Dr View for Medical Approval Respirator Fit Test Records

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Name	Alberta Keams
Location:	1225 main st Elko, NV 89801 Map It
Company	RAM enterprise
Position	Welder
Type Full Name	Alberta
Evaluation Results	Evaluation Results
Your Evaluation Results	Approved
Respirator Type	You are medically approved for the following types of Respirator:
Respirator Type	Half Face Respirator
Frequency of Respirator Usage	Daily
Work Load	Light to Heavy Duty work with potential lifting excess of 50lbs
Approval Fit For Duty:	Yes, 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 identified 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	12 hours
What PPE Personal Protective Equipment will you be wearing while using a respirator?	LEVEL "A" : Fully encapsulated chemical suit protecting skin and eyes, positive pressure full face respirator using SCBA, inner and outer, gloves, chemical boots to protect from toxic chemicals or particles
What is the maximum expected temperature you will be working?	0-100 Degrees Fahrenheit
What is the estimated humidity range you will be working in your work environment?	0 - 20%
Comments:	N/A
Frequency of Medical Exam	Annually
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