Medical Evaluation: Enrollment Instructions

Required Medical Evaluation

Requesting a Fit Test

Respirator Medical Evaluation Instructions

All University of Minnesota Duluth Employees who are required to use a respirator must enroll in the UMD respiratory protection program by first fill out the following OSHA Medical Evaluation Questionnaire (Non-animal users only), in order to be medically cleared for respirator use.  Please include your name, employee ID, respirator type (if known), and whether or not your use is required or voluntary. You will also need to describe your work effort as light, moderate, or heavy.

If you work with animals, please fill out the following web form to obtain access to the online Respirator Medical Evaluation questionaire.

Examples of light work:

• sitting while writing, typing, drafting, or performing light assembly work
• standing while operating a drill press (1-3 lbs.) or controlling machines

Examples of moderate work:

• sitting while nailing or filing
• driving a truck or bus in urban traffic
• standing while drilling, nailing, performing assembly work, or transferring a moderate load (about 35 lbs.) at trunk level
• walking on a level surface about 2 mph or down a 5-degree grade about 3 mph
• pushing a wheelbarrow with a heavy load (about 100 lbs.) on a level surface

Examples of heavy work:

• lifting a heavy load (about 50 lbs.) from the floor to your waist or shoulder
• working on a loading dock
• shoveling
• standing while bricklaying or chipping castings
• walking up an 8-degree grade about 2 mph
• climbing stairs with a heavy load (about 50 lbs.)

Send your completed questionnaire, to the address on the questionnaire:

When you receive your respirator medical recommendations back and you have been cleared for respirator use, you should contact Andrew Kimball at akimball@d.umn.edu to schedule your respirator fit test.

However, If you are not immediately cleared for respirator use  you may contacted for additional information. An occupational medicine physician will then medically clear you for respirator use or recommend a physical exam.  If you are told that you need a physical exam.

The University of Minnesota will not receive any of the medical information or history that you provide on to the physician directly or on the questionnaire. The UMD Office of Environmental Health and Safety will only need information on your clearance status in order to administre a respirator fit test

If you have any questions regarding this program, please contact Mahjoub Labyad at mlabyad@d.umn.edu or 218-726-7273.

Instructions for Requesting a Respirator Fit Test.

1. Set up an appointment for a fit test by contacting Andrew Kimball at akimball@d.umn.edu or 218-726-6764.
2. Bring a copy of your Respirator Medical Recommendation form to your fit test. If you already use a respirator bring it with you. Otherwise, the appropriate respirator will be provided to you.
3. The fit test takes about 15 minutes. The fit test is a series of 7-8 simple one-minute exercises designed to test the overall fit of the respirator. You will also receive basic information on using the respirator.
4. No chewing gum, drinking coffee, or smoking for 15 minutes before the test.
5. Men are required to be clean shaven in the areas where the respirator seal touches the face. If you are not clean shaven, you will not be fit tested.
6. It gets hot under the fit test hood. Wear scrubs or a short sleeved shirt.