Appendix A - Sample Respirator Program
Respirator Program Evaluation Check List

ABC COMPANY

RESPIRATOR PROGRAM

The purpose of this operating procedure is to ensure the protection of all employees from respiratory hazards, through proper use of respirators. Respirators are to be used only where engineering control of respirator hazards is not feasible, while engineering controls are being installed, or in emergencies.

The company Safety Officer is __________________________________. He/she is solely responsible for all facets of this program and has full authority to make necessary decisions to ensure success of this program. This authority includes hiring personnel and equipment purchases necessary to implement and operate the program. The Safety Officer will develop written detailed instructions covering each of the basic elements in this program, and is the sole person authorized to amend these instructions.

The ABC Company has expressly authorized the Safety officer to halt any operation of the company where there is danger of serious personal injury. This policy includes respiratory hazards.

Program Elements

1. The Safety Officer will develop detailed written standard operating procedures governing the selection and use of respirators, using the NIOSH Respirator Decision Logic as a guideline. Outside consultation, manufacturer’s assistance, and other recognized authorities will be consulted if there is any doubt regarding proper selection and use. These detailed procedures will be included as appendices to this respirator program. Only the Safety Officer may amend these procedures.
2. Respirators will be selected on the basis of hazards to which the worker is exposed. All selections will be made by the Safety Officer. Only MSHA/NIOSH-certified respirators will be selected and used.
3. The user will be instructed and trained in the proper use of respirators and their limitations. Both supervisors and workers will be so instructed by the Safety Officer. Training should provide the employee an opportunity to handle the respirator, have it fitted properly, test its facepiece-to-face seal, wear it in normal air for a long familiarity period, and finally to wear it in a test atmosphere. Every respirator wearer will receive fitting instructions, including demonstrations and practice in how the respirator should be worn, how to adjust it, and how to determine if it fits properly.

Respirators should not be worn when conditions prevent a good face seal. Such conditions may be a growth of beard, sideburns, a skull cap that projects under the facepiece, or temple pieces on glasses. No employees of ABC, who are required to wear respirators, may wear beards. Also the absence of one or both dentures can seriously affect the fit of a facepiece. The worker’s diligence in observing these factors will be evaluated by periodic checks. To assure proper protection, the facepiece fit will be checked by the wearer each time the wearer puts on the respirator. This will be done by following the manufacturer’s facepiece-fitting instructions.

4. Where practicable, the respirators will be assigned to individual workers for their exclusive use.
5. Respirators will be regularly cleaned and disinfected. Those issued for the exclusive use of one worker will be cleaned after each day’s use, or more often if necessary. Those used by more than one worker will be thoroughly cleaned and disinfected after each use. The Safety Officer will establish a respirator cleaning and maintenance facility and develop detailed written cleaning instructions.
6. The central respirator cleaning and maintenance facility will store respirators in a clean and sanitary location.
7. Respirators used routinely will be inspected during cleaning. Worn or deteriorated parts will be replaced. Respirators for emergency use such as self-contained devices will be thoroughly inspected at least once a month and after each use. Inspection for SCBA breathing gas pressure will be performed weekly.
8. Appropriate surveillance of work area conditions and degree of employee exposure or stress will be maintained.
9. There will be regular inspection and evaluation to determine the continued effectiveness of the program. The Safety Officer will make frequent inspections of all areas where respirators are used to ensure compliance with the respiratory protection programs.
10. Persons will not be assigned to tasks requiring use of respirators unless it has been determined that they are physically able to perform the work and use the equipment. The ABC Company physician will determine what health and physical conditions are pertinent. The respirator user’s medical status will be reviewed annually.
11. Certified respirators will be used.

John Doe
President, ABC Company

Respirator Program Evaluation Checklist, Page 1.
Respirator Program Evaluation Checklist, Page 2.
Respirator Program Evaluation Checklist, Page 3.
Respirator Program Evaluation Checklist, Page 4.
Sample Respirator Inspection Record, Page 1.

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