SCBA - Medical evaluation Q&A

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QUESTIONS AND ANSWERS ON THE RESPIRATORY PROTECTION STANDARD

Note: The page numbers referenced at the end of some of the Questions refer to specific pages in the January 8, 1998, Federal Register, Volume 63, No. 5. (Revised August 17, 1998)

Paragraph (e) Medical Evaluation
(e)(1)
Q. Are seasonal or temporary workers exempt from the requirement for medical evaluations? (FR p. 1209-1210)

A. No. The frequency and duration of respirator use and the worker’s term of employment,
does not affect the requirement for medical evaluation.

Q. Can a fit test for a respirator be performed before the initial medical evaluation has been completed? (FR p.1209)

A. No. The initial medical evaluation must be conducted prior to fit testing to identify
individuals whose health may be harmed by the limited amount of respirator use associated with fit testing.

Q. Are employees who use filtering facepiece respirators (dust masks) voluntarily (e.g., for employee comfort) also required to have medical evaluations? (FR p.1190, 1210)

A. No. If the employer has determined that there is no hazard, and dust mask use is
voluntary, then no medical evaluation is required. If employers allow voluntary use of this type of respirator, then they must provide the employee the information contained in
Appendix D of the standard, and ensure that such respirator use will not itself create a
hazard.

Q. Are medical evaluations required for positive pressure, as well as negative pressure,
respirators? (FR p.1210)

A. Yes. Clinical studies show that positive pressure respirator use can harm the employee.

(e)(2)(i)
Q. Are physicians the only medical professionals allowed to perform medical evaluations for respirator use? (FR p.1211)

A. No. A variety of health care professionals may do this depending on the scope of practice permitted by the state’s licensing, registration, or certification agencies. Each employer must check with the state licensing agency to see if other health care professionals under their state law can independently perform this evaluation, or must do so under the direction of a licensed physician. Attached to this document is a phone listing of all the17 State Licensing Boards in the United States, to assist in determining compliance with this provision.

Q. Can a nurse who does not meet the qualifications of a PLHCP assess a questionnaire? (FR p. 1212)

A. A nurse not otherwise qualified to be the PLHCP can perform some tasks, such as distributing the questionnaire, respond to some questions such as providing advice to employees on where they can obtain assistance in understanding or reading the questions, and gathering the completed forms in preparation for delivery to the PLHCP. If the nurse is working under the direction of a physician (or other PLHCP consistent with state law) who will perform the final review of the assessment, then this arrangement is acceptable.

(e)(2)(ii)
Q. Does the employer have to use the exact language of the questionnaire in Appendix C if they choose to evaluate by medical questionnaire? (FR p. 1212)

A. The language of Part A , Appendix C is mandatory if the employer chooses to medically evaluate by questionnaire. The employer may choose a medical examination in lieu of the medical questionnaire.

Q. If the employer chooses to provide physical exams , rather than use the questionnaire, what information must be obtained?

A. The employer who chooses to skip the questionnaire, and instead go directly to an exam shall ensure that the exam obtains the same information as is found in the questionnaire.

Q. May the PLHCP add questions to the questionnaire provided in Appendix C? (FR p.
1283)

A. Yes. Part B of the questionnaire contains 19 optional questions that may be added In addition, the instructions to Part B state that any other questions not listed can be added.

(e)(3)(i)
Q. Who determines the scope and form of the medical evaluation if an employee gives a positive response to questions 1 through 8 in Section 2, Part A of the questionnaire? (FR
1214)

A. The PLHCP makes this determination. The PLHCP is also expected to refer the employee to a physician if warranted.

Q. If there is a single positive response on the questionnaire, does that automatically require a face-to-face visit with the PLHCP? (FR p. 1214)

A. No, the scope of the medical evaluation is left to the discretion and professional judgment of the PLHCP. There may be occasions where all that is needed is clarification of an issue by telephone.

(e)(3)(ii)
Q. If a PLHCPs scope of practice is limited to questionnaire evaluation or a basic physical exam, can that PLHCP still be used even though further testing and decision making may be necessary? (FR p.1214)

A. Yes. In some cases where medical issues arise that are beyond the scope of the PLHCP’s license, the remainder of the evaluation will need to involve a physician or other authorized health care professional (for example, conducted under the direction of a physician).

Q. Can an employee decline to be medically evaluated for the use of a respirator? (FR p.1220-1221)

A. Paragraph (e)(1) requires the employer to provide a medical evaluation to an employee before the employee uses a respirator in the work place. Therefore, an employee cannot refuse to undergo medical evaluation and continue to use a respirator.

(e)(4)(i)
Q. Who pays for the medical evaluation and any subsequent exams? (FR 1214) 19

A. The employer must pay for the medical evaluation and any related expenses incurred by the employee during the evaluation, including travel costs.

Q. Does the medical questionnaire have to be administered by a PLHCP? (FR 1214-1215)

A. While the employee must be able to discuss the results of the questionnaire with the PLHCP, the standard does not specify the qualifications of the individual who administers the medical questionnaire.

Q. How does an employer ensure the employee understands the questions on the medical questionnaire if the employee only speaks and/or reads a language other than English?
(FR p. 1215)

A. Under these circumstances, the PLHCP can assist the employee in filling out the questionnaire, with the aid of an employer-provided interpreter. The interpreter need not
be a professional and can be a bilingual employee, family member, or friend who is fluent in the native language of the person answering the questionnaire. The employer may also have the questionnaire translated into the appropriate language.

Q. What happens if an employee has difficulty reading or understanding the questionnaire? (FR p.1215)

A. The employer must take action to ensure the employee understands the questionnaire. The employer may have the PLHCP assist the employee in filling out the medical
questionnaire or go directly to a physical examination.

