The Occupational and Diving Medicine Centre
Entrushed with the Health of ALL@Work
This questionnaire will only be used for purpose of assessing fitness to work with respirators. The questionnaire meets the US HIPAA (Health Insurance Portability & Accountability Act) requirements for medical information. A password protected FILLED copy will be sent to you after submission. Please print a copy to bring to clinic.
Questionnaire to determine fitness to wear a respirator. You may be asked to do additional tests.
*Spirometry advised +ECG advised