OSHA Appendix C: Complete Respirator Medical Questionnaire Guide
Question-by-question breakdown, honest answers, and what happens after submission
January 15, 2025
If your job requires wearing a respirator, you'll need to complete the OSHA Appendix C medical questionnaire before you can legally use one. This mandatory form is your employer's first step in ensuring you can safely wear respiratory protection.
This comprehensive guide walks you through every question on the OSHA Appendix C questionnaire, explains what the PLHCP is looking for, and clarifies what happens after you submit your answers. For employers managing respirator compliance across multiple facilities, explore our enterprise respirator compliance solutions.
Appendix C Overview: Structure and Purpose
The OSHA Appendix C questionnaire is divided into two main parts:
Part A: Personal and Work Information
Basic demographics (age, height, weight), current job duties, type of respirator required, and work environment details. This section helps the PLHCP understand the physical demands you'll face.
Part B: Medical History Questions (15 Questions)
Detailed health screening covering cardiovascular conditions, respiratory health, medications, psychological factors, and physical limitations. Each "yes" answer triggers follow-up questions and PLHCP review.
Complete Question-by-Question Breakdown
Here's every question on the OSHA Appendix C questionnaire, why it's asked, and what the PLHCP is evaluating:
Part A: Personal Information
Name, age, gender, height, weight
Why this matters: Basic demographics for medical assessment
Current job title and duties
Why this matters: Understanding work environment demands
Phone and contact information
Why this matters: PLHCP follow-up if needed
Part B: Cardiovascular Questions (Q1-4)
Do you currently smoke tobacco?
Why this matters: Smoking affects respirator tolerance
Have you ever had heart trouble, heart disease, or heart attack?
Why this matters: Cardiovascular stress from respirator use
Do you currently have chest pain, pressure, or angina?
Why this matters: Warning sign of heart disease
Have you been told you have high blood pressure?
Why this matters: May affect respirator tolerance
Part B: Respiratory Questions (Q5-9)
Do you currently have breathing problems, shortness of breath, or difficulty breathing?
Why this matters: Core respirator safety issue
Have you ever had asthma, emphysema, COPD, or chronic bronchitis?
Why this matters: Chronic conditions may worsen with respirators
Have you ever had tuberculosis or other lung disease?
Why this matters: Lung function assessment
Do you currently take medications that affect breathing?
Why this matters: Drug interactions with respirator use
Any vision or hearing problems?
Why this matters: Affects communication and safety
Part B: Psychological Questions (Q10-12)
Do you have claustrophobia or fear of confined spaces?
Why this matters: Respirators can trigger panic attacks
Have you ever had seizures or epilepsy?
Why this matters: Safety risk if seizure occurs while wearing respirator
Do you have diabetes or take insulin?
Why this matters: Medical emergency risk assessment
Part B: Work Environment (Q13-15)
Type of respirator you will use
Why this matters: Different types have different demands
How long will you wear the respirator each day?
Why this matters: Duration affects physiological burden
Physical work load while wearing respirator
Why this matters: Exertion increases breathing difficulty
How to Answer the Questionnaire Honestly
Answer "Yes" If:
- You currently have the condition, even if controlled by medication
- You've been diagnosed with it in the past, regardless of current status
- You experience symptoms occasionally, even if not diagnosed
- You're unsure but think it might apply - let the PLHCP decide
Answer "No" Only If:
- You have never been diagnosed with the condition
- You have never experienced symptoms related to the question
- You are absolutely certain the question doesn't apply to you
What Happens After You Submit Appendix C?
