Medical Evaluation Results Olson Electric

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Name	Calvin Haskan Jr
Company or Personal Address	P.O. Box 2112 Denetso, AZ 86503 Map It
Company	Olson Electric Company
Type Full Name	Calvin Haskan Jr
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	8 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?	0-30 Degrees Fahrenheit
What is the estimated humidity range you will be working in your work environment?	0 - 20%
Comments: (Please list any physical requirements or workload changes for employee, to safeguard their health while wearing a respirator.	None
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