Respiratory Protection Program Template

Organization Name
Respiratory Protection Program

Including Appendix A: Medical Questionnaire; B: User Seal-check Instructions; C: Info re Using Non-required Respirators; and D: Glossary.

Purpose

At Organization Name, we value the safety of our employees. This respirator program describes Organization Name’s procedures to ensure the protection of each employee from respiratory hazards. Respirators are to be used only where engineering control of respirator hazards is not feasible, while engineering controls are being installed, or in emergencies. This program is in accordance with the requirements of OSHA 29 CFR 1910.134. It covers administrator duties, proper respirator selection, medical evaluations, respirator fit testing, maintenance/care procedures, and training.

Administrative Duties

Organization Name’s “Respiratory Protection Program” administrator is Job Title, Safety Professional Name. Because of His or Her experience and training in occupational safety, Safety Professional Name is solely responsible for all parts of this program and has full authority to make necessary decisions to ensure its success. His or Her authority and responsibilities include:

  • Recommending the hiring of personnel and purchasing equipment necessary to implement and operate this program.
  • Developing detailed written instructions covering each of the basic elements in this program.
  • Being the sole person authorized to amend these instructions.
  • Overseeing our “Respiratory Protection Program” and conducting the required evaluations of this program’s effectiveness.

Employees may review a copy of our “Respiratory Protection Program” upon request. It is located in:

Table 1. Program Location

Facility Program Location Person in Charge
of Keeping Program
Facility Location Safety Professional Name
Facility Location Safety Professional Name
Facility Location Safety Professional Name

 Respirator Selection

We select our employee’s respirator based on the respiratory hazards to which you are exposed and other factors that affect respirator performance and reliability. All selections are made by the Job Title, Safety Professional Name.

The Job Title will work with respiratory specialists at Organization Name when selecting your respirator. Outside consultants, manufacturer’s assistance, and other recognized authorities are consulted when there is any doubt regarding proper selection.

Respirator Types and Uses

The following types of respirators are in use in this facility for the indicated uses…