Respiratory Protection Program Template

Program Information

Company Name: _________________________
Program Administrator: _________________________
Date Established: _________________________
Last Reviewed: _________________________

1. Program Objective

This Respiratory Protection Program is established to protect employees from respiratory hazards through proper respirator use, training, and administrative practices. This program complies with OSHA Standard 29 CFR 1910.134 and applies to all employees required to wear respirators during normal work operations and emergency situations.

2. Program Administration

Responsibility

Program Administrator: Name: _________________________
Title: _________________________
Phone: _________________________
Email: _________________________

Responsibilities include:

• Maintaining and updating this written program
• Identifying work areas and processes requiring respirators
• Monitoring respirator use to ensure proper procedures
• Ensuring availability of appropriate respirators
• Coordinating medical evaluations and fit testing
• Evaluating program effectiveness
• Maintaining required records
• Providing employee training

Authority

The Program Administrator has full management support and authority to:

• Enforce program requirements
• Stop work when respiratory protection is inadequate
• Implement corrective actions
• Access necessary resources and budget

3. Workplace Evaluation

Respiratory Hazard Assessment

A comprehensive workplace evaluation has been conducted to identify operations where respiratory hazards exist. The assessment includes:

Hazard Identification Methods:

• Review of Safety Data Sheets (SDS)
• Air monitoring results
• Process evaluation
• Employee health surveillance data
• Historical exposure records

Identified Respiratory Hazards:

Engineering and Administrative Controls

Before requiring respirators, we evaluate and implement feasible engineering and administrative controls:

Engineering Controls:

• Ventilation systems (local and general)
• Process enclosure
• Substitution of less hazardous materials
• Isolation of hazardous processes
• Automation of hazardous operations

Administrative Controls:

• Work scheduling to minimize exposure
• Job rotation
• Rest breaks away from exposure
• Housekeeping procedures
• Preventive maintenance programs

Documentation: Feasibility assessments documented and retained.

4. Respirator Selection

Selection Criteria

Respirators are selected based on:

1. Nature of respiratory hazard
2. Airborne concentration levels
3. Warning properties of contaminant
4. Oxygen concentration
5. IDLH conditions
6. Work activity and duration
7. Location of work area
8. Physical characteristics of workers

Selection Table

NIOSH Certification

Only NIOSH-certified respirators shall be used. The Program Administrator maintains documentation of NIOSH approval for all respirators in inventory.

IDLH Atmospheres

For IDLH or potentially IDLH atmospheres:

• Positive-pressure SCBA or airline with escape bottle required
• Full-facepiece respirator minimum
• Buddy system mandatory
• Emergency rescue capability maintained

Oxygen-Deficient Atmospheres

For atmospheres containing less than 19.5% oxygen:

• Atmosphere-supplying respirators required
• Air-purifying respirators prohibited
• Atmosphere testing required before entry

5. Medical Evaluation

Requirements

Before fit testing or respirator use, employees must receive a medical evaluation to determine physical ability to wear respirators.

Process:

1. Employee completes Medical Evaluation Questionnaire (Appendix C of standard)
2. Questionnaire reviewed by Physician or Other Licensed Health Care Professional (PLHCP)
3. PLHCP determines if medical examination needed
4. PLHCP provides written clearance or restrictions
5. Employee notified of clearance status

Confidentiality

All medical information remains confidential between employee and PLHCP. Only clearance status shared with employer.

Medical Provider

PLHCP Contact Information: Name/Organization: _________________________
Phone: _________________________
Address: _________________________

Information Provided to PLHCP

The following information is provided to the PLHCP:

• Copy of OSHA 1910.134
• Description of work requiring respirator use
• Type and weight of respirator
• Duration and frequency of use
• Expected physical work effort
• Additional protective clothing required
• Temperature and humidity extremes

Follow-Up Medical Examinations

Additional medical evaluations required when:

• Employee reports medical signs/symptoms related to respirator use
• PLHCP, supervisor, or Program Administrator recommends
• Program changes that increase physiological burden
• Fit test or program evaluation indicates need

