{"id":208,"date":"2014-03-03T12:19:23","date_gmt":"2014-03-03T18:19:23","guid":{"rendered":"https:\/\/wp.stolaf.edu\/facilities\/?page_id=208"},"modified":"2023-06-07T08:18:49","modified_gmt":"2023-06-07T13:18:49","slug":"section3","status":"publish","type":"page","link":"https:\/\/wp.stolaf.edu\/facilities\/respiratory-protection-program\/section3\/","title":{"rendered":"Section 3 &#8211; Exposure and Evaluation"},"content":{"rendered":"<div data-modular-content-collection><p><strong><a name=\"top\"><\/a>Table of Contents:<\/strong><\/p>\n<ul>\n<li><a href=\"#id\">Identification and Location of Exposures<\/a><\/li>\n<li><a href=\"#medeval\">Medical Evaluation<\/a><\/li>\n<li><a href=\"#medhistory\">Medical History for Respiratory Protection Use<\/a><\/li>\n<li><a href=\"#phyeval\">Physician&#8217;s Evaluation<\/a><\/li>\n<li><a href=\"#medqual\">Medical Qualification for Respirator Use<\/a><\/li>\n<\/ul>\n<p><a href=\"https:\/\/wp.stolaf.edu\/facilities\/respiratory-protection-program\/\"><strong>Respiratory Protection Table of Contents<\/strong><\/a><\/p>\n<hr style=\"width: 100%;\" width=\"100%\" \/>\n<h2><\/h2>\n<h2><a name=\"id\"><\/a>Identification and Location of Exposures<\/h2>\n<ol style=\"list-style-type: upper-alpha;\">\n<li>Products or jobs which may indicate or which do require the use of respiratory protection are listed in the Facilities Application Section.<\/li>\n<li>Any task or product may be reevaluated any time there is a change in the nature of the job or product. Employee complaint will also trigger a review of a task or product.<\/li>\n<\/ol>\n<p><a href=\"#top\"><b>Top of Page<\/b><\/a><b><\/b><\/p>\n<hr \/>\n<h2><\/h2>\n<h2><a name=\"medeval\"><\/a>Medical Evaluation<\/h2>\n<ol style=\"list-style-type: upper-alpha;\">\n<li>River Valley Clinic will assess the ability of each employee required to wear a respirator to do so. A medical history questionnaire will be filled out by prospective respirator users and evaluated by a physician. A medical exam shall be performed as recommended by the physician. This assessment shall be repeated every two years or whenever a change in the employee&#8217;s medical condition occurs.<\/li>\n<\/ol>\n<p><a href=\"#top\"><b>Top of Page<\/b><\/a><\/p>\n<hr \/>\n<h2><\/h2>\n<h2><a name=\"medhistory\"><\/a>Medical History for Respiratory Protection Use<\/h2>\n<ol style=\"list-style-type: upper-alpha;\">\n<li>For our physician to properly assess the ability of an employee to wear a respirator, each employee&#8217;s medical history must be known. This questionnaire will aid in that regard. In addition to this questionnaire, the reviewing physician may require a physical exam and a pulmonary function test to be performed.<\/li>\n<\/ol>\n<pre>Employee_________________________ Job Title__________________\r\n\r\nType of Exposure(s)__________________________________________\r\n\r\nRespirator Recommended_______________________________________\r\n                      Manufacturer  Model  Type  Size\r\n\r\nPlease fill out this questionnaire as accurately as possible.\r\n\r\nYes  No\r\n___  ___   Do you Have insulin dependent diabetes or mellitus?\r\n\r\n           Do you have epilepsy, grand mal or petit mal (uncontrolled; \r\n___  ___   e.g., seizure within the past six months)?\r\n\r\n___  ___   Has your health changed for the worse within the past year?\r\n\r\n___  ___   Do you use medications?  Please list:\r\n\r\n___  ___   Have you ever had a punctured ear drum?\r\n\r\n___  ___   Do you have any skin sensitivities (allergies)?\r\n\r\n___  ___   Do you have impaired or nonexistent sense of smell?\r\n\r\n___  ___   Do you have emphysema?\r\n\r\n___  ___   Do you have chronic pulmonary obstructive disease (CPOD)?\r\n\r\n___  ___   Do you have asthma (wheezing)?\r\n\r\n           Do you have or have you ever had pneumoconiosis (dust related\r\n___  ___   disease)?\r\n\r\n           Is there any evidence of reduced pulmonary function to your\r\n___  ___   knowledge?\r\n\r\n           Do you have a history of heart attack, stroke, or other heart\r\n___  ___   problems?\r\n\r\n___  ___   Do you have untreated or uncontrolled hypertension?\r\n\r\n           Do you have other breathing problems?  Write down specific \r\n___  ___   problems on the back of this form.\r\n\r\n           Have you ever experienced breathing difficulty when wearing a\r\n___  ___   respirator?