OSHA Respirator Medical Evaluation Questionnaire
The Official Appendix C Questionnaire, Completed Online • Physician (PLHCP) Reviewed • $22
15 Minutes
Average completion
Official Appendix C
29 CFR 1910.134 content
Confidential
Employer never sees answers
98% Instant
Immediate clearance
✓ 2 Free Credits • ✓ No Clinic Visit Required
What Is the OSHA Respirator Medical Evaluation Questionnaire?
The OSHA respirator medical evaluation questionnaire is the mandatory health questionnaire in Appendix C of 29 CFR 1910.134. Every employee required to wear a respirator must complete it — or an equivalent medical exam — and have it reviewed by a physician or other licensed health care professional (PLHCP) before being fit tested or wearing a respirator at work. You can complete the same Appendix C questionnaire online in about 15 minutes for $22; a licensed physician reviews it and 98% of employees receive their clearance certificate instantly.
OSHA 1910.134 Compliant
PLHCP Reviewed
98% Instant Results
85% Cheaper Than Clinics
Why OSHA Requires the Questionnaire
OSHA's Respiratory Protection standard states: "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" (29 CFR 1910.134(e)(1)). The Appendix C questionnaire is how that evaluation is performed — the employer identifies a PLHCP who reviews either the questionnaire or a medical exam that obtains the same information (1910.134(e)(2)).
This is not a formality. Respiratory Protection ranked #5 on OSHA's Top 10 most frequently cited standards in fiscal year 2025, and skipping the medical evaluation step is one of the easiest violations for an inspector to find — it is documented (or not) in your records. The evaluation must be provided at no cost to the employee (1910.134(c)(4)), during normal working hours or at a convenient time and place (1910.134(e)(4)).
What the Appendix C Questionnaire Asks
The mandatory portion (Part A, Sections 1 and 2) contains 12 administrative items and 9 health question groups covering more than 50 specific conditions and symptoms. Here is the actual structure, straight from Appendix C of 29 CFR 1910.134:
Section 1: About You & Your Respirator
Mandatory for every employee — 12 administrative items
- Name, age, sex, height, and weight
- Job title and a phone number where the PLHCP can reach you
- Whether your employer told you how to contact the PLHCP
- The type of respirator you will use (N95/disposable vs. half- or full-facepiece, PAPR, supplied-air, SCBA)
- Whether you have worn a respirator before, and what type
Section 2: Health History (Questions 1–4)
Mandatory — smoking, conditions, and lung problems
- Current or recent tobacco smoking
- Seizures, diabetes, allergic reactions that interfere with breathing, claustrophobia, trouble smelling odors
- Lung problems: asbestosis, asthma, chronic bronchitis, emphysema, pneumonia, tuberculosis, silicosis, pneumothorax (collapsed lung), lung cancer, chest injuries or surgeries
- Current breathing symptoms: shortness of breath, coughing, wheezing, chest pain when breathing deeply
Section 2: Heart, Medications & Respirator History (Questions 5–9)
Mandatory — cardiovascular health and prior respirator use
- Cardiovascular history: heart attack, stroke, angina, heart failure, arrhythmia, high blood pressure
- Heart symptoms: chest pain or tightness, skipped heartbeats, unexplained heartburn
- Medications for breathing, heart trouble, blood pressure, or seizures
- Prior problems using a respirator: eye irritation, skin allergies, anxiety, fatigue
- Whether you would like to discuss your answers with the PLHCP
Questions 10–15: Full-Facepiece & SCBA Users Only
Mandatory only for full-facepiece respirators or SCBA — voluntary for everyone else
- Vision loss, contact lenses or glasses, color blindness
- Ear injuries and hearing problems
- Back injuries
- Musculoskeletal problems that could interfere with respirator use (weakness, limited mobility, difficulty climbing while carrying weight)
Part B Is Optional
Appendix C also includes Part B questions, but they are not mandatory — they may be added at the discretion of the health care professional who reviews the questionnaire. The mandatory content every employee completes is Part A, Sections 1 and 2.
What Happens If You Answer "Yes"?
A "yes" answer is not a failure. Under 1910.134(e)(3), a positive response to any of questions 1 through 8 in Part A Section 2 triggers a follow-up medical examination — whatever tests, consultations, or diagnostic procedures the PLHCP deems necessary to make a final determination. The PLHCP then issues a written recommendation stating only whether you are medically able to use the respirator and any limitations — for example, clearance limited to certain respirator types.
If a medical condition makes a negative pressure respirator risky, that is still not the end of the road: 1910.134(e)(6) requires the employer to provide a powered air-purifying respirator (PAPR) if the PLHCP determines you can safely use one. You also have the right to discuss your questionnaire and results directly with the PLHCP (1910.134(e)(4)).
The questionnaire exists to catch the small number of people for whom a respirator itself is a hazard — restricted breathing, cardiac strain, heat stress. Answer it honestly: a yes answer almost never ends a career, but an undisclosed condition under a respirator can end a life.
