Medical Evaluation

After selecting the correct respirator specified by the label of the pesticide product to be used, an agricultural employer must provide the pesticide handler with a medical evaluation.  The requirement for a medical evaluation applies to all respirators, regardless of the type, level of protection, or whether it is tight-fitting or loose-fitting.  The medical evaluation must be performed by a physician or other licensed health-care professional (PLHCP) at no cost to the employee.  The pesticide handler must be medically evaluated before being fit-tested or using the respirator.

Why is a medical evaluation necessary prior to using a respirator?

Breathing through a respirator requires more effort than breathing ambient air.  The added effort can stress the heart and lungs.  This varies with the type of respirator worn, the job and conditions in which the respirator is used, and the medical status of the pesticide handler.  Pesticide handlers must be medically evaluated to determine their ability to use a respirator without placing their health at risk.

What does a medical evaluation consist of?

The PLHCP performs the medical evaluation using a medical questionnaire or initial medical examination that obtains the same information requested by the Occupational Safety and Health Administration (OSHA) Respirator Medical Evaluation Questionnaire.  The medical evaluation must be conducted in a manner that ensures the employee understands the questions and terms.  The medical questionnaire must be administered confidentially during normal working hours or at a time and place convenient to the handler.  Written responses to the questionnaire can be delivered to the PLHCP in person or by mail yet the employee must be provided with an opportunity to discuss the questionnaire and examination results with the PLHCP.  The handler’s responses to the questionnaire must not be reviewed by the handler employer.  A follow-up medical examination must be provided for an employee who answers “Yes” to any question among questions 1 through 8 in Section 2, Part A of OSHA’s Respirator Medical Evaluation Questionnaire or whose initial medical examination demonstrates the need for a follow-up medical examination.  While the employer has the option of not allowing the employee to undergo further evaluation, the employer cannot allow that employee to participate in any handler activities that require the use of a respirator.

Obtaining a medical evaluation

Agricultural employers can find a local PLHCP who provides respirator medical evaluation services by looking up occupational healthcare providers in their area.  Although any healthcare professional with the appropriate license may perform a medical evaluation, not all focus on occupational medicine, are familiar with OSHA’s requirements, or have medical evaluation forms on file.

Before the PLHCP can approve or disapprove an agricultural employee’s use of a respirator, the PLHCP needs the following information:

• • • The type and weight of the respirator to be used by the employee;
    • The duration and frequency of respirator use;
    • The expected physical work effort;
    • Additional protective clothing and equipment to be worn; and
    • Temperature and humidity extremes that may be encountered.

Additional medical evaluations

An agricultural employer must provide additional medical evaluations if:

1. 1. • The medical determination is only good for a specified length of time;
      • The employee reports medical signs or symptoms that are related to ability to use a respirator;
      • The PLHCP, a supervisor, or observations made during fit-testing indicate a need for employee reevaluation; or
      • A change occurs in working conditions (e.g., physical work effort, protective clothing, temperature) that increases respiratory stress on the employee.

What kind of medical evaluation documentation must be maintained and for how long?

The PLHCP provides the agricultural employer with a written medical determination of an employee’s ability to use the respirator that includes the following information:

• • • Any limitations on respirator use related to the medical condition of the employee, or relating to the workplace conditions in which the respirator will be used, including whether or not the employee is medically able to use the respirator;
    • The need, if any, for follow-up medical evaluations; and
    • A statement that the PLHCP has provided the employee with a copy of the PLHCP’s written recommendation.

The agricultural employer must maintain a copy of the written medical determination for at least two years.