REMAIN in App State Respiratory Protection Program

What it Means to Remain in the Respiratory Protection Program
How to Remain in the App State Respiratory Protection Program
Periodic & Followup Medical Evaluation Forms

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What it Means to Remain 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 remain in the University Respiratory Protection Program for as long as you continue to use a respirator. This means that you will:

  1. Have periodic and/or follow-up medical evaluations if required by OSHA, State or University policy, or if recommended by the occupational medicine provider. However, unless you have exposure to certain materials such as asbestos, follow-up medical evaluations are rarely required. For persons not exposed to asbestos, the medical provider will decide if and when you need follow-up during your initial visit. For persons who are exposed to asbestos, annual medical evaluations are required by OSHA. Your department will pay for all medical evaluations and tests. 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 annual respirator training conducted by EHS&EM. There is no charge. You cannot be asked to use leave time to attend.
  3. Have an initial and annual respirator fit-test conducted by EHS&EM. There is no charge. You cannot be asked 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 REMAIN in the App State Respiratory Protection Program

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

  1. Contact the Respiratory Protection Program Manager if there has been any change in: (1) your respirator's comfort or effectiveness; (2) any change in the work process or chemicals used; (3) any significant change in your health or ability to wear a respirator; (4) any concerns that may affect your ability to safely wear a respirator.
  2. In the unlikely event air monitoring is necessary to address new issues, the Respiratory Protection Program Manager will make the necessary arrangements with you.
  3. If you are not required to receive an annual or other follow-up medical evaluation, skip to step 2 below.

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. If you are required to receive an annual or other follow-up medical evaluation, schedule your medical evaluation using the App State Workshops registration site: select the "Environmental, Health, Safety, & Emerg Mgt" community and look for "2013 Respiratory Medical Evaluations."  If no slots are listed or available, contact the Respiratory Protection Program Manager.       

    1. Complete the applicable Periodic or Followup Medical Evaluation Forms below. Do not give a copy to anyone at App State; these are between you and the medical provider only!
    2. Bring your completed forms and a photo ID to your medical evaluation.
    3. 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.
  2. Now that you are medically approved to wear a respirator, click here to see when EHS&EM's next Respiratory Protection Training & Fit-Testing Week will be held (usually in the Fall).

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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Periodic & Follow-Up Medical Evaluation Forms

You have indicated that this is a periodic or follow-up medical evaluation for respirator use.
Use the table below to find the reason you wear a respirator, and complete the forms required.

 

Please review and complete the forms here.

 

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

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

If you have not already scheduled your medical evaluation, click here to go back up to step 4 in this procedure.

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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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