Form Name:	House Officer OSHA Respirator Medical Evaluation Questionnaire
Also Known As:	Mask Fit Test Medical Form
Completed By:	House Officer
Used When:	Required for Mask Fit Testing
Purpose:	Provides medical clearance for residents undergoing mask fit testing. Required by OSHA.
Direct Questions To:	Ashley Walker
Form Link:	Included with new hire documents for new hires: Newhire Documents OSHA Respirator Medical Evaluation Questionnaire.pdf

Instructions for Completing Form

This form is provided automatically as part of the online Newhire Documents process. It is included in the Newhire Packet that is submitted to the GME Office.

Continuing House Officers undergoing mask fit testing should manually complete the form.

Other Info

Places This Form is Referenced

Page:

Mask Fit Test Medical Form (Forms & Documents)
Page:

House Officer OSHA Respirator Medical Evaluation Questionnaire (Forms & Documents)

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