Standard Interpretations - Table of Contents
• Standard Number: 1910.134(e)(2); 1910.134 App C

January 4, 1999

Mr. Stephen P. Wolf, CIH, CSP, CHMM
Corporate Industrial Hygienist
Akzo Nobel Chemical
300 South Riverside Plaza
Chicago, Ill 60606

Dear Mr. Wolf:

This is in response to your letter dated September 1, addressed to the Occupational Safety and Health Administration's (OSHA's) Office of Health Compliance Assistance (OHCA). In your letter you requested that OSHA review your respirator questionnaire. Unfortunately, we do not approve questionnaires. However, we can provide you with some guidance regarding what we expect in a modified form.

In your letter you stated that you have slightly reworded some questions to allow for a scannable format. The medical questionnaire does not have to be in the same format as Appendix C. The form can be converted to a scannable format, as you have done with yours. The employee in this case will fill in a circle with a No. 2 pencil next to the appropriate "Yes" or "No" rather than a circle around the word "Yes" or "No" as presented in the Appendix. Some of the questions in Section 1 of Part A can be reworded to get the same information. Question 3 can be reworded to ask for an employee's date of birth rather that his or her age (to nearest year). Question 5 can ask for height in inches, rather than feet and inches.

The questions in Part A. Section 2 are Mandatory, if the form is to be the sole basis for evaluating an employee's ability to use a respirator. All questions must be asked and each worded in the same manner as the Appendix in any form that is generated by the employer or a third party. The order of the questions can be changed and additional questions can be asked, if the Physician or other Licensed Health Care Practi