— Dr. Nader Mikhail, MD, Medical Review Officer, RespiratorTest.com
How to Complete the Questionnaire Online
Same official Appendix C content, administered digitally with licensed PLHCP review
Start the Questionnaire
Open the secure online form from your email invite or employer portal — any device works
⏱ 1 minuteAnswer the Appendix C Questions
Complete Sections 1 and 2 of the official OSHA questionnaire; progress saves automatically
⏱ 10-15 minutesPLHCP Physician Review
A licensed physician reviews your responses; 98% are cleared instantly, the rest within 24 hours
⏱ Instant (98%)Receive Your Certificate
Your OSHA 1910.134 clearance certificate is delivered digitally to you and your employer
⏱ 1-2 minutesTotal Time: 15-20 Minutes From Start to Certificate
Start Your Questionnaire NowOnline vs Clinic: Same Questionnaire, Different Cost
The Appendix C content is identical either way — OSHA requires the same information. What changes is the price and the hours out of your day.
| Method | Cost | Time Required | Device Options |
|---|---|---|---|
| RespiratorTest.com Online | $22 | 15 minutes | Phone, tablet, computer |
| Occupational Health Clinic | $75-150 | 2-4 hours (+ travel) | Paper form at clinic |
| Your Savings | $53-128 | 1.75-3.75 hours | Complete anywhere |
Same OSHA questionnaire. Same PLHCP review. A fraction of the cost.
Complete Questionnaire Online - $22Remember: OSHA requires your employer to pay for the evaluation (1910.134(c)(4)). Employers can clear whole teams with bulk respirator clearance at volume pricing.
Respirator Questionnaire FAQs
Common questions about the OSHA respirator medical evaluation questionnaire
What is the OSHA respirator medical evaluation questionnaire?
It is the mandatory medical questionnaire in Appendix C of OSHA's Respiratory Protection standard, 29 CFR 1910.134. OSHA requires employers to provide a medical evaluation — using this questionnaire or an equivalent medical exam — to determine an employee's ability to use a respirator, before the employee is fit tested or required to wear a respirator at work. A physician or other licensed health care professional (PLHCP) must review the responses.
What questions are on the OSHA Appendix C questionnaire?
The mandatory portion (Part A) has two sections. Section 1 collects 12 administrative items: name, age, sex, height, weight, job title, contact information, and the type of respirator you will use. Section 2 asks 9 mandatory health question groups covering smoking history, seizures, diabetes, claustrophobia, lung conditions (asthma, chronic bronchitis, emphysema, pneumonia, tuberculosis, silicosis, collapsed lung), breathing symptoms, cardiovascular history and symptoms, medications, and prior problems using a respirator. Questions 10-15 (vision, hearing, back, and musculoskeletal issues) are mandatory only for full-facepiece or SCBA users. Part B questions are optional, added at the reviewing PLHCP's discretion.
Can I complete the OSHA respirator questionnaire online?
Yes. OSHA 1910.134(e)(2) requires that the medical evaluation obtain the information requested by the Appendix C questionnaire — it does not require a paper form or an in-person visit. RespiratorTest.com administers the same Appendix C content online, a licensed PLHCP physician reviews every submission, and 98% of employees receive their clearance certificate instantly. The whole process takes about 15 minutes and costs $22.
What happens if I answer yes to a question?
A "yes" answer does not automatically disqualify you. OSHA 1910.134(e)(3) requires a follow-up medical examination for any employee who gives a positive response to any of questions 1 through 8 in Part A Section 2. The follow-up includes whatever tests or consultations the PLHCP deems necessary to make a final determination. In practice, most positive responses are resolved with clearance, clearance with restrictions, or a recommendation for a powered air-purifying respirator (PAPR).
Is the respirator medical questionnaire confidential?
Yes. Under OSHA 1910.134(e)(4), the questionnaire must be administered confidentially, and OSHA's guidance is explicit that your employer or supervisor must not look at or review your answers — the completed questionnaire goes directly to the PLHCP. Your employer receives only the written clearance determination: whether you are medically able to use the respirator and any limitations, never your underlying medical answers.
Who reviews the respirator medical questionnaire?
A PLHCP — a physician or other licensed health care professional whose scope of practice permits providing the health care services required by 1910.134(e). At RespiratorTest.com, every questionnaire is reviewed under Dr. Nader Mikhail, MD, a board-certified physician and Medical Review Officer (California Medical License #G88906).
Does OSHA require a physical exam for respirator clearance?
No — not initially. OSHA 1910.134(e)(2) allows the medical evaluation to be performed using the Appendix C questionnaire alone, reviewed by a PLHCP. A medical examination is required only as a follow-up when an employee answers yes to any of questions 1-8 in Part A Section 2, or when an initial examination shows one is needed.
Who pays for the respirator medical evaluation?
Your employer. OSHA 1910.134(c)(4) states that "the employer shall provide respirators, training, and medical evaluations at no cost to the employee." The questionnaire must also be administered during normal working hours or at a time and place convenient to you.
How often does the respirator questionnaire need to be repeated?
OSHA does not set a fixed calendar interval. Re-evaluation is required when an employee reports relevant symptoms, a PLHCP or supervisor requests it, fit-test observations indicate a need, or workplace conditions change (1910.134(e)(7)). Most employers re-evaluate annually alongside the required annual fit test, and RespiratorTest.com certificates carry a 12-month validity period to match that practice.
How long does the online questionnaire take?
About 15 minutes for most employees. The online form is mobile-friendly and saves your progress automatically, so you can complete it on any device, in one sitting or several. 98% of submissions are cleared instantly after PLHCP review; the rest are individually reviewed within 24 hours.
Related Resources
Online Respirator Medical Evaluation
The complete evaluation process the questionnaire is part of — requirements, review, and certificates.
Online respirator medical evaluation guide →Respirator Clearance for Teams
Employers: invite your whole team, track completions, and download certificates from one dashboard.
Employee respirator clearance →Clearance Before Fit Testing
Why the medical evaluation must come before your fit test, and what happens if you skip it.
Fit test medical clearance →NM
Dr. Nader Mikhail, MD
Medical Review Officer
Board-certified physician with expertise in occupational medicine. Dr. Mikhail oversees all medical evaluations at RespiratorTest.com, ensuring OSHA compliance and accurate medical determinations.
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