Frequency

Medical evaluations conducted:

• Before initial respirator use
• As determined by PLHCP
• At least annually for SCBA users
• When conditions warrant

6. Fit Testing

Requirements

All employees using tight-fitting respirators must be fit tested:

• Before initial use
• Annually thereafter
• When different respirator make/model/size used
• When physical changes could affect fit

Fit Test Methods

Qualitative Fit Testing (QLFT):

• Isoamyl acetate (banana oil)
• Saccharin solution aerosol
• Bitrex solution aerosol
• Irritant smoke

Quantitative Fit Testing (QNFT):

• Ambient aerosol CNC
• Generated aerosol
• Controlled negative pressure

Fit Test Protocol

Fit tests conducted according to OSHA-mandated protocols in Appendix A. Test includes exercises:

1. Normal breathing
2. Deep breathing
3. Turning head side to side
4. Moving head up and down
5. Talking
6. Grimace (not graded)
7. Bending over
8. Normal breathing

Fit Test Administrator

Name: _________________________
Training: _________________________
Certification: _________________________

Record Keeping

Fit test records maintained for 30 years including:

• Employee name
• Type of fit test
• Specific respirator make, model, style, size
• Date of test
• Pass/fail result (QLFT) or fit factor (QNFT)

7. Respirator Use Procedures

General Use

Before Each Use:

• Inspect respirator for damage
• Ensure appropriate cartridges/filters installed
• Verify respirator approved for hazard
• Perform user seal check (positive and negative pressure)

During Use:

• Monitor for breakthrough (odor, taste, irritation)
• Watch for breathing difficulty
• Exit area immediately if problems occur
• Do not remove respirator in contaminated area

After Use:

• Remove without contaminating face
• Clean and disinfect (if reusable)
• Inspect for damage
• Store properly

Facial Hair Policy

Policy: Tight-fitting facepiece respirators shall not be worn when facial hair comes between sealing surface and face or interferes with valve function.

• Clean-shaven required in seal area
• Includes stubble (same-day shaving required)
• Applies to sideburns, mustaches, beards in seal area
• Enforcement: Employees non-compliant cannot wear respirators or enter areas requiring respiratory protection

Corrective Lenses

Eyeglasses with temple bars that pass through facepiece seal are prohibited. Approved methods:

• Spectacle kits designed for specific respirator
• Contact lenses
• Goggles worn over full-facepiece respirator

User Seal Check

Employees must perform user seal check each time respirator is donned:

Positive Pressure Check:

1. Cover exhalation valve
2. Breathe out gently
3. Slight positive pressure indicates good seal

Negative Pressure Check:

1. Cover filter/cartridge inlets
2. Breathe in gently
3. Facepiece should collapse slightly and stay collapsed

8. Cleaning, Maintenance, and Storage

Cleaning Schedule

Routine Use Respirators:

• Clean after each day's use
• Disinfect if shared (but sharing discouraged)
• Inspect during cleaning

Emergency Use Respirators:

• Clean after each use
• Inspect monthly

Escape-Only Respirators:

• Maintained per manufacturer instructions

Cleaning Procedure

1. Remove filters, cartridges, canisters
2. Wash facepiece and breathing tube in warm water with mild detergent
3. Rinse thoroughly with clean water
4. Air dry in clean area
5. Disinfect if necessary
6. Reassemble with new filters/cartridges

Prohibited:

• Do not use solvents
• Do not use excessive heat
• Do not machine wash

Inspection

Routine Inspection (before each use):

• Facepiece: cracks, tears, distortion
• Head straps: elasticity, breaks
• Inhalation/exhalation valves: residue, damage
• Cartridges: damage, expiration, appropriate for hazard
• Air supply systems: functioning properly

Emergency Respirator Inspection:

• Monthly inspection
• Documented on inspection tag
• Readily accessible location

Storage

Routine Use:

• Clean, dry location
• Protected from sunlight, heat, cold, moisture, chemicals
• Stored in sealed bag or container
• Protected from physical damage

Emergency Use:

