House Officer OSHA Respirator Medical Evaluation Questionnaire

House Officer OSHA Respirator Medical Evaluation Questionnaire

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

LSU GME Knowledge Base

Copyright 2020 LSU School of Medicine unless otherwise specified.