Q. Why does the questionnaire in Appendix C begin with the question “can you read”? (FR p.1215 & 1282)

A. This question is included to remind those who are responsible for administering and reviewing the questionnaire that employees who cannot read may need additional assistance in completing the questionnaire.

(e)(4)(ii)
Q. How can an employer ensure the employee understands the medical questionnaire while still meeting the requirements of confidentiality? (FR p.1215)

A. Since the medical questionnaire provided in the standard was designed to be easily understood, oversight should not generally be necessary. When employees have questions
about the questionnaire, they must be provided with the opportunity to discuss the questions with the PLHCP.

Q. What procedures should be used to maintain confidentiality if the questionnaire is administered by the employer? (FR p.1215 & 1282)

A. The directions to the employee for answering the medical questionnaire state that the employer must not look at or review their answers. The employee must be instructed on how to deliver or send the completed questionnaire to the PLHCP who will review it. One method for accomplishing this task is for the employer to provide the employee with a stamped envelope addressed to the PLHCP at the time the questionnaire is administered.

(e)(5)(i)
Q. Why does supplemental information need to be provided to the PLHCP? (FR p.1216- 1217)

A. When evaluating an employee’s medical limitations, the PLHCP may need to consider other workplace variables that may increase pulmonary and cardiovascular stress during respirator use.

Q. Why is there no specific requirement to give the PLHCP a list of substances the employee may be exposed to? (FR 1215-1216)

A. The company’s written respiratory program already specifies the exposure conditions that require the use of a respirator. A copy of the written program must be provided to the PLHCP instead. The program will provide the necessary information to the PLHCP without imposing an additional paperwork burden on employers.

Q. Does the PLHCP have to visit the worksite to perform a medical evaluation? (FR p.1217)

A. While it might be helpful for the PLHCP to visit the site, there is no requirement to do so under the standard. The supplemental information required to be provided to the PLHCP by the standard is sufficient for the PLHCP to make a valid recommendation on the employee’s ability to wear a respirator.

(e)(5)(ii)
Q. How often must supplemental information be provided to the PLHCP? (FR p.1217)

A. It need only be provided once, unless there are changes in the supplemental information; in that case updated information must be provided to the PLHCP. If you change PLHCP’s, then the employer must assure that all the information has been transferred or that new documents are provided to the new PLHCP.

Q. Can an employer choose to let each employee use their own personal physician to provide a medical evaluation rather than using the employer’s PLHCP? (FR p.1217)

A. Yes. This may be a workable system where few employees are involved. The employer will have to contact each of these PLHCPs and provide them with a copy of the Respiratory Protection standard and other required supplemental information, as well as updates when required. The employer shall bear the costs of the evaluation. It is not acceptable for an employee to use their health insurance for this purpose, unless the employer pays 100% of the insurance premiums.

(e)(6)(i)
Q. Who is responsible for determining an employee’s ability to use a respirator? (FR p.1218)

A. The responsibility rests with the employer. The PLHCP’s opinion regarding the employee’s medical ability to wear a respirator is an important element in making the final determination.

Q. Does the PLHCP’s opinion on the employee’s medical ability to use a respirator have to be in writing? (FR p. 1218)

A. Yes.

Q. If the PLHCP discovers that the employee uses drugs, does the PLHCP have an obligation to tell the employer? (FR p.1218)

A. No. The PLHCP must maintain strict confidentiality on specific medical findings unrelated to the ability to wear a respirator. Information regarding pregnancy, genetic susceptibility, mental health problems, and drug use are not to be revealed to the employer when they result from the medical evaluation process. These findings must remain confidential. How specific medical information is addressed between the employee and PLHCP should be determined by the legal, professional, and ethical standards that govern the PLHCP’s practice.

Q. Can the employer maintain a copy of the employee’s completed medical questionnaire? (FR p.1218 & 1282)

A. No. The employer must maintain only the PLHCP’s written recommendation on an employee’s eligibility to wear a respirator. The completed questionnaire and PLHCP’s documented findings or diagnosis are confidential and must not be maintained by the employer. An exception is made when the employer’s health office is administratively separate from the employer’s central administration offices.

Q. How does the PLHCP’s opinion affect periodic medical evaluation? (FR p. 1218)

A. The final standard does not automatically require periodic medical reevaluation. It is critical, however, that the PLHCP address this issue in their medical opinion. If there is an underlying medical concern that requires periodic medical reevaluation, it must be included in the written medical opinion so that the employee can be monitored in the future by the PLHCP.

Q. How can the employee obtain a copy of their medical evaluation or the medical questionnaire? (FR p.1218)

A. The employer is required to provide a copy of the written opinion to the employee. The written opinion should be provided by the PLHCP but can be provided by the employer. Requests for copies of the questionnaire should be made to the PLHCP consistent with the requirements of 29 CFR 1910.1020, “Access to Employee Exposure and Medical Records”.

(e)(7)
Q. Does the employer have to medically reevaluate the employee’s ability to wear a respirator on an annual basis? (FR 1219)

A. No. There is no annual or periodic requirement for medical reevaluation. The standard lists four conditions that trigger medical reevaluation: an employee reports signs or symptoms related to the ability to wear a respirator; the PLHCP, administrator or supervisor determine it is necessary; information from the respiratory protection program indicates a need for reevaluation; or a change in workplace conditions substantially increases the physiological burden placed on the employee.(FR p.1219-1220)

Q. Is there a medical removal provision in this standard for persons medically unable to wear a respirator? (FR p.1220)

A. No. The final standard does not include a medical removal provision.

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