OH Intake Form Respiratory

How many employees need testing?

How many shifts are being tested?

Do they rotate over multiple days?

What are the shift times?

What type of fit testing, Qualitative or Quantitative?

Are there any days during the week that you cannot test? (select all that apply)

How many employees per shift?

What is the make and model of the respirator(s) your employees wear?

Do your employees utilize more than one respirator?

Do you need EI to provide your respiratory medical clearances?

Who will be the main contact? (Need email and cell#)

If so, will you be able to provide computer access to those completing the respiratory medical questionnaire?