation of authority and responsibility;

           ______respirator selection;

           ______purchase of approved equipment;

           ______medical aspects of respirator usage;

           ______issuance of equipment;

           ______fitting;

           ______training;

           ______maintenance, storage, and repair;

           ______inspection;

           ______use under special conditions;

           ______when and where respirators are required?

 

B.  PROGRAM OPERATION

 

1.  Respiratory protective equipment selection

______ Have work area conditions and worker exposures been properly evaluated?

______ Are respirators selected on the basis of hazards to which the workers are exposed?

______ Are selections made by persons knowledgeable of proper selection procedures?

______ Are only NIOSH approved respirators purchased and used?

______ Do the respirators provide adequate protection for the specific hazard in the concentration found?

______ Has a medical evaluation of the prospective user been made to determine physical and psychological fitness to

             wear the selected respirator?

______ Where practical, have respirators been issued to single users?

 

2. Respiratory protective equipment fitting

______ Are the users given the opportunity to try on several respirators to determine the one with the best fit?

______ Is the fit tested before the wearer begins using the respirator in the work area, both on initial assignment, and on a

            daily basis (positive and negative pressure tests)?

______ Are users who wear glassed properly fitted?

______ Is the face piece-to-face seal tested using one of the methods described earlier?

______ Are workers prohibited from entering contaminated work areas when they have facial hair or other characteristics

             which prohibit the use of tight-fitting face pieces?

3. Respirator use in the work area

______ Are respirators being worn correctly?

______ Are workers keeping respirators on all the time while in the work area?

 

4. Maintenance of respiratory protective equipment

______ Are respirators cleaned and sanitized after each use (when different people use the same device) or as frequently as

             necessary (for devices issued to individual users)?

______ Are respirators stored so as to protect them from dust, sunlight, heat, and chemicals?

______ Is storage in lockers, tool boxes, or work areas permitted only if the respirator is in a carton, carrying case, or

             closed container?

______ Are respirators inspected before and after each use, and after cleanup?

______ Are individuals instructed in inspection methods?

______ Are cartridges and filters changed on a regular basis?

______ Are respirators designated as "Emergency Use" inspected at least monthly (in addition to after each use), and is a

             record kept of such inspections?

______ Are replacement parts of the same brand as the respirator?

______ Are repairs made by manufacturers or manufacturer-trained persons?

 

5. Special use conditions (if applicable)

______ Is there a procedure for respirator use in atmospheres immediately dangerous to life and health?

______ Is there a procedure for confined space entry?

 

6. Training

______ Are users trained in proper respirator use, cleaning, and inspection?

______ Are employees trained in the health effects of the respiratory hazard present?

______ Are users evaluated, using competency-based evaluation, before and after training?

 

SECTION 3.  Respirator Fit Testing

 

Respirator fit is extremely important.  Respirator fit testing is used to test how well the tight fitting respirator face piece seals against the face.  If there is not a good face-to-face piece seal, the contaminants may pass around the face piece and be breathed into the lungs.  The results of the fit test are to be recorded on Form A - Respirator Selection and Fit Record.  Respirator fit testing must be conducted annually.

 

Respirator fit testing may be done using two basic methods: qualitative or quantitative fit testing.  Most employers use qualitative methods since quantitative procedures may be expensive and require complicated equipment.  Currently only certain rules required quantitative fit test which include lead and asbestos regulations once exposure levels reach a certain exposure level.

 

Quantitative fit testing uses sophisticated equipment to measure the amount, if any of test material that leaks into the face piece of the respirator.  County operations do not have exposures of the type of contaminates that requires quantitative fit testing.

 

Qualitative fit testing must to be done upon initial assignment of a respirator and annually there after. Once the employee passes a fit test using a proper respirator, they should perform a simple daily negative or positive pressure test to ensure that the respirator is properly worn.

 

Respirators that are mandatory are not to be worn if the wearer has facial hair (beards or stubble).  Head coverings, scars, and missing dentures or teeth can also affect respirator fit.  Glasses will interfere with fit when using a full face piece.  Full face piece can be fitted with spectacle inserts.

 

No one is permitted to cut off respirator straps, leave the straps off or wear them too loosely.

 

Positive and Negative Pressure Tests

 

Each time a respirator is put on, and prior to the qualitative fit testing procedures, the wearer should conduct a positive and a negative pressure test to ensure that the respirator is seated correctly against the face.

 

The negative pressure test is performed on any respirator with a tight fitting face piece. For cartridge respirators, the test consists of covering the air inlet lightly and inhaling lightly, then holding the breath for a few seconds. For SCBA and supplied air respirators, block the end of the breathing tube so it will not allow air in.  Inhale lightly and hold the breath for a few seconds. In either type, if a leak exists, the air can be felt as it enters.  The common leak areas are around the nose and chin.