Before a fit test
OSHA respirator medical evaluation questionnaire.
OSHA requires this questionnaire before you are fit tested for a respirator. A clinician reviews your answers; your employer does not see them.
Answer every question in Part A, Section 1 and questions 1 to 9. Questions 10 to 15 are required only if you will use a full-facepiece respirator or a self-contained breathing apparatus; otherwise they are voluntary.
Your answers go to OMP for a clinician to review. They are not kept on this website, and your employer does not see them.
Have on hand
- The type of respirator your employer selected for you
- Your job title
- A phone number where the clinician can reach you, and the best time to call
Respirator questionnaire
Questions? Call 812.271.4240, Monday to Friday, 8:00am to 5:00pm.
Looking for something else?
- Respirator fit test What to bring and how the visit goes.
- Consent for services Fill it out before any visit.
Getting here
- Directions
- Off I-65 at Exit 4.
- Parking
- Truck-friendly parking with room for a tractor-trailer.
- Hours
- Mon to Fri, 8:00am to 5:00pm
- Phone
- 812.271.4240
Satellite imagery from Google Maps; the truck route and legend were added.