Procedure to ENROLL in the App State Respiratory Protection Program

What it Means to Enroll in the Respiratory Protection Program
How to Enroll in the App State Respiratory Protection Program
Initial Medical Evaluation Forms

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What it Means to Enroll in the Respiratory Protection Program

If you are required to wear a respirator, or if you voluntarily choose to wear any kind of respirator other than a "dust mask," you must enroll in the University Respiratory Protection Program. This means that you will:

  1. Have an initial medical evaluation by the App State occupational medicine provider. Your department will bear the cost. You will be scheduled at a time reasonably convenient for you, and you do not have to use leave time for the appointment.
  2. Attend initial and annual respirator training conducted by EHS&EM. There is no charge. You do not have to use leave time to attend.
  3. Have an initial and annual respirator fit-test conducted by EHS&EM. There is no charge. You do not have to use leave to attend. Whenever possible, the fit-testing is held within the same week as the training.

For more information about the App State Respiratory Protection Program, go to the main Respiratory Protection page.

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Procedure to Enroll in the App State Respiratory Protection Program

To initially enroll in the App State Respiratory Protection Program, complete the following steps together with your Shop/Area Supervisor or Department Chair or Facility Manager:

  1. Contact the Respiratory Protection Program Manager to find out what kind of respirator and what kind of medical evaluation you will need. Avoid purchasing a respirator before this consultation.
  2. If air monitoring is necessary to determine the type or changeout schedule for respirator filters, then the Respiratory Protection Program Manager will make the necessary arrangements with you.

The remaining instructions may not be accurate. Contact the Respiratory Protection Program Manager for up-to-date instructions.We appreciate your patience as we work out new procedures with our new occupational health provider.  

  1. Sign up for a medical evaluation by registering for a time slot on the App State Workshops registration site (select the "Environmental, Health, Safety, & Emerg Mgt" community). If no slots are available, contact the Respiratory Protection Program Manager.
  2. Complete the applicable Initial Medical Evaluation Forms below. Only complete the forms that apply to you. Some forms can be filled out online and emailed if you use a digital signature; otherwise they can be filled out online and printed for a handwritten signature. Do not give a copy of your forms to anyone at App State; these are between you and the occupational medicine provider only!
  3. Bring your completed forms and a photo ID to your medical evaluation.
  4. At your medical evaluation, the occupational medicine provider will tell you whether you are medically able to wear a respirator. If the medical provider has any followup requirements or has placed any restrictions on your respirator use, they will inform you at that time.  The medical provider also will return the completed Medical Approval Form to the EHS&EM Office.  This form simply confirms that the provider did the correct evaluation, and indicates the extent to which you are medically able to wear a respirator. This is the only information App State receives; by law, no one at App State receives any information about your medical questionnaire or what you discussed with the medical provider.
  5. Once you are approved to wear a respirator, click here to see when EHS&EM's next Respiratory Protection Training & Fit-Testing Event will be held (usually in the Fall).  If you must do work that requires wearing a respirator before the event, contact the Respiratory Protection Program Manager to arrange one-on-one training and fit-testing (please note that one-on-one training/fit-testing takes more of your time than attending a session during the annual event).

If you encounter any problems with this process, or at the occupational medicine provider's office, please contact the Respiratory Protection Program Manager for help.

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Initial Medical Evaluation Forms

This your first ("initial") medical evaluation for respirator use.

Use the table below to find the reason you need a respirator, and complete the forms required.

Please be sure to bring the completed forms and a photo ID with you to your medical evaluation!  

FORMS FOR INITIAL MEDICAL EVALUATION: 
REASON(S) WHY YOU WEAR A RESPIRATORCOMPLETE, PRINT, & BRING THESE FORMS TO MEDICAL EVALUATION
You wear a respirator to work with asbestos . . . . . . . . . . . . . . . . . .Complete Medical Approval for Respirator Use for Asbestos Exposed Employees & Medical Questionnaire, Appendix D
You wear a respirator to work with formaldehyde or formalinComplete Medical Approval for Non-Asbestos Respirator Use, Medical Questionnaire, Appendix CMedical Questionnaire, Appendix D
You wear a respirator to handle research animals or their beddingComplete Medical Approval for Non-Asbestos Respirator UseMedical Questionnaire Appendix C and if not done previously, submit the Office of Research Protections' "OHS Form for Faculty/Staff"
You wear a respirator for any reason not listed above . . . . . . . . . .Complete Medical Approval for Non-Asbestos Respirator Use & Medical Questionnaire Appendix C 

Remember, you must complete the medical evaluation before attending training/fit-testing!

If you have not already scheduled your medical evaluation, click here.

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If you encounter any problems with this process, or at the occupational medicine provider's office, please contact the Respiratory Protection Program Manager for help.

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(last updated May 13, 2021)

 

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Office of Environmental Health, Safety and Emergency Management
P.O. Box 32112
Boone, NC, 28608 USA
(828) 262-4008

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1039 State Farm Road
Boone, NC

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