What is Required Before Using a Respirator? OSHA Medical Evaluation & Compliance Checklist (2025)

You've purchased N95 respirators for your employees. Production is scheduled to start Monday. Can your workers simply put on the respirators and begin work? Absolutely not—and making that mistake could cost your company over $100,000 in OSHA fines and expose you to serious legal liability.

OSHA's Respiratory Protection Standard (1910.134) mandates specific requirements that must be completed BEFORE any employee uses a respirator in the workplace. This comprehensive guide explains exactly what's required, the correct sequence, potential violations, penalties, and your legal obligations as an employer.

The Complete Pre-Use Requirements: Step-by-Step

OSHA 1910.134 establishes a specific sequence of requirements before respirator use. The order matters—each step builds on the previous one.

Step 1: Medical Evaluation (REQUIRED FIRST)

OSHA Requirement: 1910.134(e)(1) - "The employer shall provide a medical evaluation to determine the employee's ability to use a respirator, before the employee is fit tested or required to use the respirator in the workplace."

What the Medical Evaluation Includes

• OSHA Appendix C Questionnaire

  Employee completes mandatory medical questionnaire covering medical history, cardiovascular health, respiratory conditions, and work environment factors

• PLHCP Review

  A Physician or other Licensed Health Care Professional (PLHCP) reviews the questionnaire and determines medical clearance

• Medical Clearance Decision

  PLHCP issues one of three determinations: Cleared for respirator use, Cleared with limitations, or Not cleared

• Documentation

  Employer receives written medical clearance (not medical details - those are confidential)

Who Qualifies as a PLHCP?

OSHA defines PLHCPs as licensed physicians (MD or DO), or other licensed healthcare professionals (physician assistants, nurse practitioners, or other licensed professionals) operating within their scope of practice and with expertise in pulmonary medicine and occupational health.

How Often Are Medical Evaluations Required?

Step 2: Fit Testing (AFTER Medical Clearance)

OSHA Requirement: 1910.134(f)(1) - "The employer shall ensure that an employee using a tight-fitting facepiece respirator is fit tested prior to initial use of the respirator, whenever a different respirator facepiece is used, and at least annually thereafter."

What Fit Testing Accomplishes

Fit testing verifies that a specific make, model, and size of respirator forms an adequate seal on an individual employee's face. Even the best respirator is ineffective if contaminated air leaks around the edges.

Two Approved Methods

• Qualitative Fit Testing (QLFT)

  Uses taste or smell detection (saccharin, Bitrex, isoamyl acetate) to identify leakage. Pass/fail result. Lower equipment cost.

• Quantitative Fit Testing (QNFT)

  Uses machine (PortaCount) to numerically measure particle leakage. Produces fit factor number. More objective but requires equipment investment.

When Fit Testing is Required

• • Before initial respirator use
• • Annually (at least every 12 months)
• • When changing to a different respirator make or model
• • When changing to a different size of the same model
• • After significant physical changes (±20 lbs weight change, dental work, facial surgery)

Step 3: Training (BEFORE Workplace Use)

OSHA Requirement: 1910.134(k)(1) - "The employer shall ensure that each employee can demonstrate knowledge of at least the following: why the respirator is necessary, how improper fit/usage/maintenance can compromise protection, limitations and capabilities, use in emergency situations, and procedures for inspection, donning, checking, use, and removal."

Required Training Topics

• 1. Why respirator is necessary and how improper use compromises protection
• 2. Respirator limitations and capabilities
• 3. How to inspect, put on, check, use, and remove the respirator
• 4. Procedures for maintenance and storage
• 5. How to recognize medical signs/symptoms limiting effective use
• 6. General requirements of the respiratory protection program

Training Frequency

• • Initial training before respirator use
• • Annual retraining
• • When workplace changes affect respirator use
• • When employee demonstrates inadequate knowledge or unsafe use

Documentation Requirements

While OSHA doesn't explicitly require written documentation of training, maintaining records is critical for demonstrating compliance during inspections. Best practice: document training date, topics covered, trainer name, employee signature, and assessment results.

Employer Making Employee Wear N95 Respirator Without Physician's Examination: Legal Liability & OSHA Penalties

This is one of the most serious compliance violations employers make—and it carries both regulatory penalties and significant legal liability.

Can an Employee Sue the Employer?

Yes, under multiple legal theories:

1. Workers' Compensation Claims

If an employee develops a medical condition or experiences injury due to respirator use without proper medical evaluation, they can file a workers' compensation claim. Examples include:

• • Heart attack or cardiac event triggered by respirator use in an employee with undiagnosed heart condition
• • Exacerbation of asthma or COPD due to increased breathing resistance
• • Panic attacks or claustrophobia-related incidents
• • Heat stress or dehydration from extended respirator use

2. Negligence Claims

In some jurisdictions, employees can pursue negligence claims if the employer's OSHA violations constitute gross negligence or willful misconduct. If an employer knowingly required respirator use without medical evaluations and an employee was harmed, courts may allow civil suits beyond workers' compensation.

3. Wrongful Death Claims

If an employee dies due to a medical emergency caused by respirator use without proper evaluation, family members can file wrongful death lawsuits. These cases often result in multi-million dollar settlements or verdicts.

Can OSHA Fine the Employer?

Absolutely—and the penalties are substantial.

