University Safety and Assurances

Respiratory Protection Information

Medical Evaluations

Using a respirator may place a physiological burden on employees that varies with the type of respirator worn, the job and workplace conditions in which the respirator is used, and the medical status of the employee. In those situations where the use of a respirator is required, you must have a medical evaluation to determine your ability to use a respirator prior to use.

UWM has a contract with Columbia St. Mary's Corporate WORx to perform these medical evaluations. The CorporateWORx physician will review your medical evaluation questionnaire and will provide a written recommendation regarding your ability to use a respirator. The physician must know specific parameters of respirator use, such as the length of time that a person will use the respirator, the frequency of use, and any additional stresses that may be experienced during use.

Each person covered by this program will complete an OSHA Respirator Medical Evaluation Questionnaire (Mandatory). Put the completed questionnaires into a sealed envelope identified with your name and marked "Confidential Medical Record" and send or deliver the envelope to University Safety and Assurances (US & A). US & A will forward the completed questionnaires to the CorporateWORx Office.

The CorporateWoRx physician will review the completed questionnaire and make a determination as follows:

  1. The questionnaire is complete and a determination can be made.
  2. The questionnaire is incomplete and additional information is required. In the case of an incomplete questionnaire, the physician will contact University Safety and Assurances and indicate what information is missing. US & A will follow-up with the employee.
  3. The questionnaire is complete, but further medical evaluation is indicated. If further medical evaluation is needed, the physician will contact US & A, who in turn will notify the employee that an appointment needs to be scheduled. Your appointment should be scheduled at the River Glen Clinic (414)961-2750, 201 W. Capitol Dr., Milwaukee, WI 53212.

    You will need to complete the following form and take it with you to your appointment:

The CorporateWORx physician will maintain the OSHA Respirator Medical Evaluation Questionnaire (Mandatory) as a medical record subject to confidentiality protocols.

While the physician will retain the medical record, a copy of the physician's External Occupational Health Recommendation for Respirator Wear certification will be sent to University Safety and Assurances. US & A will maintain these records for the statutory required period of time.

Additional medical evaluations are required under certain circumstances, e.g.:

  • The employee reports medical signs or symptoms related to the ability to use a respirator;
  • The CorporateWORx physician, program administrator or supervisor recommends reevaluation;
  • Information from the respirator program, including observations made during fit-testing and program evaluations indicates a need, or
  • A change occurs in workplace conditions that may substantially increase the physiological burden of an employee.

Additionally some employees are required to undergo a "periodic medical examination" under the medical surveillance provisions of the respiratory protection standard. If you are required to participate in the periodic evaluation, you will need to complete the following form:

Again, this form should be completed, placed in a sealed envelope with your name and marked "Confidential Medical Record" and forwarded to University Safety & Assurances.

Any charges for the medical evaluation or medical testing will be the responsibility of the employee's department.

Respirator Training

OSHA Information

NIOSH Information

Additional Resources

 
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