Once you complete the questionnaire, here's the review process:
| Scenario | What Happens | Timeline |
|---|---|---|
| All "No" Answers | Automatic clearance in most cases. PLHCP reviews briefly and issues certificate. | Instant - 1 hour |
| 1-2 "Yes" Answers (Minor) | PLHCP reviews details. Usually cleared with or without restrictions. | 2-24 hours |
| Multiple "Yes" Answers | PLHCP may request additional medical records or phone consultation. | 1-3 days |
| Serious Condition Flagged | Physical examination may be required before clearance decision. | 3-7 days |
Privacy and Confidentiality Rights
Your Appendix C responses are protected medical information under HIPAA regulations:
What Your Employer CANNOT See:
- Your specific answers to any questionnaire questions
- Your medical diagnoses or health conditions
- Medications you're taking
- PLHCP's detailed medical reasoning
What Your Employer CAN See:
- Clearance status: Approved / Restricted / Denied
- Work restrictions (if any): e.g., "Approved for PAPR only"
- Expiration date of medical clearance
Completing Appendix C Online
OSHA explicitly permits online completion of Appendix C questionnaires. Online evaluations offer several advantages:
Convenience Benefits
- Complete from anywhere (home, work, mobile)
- No travel or scheduling required
- Takes 10-15 minutes vs 2-4 hours at clinic
- Auto-save progress if interrupted
Cost Savings
- $22 online vs $150+ at clinics
- No lost productivity (save 2-3 hours)
- No travel expenses
- Instant results (98% approval rate)
Frequently Asked Questions
What is OSHA Appendix C?
OSHA Appendix C is the mandatory respirator medical evaluation questionnaire included in OSHA standard 1910.134. It contains questions about your health history, respiratory conditions, cardiovascular health, and work environment to determine if you can safely wear a respirator. All employees must complete this questionnaire before using respirators at work.
How many questions are on the OSHA Appendix C questionnaire?
The OSHA Appendix C questionnaire has 15 main questions with multiple follow-up sub-questions. If you answer "no" to all questions, the evaluation is quick (10-15 minutes). Answering "yes" triggers additional questions about specific conditions. Most employees complete it in 15-20 minutes.
Can I complete OSHA Appendix C online?
Yes, OSHA explicitly permits online completion of Appendix C questionnaires. OSHA 1910.134(e)(4) allows medical evaluations via questionnaire without physical examination. Online evaluations must include PLHCP review and provide written recommendations, which platforms like RespiratorTest.com offer.
What happens if I answer "yes" on Appendix C?
If you answer "yes" to any question, a PLHCP (physician or licensed healthcare professional) will review your response. They may: clear you without restrictions, request additional medical information, recommend restrictions (like using PAPR instead of N95), or suggest a physical examination. Most "yes" answers still result in clearance with or without modifications.
Is OSHA Appendix C confidential?
Yes, Appendix C responses are confidential medical information protected by HIPAA. Only the PLHCP can see your detailed answers. Your employer receives only the clearance determination (approved/restricted/denied) and any work restrictions, never your specific health information or questionnaire answers.
Can I refuse to complete OSHA Appendix C?
You cannot refuse if respirator use is required for your job. OSHA 1910.134 mandates medical evaluation before respirator use. Refusal means you cannot legally use a respirator, which may prevent you from performing job duties. However, if respirator use is voluntary, requirements may differ based on your employer policy.
How long does Appendix C clearance last?
Appendix C medical clearance is typically valid for 12 months. Re-evaluation is required if: you report respiratory symptoms, your supervisor observes medical concerns, the PLHCP recommends follow-up, workplace conditions change significantly, or you switch to a different respirator type with greater physiological burden.
Who reviews my Appendix C questionnaire?
A PLHCP (Physician or Licensed Healthcare Professional) must review all Appendix C questionnaires. This includes physicians (MD/DO), physician assistants (PA), or nurse practitioners (NP) licensed to provide medical evaluations. The PLHCP determines if you can safely wear a respirator based on your responses.
Should I lie on the Appendix C questionnaire?
No, never lie on Appendix C. Dishonest answers put your health at risk - respirators can cause serious medical emergencies if you have undisclosed conditions. Additionally, providing false information can result in: termination for cause, denial of workers compensation claims if injury occurs, potential fraud charges, and liability for your employer.
Can I complete Appendix C in Spanish?
Yes, employers must provide Appendix C in a language the employee understands. OSHA provides official Spanish translations, and many online platforms offer multi-language questionnaires. The PLHCP review and clearance determination follow the same process regardless of language.
Complete Your OSHA Appendix C Questionnaire Online
Finish the OSHA-required questionnaire in 15 minutes. PLHCP reviewed, HIPAA secure, instant results in 98% of cases.