• Quickly accessible
• Clearly marked
• Protected from environment
• Inspected monthly

9. Cartridge/Filter Change-Out Schedule

Change-Out Criteria

Replace cartridges/filters when:

• End-of-service-life indicator activates
• Breakthrough detected (odor, taste, irritation)
• Breathing resistance increases
• Time-based schedule reached
• Physical damage observed
• Manufacturer time limit reached

Change-Out Schedule

Documentation

Cartridge changes documented including:

• Date
• Respirator serial number
• Cartridge type
• Reason for change
• Person performing change

10. Breathing Air Quality

Complete this section if atmosphere-supplying respirators used

Compressed Breathing Air

Meets Grade D specifications (CGA G-7.1):

• Oxygen content: 19.5-23.5%
• Hydrocarbon content: 5 mg/m³ maximum
• Carbon monoxide: 10 ppm maximum
• Carbon dioxide: 1,000 ppm maximum
• Lack of noticeable odor

Compressor Systems

• Located to prevent contamination
• Equipped with CO monitor and alarm (if oil-lubricated)
• Equipped with high-temperature alarm
• Maintained per manufacturer schedule
• Air tested quarterly

Cylinders

• NIOSH-certified
• Labeled as "breathing air"
• Maintained fully charged
• Inspected per DOT requirements
• Changed when pressure falls below minimum

11. Training

Initial Training

Before respirator use, employees receive comprehensive training:

Topics Covered:

• Why respirator necessary for protection
• How improper fit, use, maintenance compromises protection
• Limitations and capabilities of respirator
• Emergency use procedures
• Inspection, donning, removal, seal checking
• Maintenance and storage
• Medical signs and symptoms limiting effective use
• General OSHA requirements

Training Methods:

• Classroom instruction
• Hands-on demonstration
• Video presentations
• Return demonstration by employee

Retraining

Annual retraining or when:

• Workplace or respirator changes make prior training obsolete
• Inadequate employee knowledge or use observed
• Other situation requiring retraining

Training Records

Records maintained including:

• Employee name
• Training date
• Topics covered
• Trainer name
• Comprehension assessment results

12. Program Evaluation

Annual Review

Program reviewed at least annually to assess:

• Continued effectiveness
• Workplace changes affecting program
• Employee compliance
• Record keeping adequacy
• Availability of appropriate respirators

Evaluation Methods

• Workplace inspections
• Employee interviews
• Program records review
• Air monitoring data review
• Medical surveillance trends

Documentation

Evaluation documented including:

• Date
• Evaluator
• Findings
• Corrective actions needed
• Follow-up schedule

13. Record Keeping

Required Records

Medical Evaluation Records:

• Retention: 30 years after last exposure
• Location: _________________________

Fit Test Records:

• Retention: 30 years after last fit test
• Location: _________________________

Training Records:

• Retention: Duration of employment plus 30 years
• Location: _________________________

Air Monitoring:

• Retention: 30 years
• Location: _________________________

Program Evaluations:

• Retention: Permanent
• Location: _________________________

Record Access

Records made available to:

• Subject employee
• OSHA representatives
• NIOSH representatives

Appendices

• Appendix A: Workplace Hazard Assessment
• Appendix B: Respirator Selection Decision Logic
• Appendix C: Medical Evaluation Procedures
• Appendix D: Fit Testing Procedures
• Appendix E: Cleaning and Maintenance Procedures
• Appendix F: Training Materials and Records
• Appendix G: Program Evaluation Forms

Program Revision History

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Program Administrator Signature: _________________________
Date: _________________________

Management Approval: _________________________
Date: _________________________

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Customization Notes

This template must be customized for your specific workplace:

1. Complete all blank fields
2. Fillout all tables with workplace-specific information
3. Remove sections not applicable
4. Add appendices with actual procedures and forms
5. Have reviewed by qualified professional (industrial hygienist, safety professional, or attorney)
6. Obtain management approval
7. Distribute to all affected employees
8. Review and update annually

Need assistance? VestMed offers program development services. Contact us at 1-844-837-8767.