| Diane Hale | |
| 820 Valley View Blvd Las Vegas, NV 89103 Map It | |
| BIWS | |
| Comstock Gold Mine | |
| Miner | |
| Diane Hale | |
| Evaluation Results | |
| |
| You are medically approved for the following types of Respirator: | |
| Half Face Respirator | |
| Daily | |
| Medium Duty | |
| The above worker is fit for duty to wear the above identified respirator. This fit for duty approval is based a on the medical questionnaire answers, the identities working conditions and/or an in person exam of the worker. The worker is required to inform their supervisor if their physical health changes which may warrant another medical exam to ensure they may safely wear a respirator. |
|
| Work Shift Hours | 8 hours |
| What PPE Personal Protective Equipment will you be wearing while using a respirator? | LEVEL "D" : Standard work uniform, scubs, coveralls, Safety eyewear, gloves, hardhat, work boots |
| What is the maximum expected temperature you will be working? | 95 and higher |
| What is the estimated humidity range you will be working in your work environment? | 0 - 20% |
| Comments: | NA |
| Frequency of Medical Exam |
|
| Contact Employer | If you experience any changes in your health that could affect your ability to safely use a respirator, you should contact your employer immediately. Please feel free to contact us if you have any questions. |
| Signature | |
| Respiratory Protection Healthcare Professional | Respiratory Protection Healthcare Professional Henderson Pain Center |