OSHA Penalty Structure (2025 Rates)

How Penalties Compound

OSHA issues separate citations for EACH affected employee and EACH violation. If you have 20 employees using respirators without medical evaluations, that's potentially 20 separate violations. Here's how quickly penalties accumulate:

Additional Legal Consequences

• Increased Workers' Compensation Premiums

  OSHA violations and workplace injuries increase experience modification rates, raising insurance costs for years

• Criminal Prosecution (Willful Violations Resulting in Death)

  If OSHA violations cause an employee death, prosecutors can pursue criminal charges against company officers

• Reputational Damage

  OSHA citations are public record and may be reported in media, affecting company reputation and ability to win contracts

• Contractor/Vendor Disqualification

  Many general contractors and government agencies require OSHA compliance as a condition of doing business

• Enhanced Inspection Program

  Companies with serious violations enter OSHA's targeted inspection programs, increasing inspection frequency

What is the Minimum Type of Respirator Required by OSHA?

OSHA does not specify a single "minimum" respirator type for all situations. Instead, respirator selection must be based on the specific hazards present in your workplace through a process called "hazard assessment."

The Respirator Selection Process

OSHA 1910.134(d)(1) requires employers to:

• 1. Identify and evaluate respiratory hazards in the workplace
• 2. Determine exposure levels (air sampling, monitoring, calculations)
• 3. Select respirators certified by NIOSH for protection against identified hazards
• 4. Ensure selected respirators provide adequate protection factor for exposure level

Common Respirator Types and Minimum Protection Factors

Hazard-Specific Minimum Requirements

Certain OSHA standards specify minimum respirator requirements for particular hazards:

• Asbestos (1926.1101)

  Minimum: Full-facepiece PAPR with HEPA filters for exposures above PEL. N95s prohibited for asbestos work.

• Lead (1910.1025)

  Minimum depends on exposure level. Half-mask for lower exposures, full-facepiece or PAPR for higher levels.

• Silica (1926.1153)

  Minimum: N95 for exposures at or below 2.5x PEL. Higher exposures require half-mask or better.

• Immediately Dangerous to Life or Health (IDLH)

  Minimum: Pressure-demand SCBA or pressure-demand supplied-air respirator with escape bottle. Air-purifying respirators prohibited.

Complete OSHA Respirator Compliance Checklist

Use this comprehensive checklist to ensure full compliance with OSHA 1910.134:

Program Administration

• ☐ Written respiratory protection program established
• ☐ Program administrator designated with authority and resources
• ☐ Program reviewed and updated annually
• ☐ Program accessible to employees and OSHA inspectors

Hazard Assessment & Respirator Selection

• ☐ Workplace respiratory hazards identified and documented
• ☐ Exposure monitoring conducted where required
• ☐ Respirators selected based on hazard assessment
• ☐ All respirators are NIOSH-certified for identified hazards
• ☐ Respirators provide adequate protection factors for exposure levels

Medical Evaluations

• ☐ Medical evaluations completed BEFORE fit testing and respirator use
• ☐ OSHA Appendix C questionnaire used
• ☐ Qualified PLHCP conducts evaluations
• ☐ Medical clearance documentation on file for all respirator users
• ☐ Medical information kept confidential
• ☐ Re-evaluations conducted when triggered by health changes or workplace conditions

Fit Testing

• ☐ Initial fit test completed before respirator use
• ☐ Annual fit testing conducted for all tight-fitting respirator users
• ☐ Fit testing uses OSHA-approved protocols (QLFT or QNFT)
• ☐ Fit test records maintained (employee name, test type, date, respirator make/model/size, result)
• ☐ Re-testing conducted when respirator changes or physical changes occur
• ☐ Employees clean-shaven in sealing area during fit testing and use

Training

• ☐ Initial training completed before respirator use
• ☐ Training covers all required topics per 1910.134(k)
• ☐ Employees demonstrate understanding and competency
• ☐ Annual retraining conducted
• ☐ Training documentation maintained

Ongoing Use & Maintenance

• ☐ User seal checks (positive and negative pressure) performed each time respirator is donned
• ☐ Respirators inspected before and after each use
• ☐ Cleaning and disinfecting procedures established and followed
• ☐ Respirators stored properly to prevent damage and contamination
• ☐ Cartridge change-out schedule established based on manufacturer recommendations
• ☐ Emergency-use respirators inspected monthly
• ☐ Breathing air quality verified for supplied-air respirators

Recordkeeping

• ☐ Medical clearance records maintained (duration of employment)
• ☐ Fit test records maintained (until next fit test)
• ☐ Training records maintained
• ☐ Exposure monitoring records maintained (30 years for certain substances)
• ☐ Respirator inspection records for emergency-use equipment

How to Achieve and Maintain Compliance

Compliance doesn't have to be complicated or expensive. Follow this practical implementation roadmap:

Phase 1: Immediate Actions (Week 1)

• 1. Stop all respirator use until medical evaluations and fit testing are completed
• 2. Identify all employees who require or may require respirator use
• 3. Begin medical evaluations immediately (can be completed online in 10 minutes per employee)
• 4. Review and update (or create) written respiratory protection program

Phase 2: Fit Testing & Training (Weeks 2-3)

• 1. Schedule fit testing for all medically cleared employees
• 2. Conduct initial respirator training covering all required topics
• 3. Ensure employees demonstrate proper donning, seal checks, and use
• 4. Document all training and fit testing results

Phase 3: Ongoing Compliance (Continuous)

• 1. Implement annual medical evaluation renewal process
• 2. Schedule annual fit testing
• 3. Conduct annual retraining
• 4. Monitor for triggering events requiring re-evaluation or re-testing
• 5. Maintain organized records system for easy OSHA inspection response