OSHA Respirator Medical Evaluation Questionnaire
Part A - Section 2. (Mandatory) Questions 1 through 9 below must be answered by every employee who has been selected to use any type of respirator. Do you currently smoke tobacco or have you smoked tobacco in the last month? Yes No. 2. Have you ever had any of the following conditions? a. Seizures (fits)? Yes No. b. Diabetes (sugar disease)? Yes No ................
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