Sample Respiratory Protection Program (Page 2 of 9) in pdf

IV.

Respirator Selection

___________________ (program administrator) will select respirators to be

used on site, based on the hazards to which workers are exposed. He will

conduct a hazard evaluation for each operation, process, or work area that

will include:

1. Identification and development of a list of hazardous substances used in

the workplace, by department, or work process.

2. Review of work processes to determine where potential exposures to

these hazardous substances may occur.

3. Exposure monitoring to quantify potential hazardous exposures.

End of Service Life Indicators will be used. If there is no ESLI

appropriate for conditions in the employer's workplace, the employer

implements a change schedule for canisters and cartridges that is

based on objective information or data that will ensure that canisters

and cartridges are changed before the end of their service life. The

employer shall describe in the respirator program the information

and data relied upon and the basis for the canister and cartridge

change schedule and the basis for reliance on the data.

EXPOSURE

DEPARTMENT CONTAMINANTS

LEVEL

PEL CONTROLS

(8-hr TWA)

_____________ ________________ __________ ____ ___________

Medical Evaluations

1. __________________ (program administrator) is responsible for seeing

that medical evaluations are conducted to determine that employees who

are required to, or those who are allowed to voluntarily wear respirators

are medically able to do so.

2. ____________________ ( name of licensed health care professional) of

_________________________ (name of clinic or hospital) will provide

the medical evaluations.

3. Medical evaluations will be conducted using Appendix C of the standard.

__________ (program administrator) will give a copy to all employees

requiring medical evaluations to complete and ____________________

___________________ (how to send or take to doctor or clinic/hospital).

4. Follow-up medical exams will be granted as found necessary by the

_____________________________________ (doctor or clinic/hospital).

5. All employees will be granted an opportunity to speak with __________

Sample Respiratory Protection Program Page 2