Many workplaces rely on respiratory protective equipment to control exposure to toxic substances.  Whether for routine operations, maintenance, or emergencies respirators can provide vital protection from respiratory hazards.¹ To do so, respiratory protective equipment (RPE) must be carefully chosen to ensure the right type of protection is provided.  It’s also important to use, maintain and store RPE properly.  RPE users should be fit-tested to ensure the respirator facepiece fits properly and provides an effective facial seal.  Users and supervisors have to be trained and records kept.  Policies and procedures related to the use of respirators should be documented in a Code of Practice.  Even after all of this is done, however, some individuals won’t be able to wear a respirator – due to the state of their health.  Are your employees healthy enough to wear respirators?

Alberta Human Resources and Employment reports that about 2% of workers that undergo a health assessment for respirator usage are either disqualified from RPE use or have medical restrictions².  Inability to wear RPE may be the result of physical or psychological factors, such as respiratory disease, heart conditions, back or neck problems, claustrophobia, or panic attacks.  These and many other conditions can exclude or limit respirator use.

Health surveillance or medical assessment of RPE users has been legislated in some western provinces.  In British Columbia the requirement for medical assessment is clearly cited in the Occupational Health & Safety Regulation “when there is doubt about the worker’s ability to use a respirator for medical reasons”³.  Although similar requirements are not explicitly stated in Alberta’s OH&S Code, the legislation does specify that respirator selection must be conducted in accordance with CSA Standard Z94.4-02.⁴ Health surveillance is part of that standard.  In addition, a bulletin published by the Alberta government² recommends health surveillance “prior to fit testing and respirator use” and again cites part of CSA Standard Z94.4-02 for reference. 

A complete health surveillance procedure should include the following steps:

1. Documentation of the work environment, type of RPE and conditions of RPE usage – to be completed by the employer or employer’s representative;
2. Health questionnaire – to be completed by the worker;
3. Review of the questionnaire and workplace description – to be conducted by a health care professional⁵; and
4. Medical assessment (where recommended in Step 3) – to be performed by a physician.

The Z94.4 standard³ includes a Sample Respirator User Screening Form with complete details of this process.

The term “surveillance” implies that a worker’s fitness to wear RPE should be monitored and reassessed from time to time.  Surveillance steps should be repeated when, for example: RPE is changed, prior to periodic fit testing, or when there are known changes to an individual’s health status.  

Health surveillance is an important element of the overall respiratory protection program.  Make sure that your RPE users are healthy enough to wear respirators. 

Endnotes & References:

1. It’s generally accepted by health & safety professionals, and legislated in some provinces, that personal protective equipment (including respirators) should be a last resort to be used only when engineering and administrative controls are not practicable.

 2. “Respiratory Protective Equipment: An Employer’s Guide”, Workplace Health & Safety Bulletin PPE001, Alberta Human Resources & Employment, April 2005

 3. Occupational Health & Safety Regulation, Workers’ Compensation Board of British Columbia, Part 8.42

 4. “Selection, Use and Care of Respirators”, Z94.4-02, Canadian Standards Association, October 2002

 5. CSA Z94.4-02 defines health care professional as a licensed physician or nurse with knowledge and experience in occupational health.