Personal Protective Equipment

Respirator Medical Evaluations: Written Recommendations and Reevaluation Requirements

In the first century B.C., the Roman naturalist Pliny the Elder wrote about miners using pig bladders to try to protect themselves from hazardous breathing air in the mines. We’ve made some refinements since Pliny’s day—to the point of recognizing that the respirator itself can, under some conditions, be hazardous.

Here’s what you can expect from the written recommendation you’ll receive from your physician or other licensed healthcare professional (PLHCP) when your workers are medically evaluated—and OSHA’s requirements for when workers who wear respirators must be reevaluated.

The Written Recommendation

After the PLHCP has completed the medical evaluation, both the employee and the employer should receive a written copy of the PLHCP’s conclusions. The employee’s copy may include additional information—for example, evidence of other health problems that were found during the evaluation—but the employer’s copy must include only:

  • Any limitations on respirator use related to the employee’s medical condition or related to the workplace conditions in which the respirator will be used, including whether the employee is medically able to use the respirator,
  • The need, if any, for follow-up medical evaluations, and
  • A statement that the PLHCP has provided the employee with a copy of the PLHCP’s written recommendation.

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Some workers may be found medically unable to wear negative-pressure respirators, which create a higher physiological burden than positive-pressure types, but medically able to wear less-demanding positive-pressure types of respirators. If this happens, the employer must provide a powered air-purifying (positive-pressure or pressure-demand) respirator. The employee can be reevaluated later for his or her fitness to wear negative-pressure respirators; if the employee is found fit, the employer is no longer required to provide the positive-pressure respirator.


A worker’s physical condition can change, and workplace conditions can, too. You may need to reevaluate a worker’s medical fitness to wear a respirator if:

  • The employee reports medical signs or symptoms that are related to the ability to use a respirator (such as difficulty breathing).
  • A PLHCP, a supervisor, or the respirator program administrator informs the employer that an employee needs to be reevaluated.

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  • Information from the respiratory protection program, including observations made during fit-testing and program evaluation, indicates that employee reevaluation is needed.
  • A change occurs in workplace conditions (such as physical work effort, protective clothing, or temperature) that might cause a substantial increase in the physiological burden placed on an employee.

Workers are more likely to comply with medical evaluations and other elements of your respiratory protection program if they understand how it protects them. For that, you need training, and for that, you can count on the resources you’ll find at®.