Medical Certification Instructions

Medical Protocol for Respirator Examination

The UCSC Student Health Center conducts a medical surveillance program for respirator users. Medical clearance is required before approval for respirator use is given. The program includes a medical questionnaire, which is completed by the employee and reviewed by the Campus Physician.

Final decisions on clearance for respirator use will be made by the Campus Physician. If an employee wishes his or her personal physician to supply information about health status, this information will be considered in the decision. Once clearance is granted, the employee must take a copy of the signed form to EH&S to arrange for training and respirator fit-testing.

Information from the medical evaluation will be confidential except where disclosure is needed to protect the health of the employee or coworkers. Records are kept on file at the Health Center, according to regulations governing occupational health records.

Medical Requirements - Employees, Faculty, Students, Visiting Scholars and Volunteers

  1. Medical Certification - All first-time applicants for medical certification must complete the Respirator Medical Questionnaire.   Additional requirements may include spirometry, specifically a Forced Expiratory Volume in one second (FEV1) maneuver, and a Forced Vital Capacity (FVC).   
  2. Medical Recertification - Medical qualifications must be repeated if the employee experiences difficulty wearing the respirator, a change in workplace conditions increases the physiological burden on the employee, or if deemed necessary by the Campus Physician.   
  3. Conditional Medical Requirements - At the discretion of the Campus Physician, respirator users may be required to have a physical examination which may include an exercise electrocardiogram or a chest x­ray. The physical exam may be required if the prospective respirator wearer:
    • Has significant positive responses on the questionnaire.    
    • Fails to obtain a FEV1/FVC ratio of 70% and/or a FVC of at least 75% of predicted value.    
    • Uses a self­contained breathing apparatus (SCBA).    
    • Is referred back to the Medical Center by EH&S because s/he is having difficulty wearing the respirator.

Instructions for Obtaining Medical Certification

  • Complete the Respirator Medical Questionnaire.       
  • Submit it to the Cowell Student Health Center (attention Medical Director) for review by the Campus Physician.         
  • Once you have received medical clearance, contact EH&S to schedule training and fit testing.

For more information on respiratory protection procedures please contact EH&S at 459-2553.