\r\n\r\n           Have you ever experienced claustrophobia when wearing a \r\n___  ___   respirator (afraid of being closed in)?\r\n\r\n           Do you have a problem walking up two flights of stairs at a\r\n___  ___   rapid pace?\r\n\r\n           Are there any other conditions that you feel could affect the\r\n___  ___   safe use of a respirator?\r\n\r\n           Have you smoked more than one pack of cigarettes a day for the \r\n___  ___   previous ten years?\r\n\r\n           COMMENTS:\r\n\r\nSignature ________________________________________  Date ________________<\/pre>\n<p>&nbsp;<\/p>\n<p><a href=\"#top\"><strong>Top of Page<\/strong><\/a><\/p>\n<hr \/>\n<h2><\/h2>\n<h2><a name=\"phyeval\"><\/a>Physician&#8217;s Evaluation<\/h2>\n<pre>Employee Name: ____________________________________________\r\n\r\nCLASS:        1.No restrictions on respirator use.\r\n(Circle\r\n  One)        2.Some specific use restrictions.\r\n\r\n              3.No respirator use permitted.\r\n\r\nRestrictions:\r\n___________________________________________________________________             \r\n\r\n___________________________________________________________________\r\n\r\n___________________________________________________________________\r\n\r\n___________________________________    ___________________________________\r\n        Examining Physician                   Physician's Signature\r\n\r\n                                       ___________________________________\r\n                                                      Date<\/pre>\n<p><a href=\"#top\"><strong>Top of Page<\/strong><\/a><\/p>\n<hr \/>\n<h2><\/h2>\n<h2><a name=\"medqual\"><\/a>Medical Qualification for Respirator Use<\/h2>\n<p>I have examined the Questionnaires from the following employees of St. Olaf College:<\/p>\n<pre>___________________    ____________________    \r\n\r\n___________________    ____________________           \r\n\r\n___________________    ____________________    \r\n\r\n___________________    ____________________                          \r\n\r\n___________________    ____________________\r\n\r\n___________________    ____________________<\/pre>\n<p>To determine the physical fitness required to use respiratory protective equipment. The following restrictions shall apply:<\/p>\n<p>______________________________________________________________________<\/p>\n<p>______________________________________________________________________<\/p>\n<p>______________________________________________________________________<\/p>\n<p>At this time, I find no reason to prohibit the above named individuals from participating in programs which may require the use of respirators.<\/p>\n<pre>__________________________   ____________________________    __________\r\n   Attending Physician           Physician's Signature           Date\r\n\r\n<a href=\"#top\"><strong>Top of Page<\/strong><\/a><\/pre>\n<p><!-- begin-migrated-from-panel-builder --><!-- end-migrated-from-panel-builder --><\/p>\n<\/div>","protected":false},"excerpt":{"rendered":"<p>Table of Contents: Identification and Location of Exposures Medical Evaluation Medical History for Respiratory Protection Use Physician&#8217;s Evaluation Medical Qualification for Respirator Use Respiratory Protection Table of Contents Identification and [&hellip;]<\/p>\n","protected":false},"author":322,"featured_media":0,"parent":201,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-208","page","type-page","status-publish","hentry"],"acf":[],"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/wp.stolaf.edu\/facilities\/wp-json\/wp\/v2\/pages\/208","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/wp.stolaf.edu\/facilities\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/wp.stolaf.edu\/facilities\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/wp.stolaf.edu\/facilities\/wp-json\/wp\/v2\/users\/322"}],"replies":[{"embeddable":true,"href":"https:\/\/wp.stolaf.edu\/facilities\/wp-json\/wp\/v2\/comments?post=208"}],"version-history":[{"count":3,"href":"https:\/\/wp.stolaf.edu\/facilities\/wp-json\/wp\/v2\/pages\/208\/revisions"}],"predecessor-version":[{"id":5777,"href":"https:\/\/wp.stolaf.edu\/facilities\/wp-json\/wp\/v2\/pages\/208\/revisions\/5777"}],"up":[{"embeddable":true,"href":"https:\/\/wp.stolaf.edu\/facilities\/wp-json\/wp\/v2\/pages\/201"}],"wp:attachment":[{"href":"https:\/\/wp.stolaf.edu\/facilities\/wp-json\/wp\/v2\/media?parent=208"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}