American  ANSI/AIHA Z88.

6–2006
Z88.6–2006

National
Standard
for  Respiratory 
Protection —
Respirator Use
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Physical
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Qualifications
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 A Publication by 
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 American Industrial Hygiene Association
 ANSI/AIHA Z88.6—2006

American National Standard

for Respiratory Protection —
Respirator Use —
Physical Qualifications for Personnel

Approved: August 25, 2006

American Industrial Hygiene Association

American Approval of an American National Standard requires verification by ANSI that
the requirement for due process, consensus, and other criteria for approval
National have been met by the standard’s developer.

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Standards Review,
Review, substantial agreement has been reached by directly and
materially affected interests. Substantial agreement means much more than a
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al l
views and objection be considered, and that a concerted effort be made
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will in no circumstances give an interpretation of any American National
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Moreover, no person shall have the right
r ight or authority to issue an
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CAUTION NOTICE: This American National Standard may be revised or with-

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Published by
American Industrial Hygiene Association
2700 Prosperity Ave., Suite 250
Fairfax, VA 22031
www.aiha.org

Copyright © 2006 by the American Industrial Hygiene Association

All rights reserved.

No part of this publication may be reproduced in any form,

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Printed in the United States of America.

Stock No: SRPA06-716

ISBN: 1-931504-71-7
Contents
Page
Foreword
Foreword ..........
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Subcommittee Members.............................
Members.........................................
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1 Scope and Purpose ...........
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1.1 Scope...............................
Scope..........................................
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1.2 Purpose ............
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1.3 “Shall” and “Should” ...........
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1.4 Exceptions ............
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2 Normative References.................
References............................
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3 Definitions...........
Definitions .......................
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4 Respirator Characteristics ...........
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5 Medical Evaluation Rationale ...........
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6 Qualificatio
Qualification
n of Person
Persons
s Who
Who Conduct
Conduct Medical
Medical Evaluati
Evaluations ons to Determi
Determine ne Suitability
Suitability to
Use Respiratory Protective Devices................................
Devices...........................................
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7 Evaluation Requirements ............
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8 Medical History ...........
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9 Medical Evaluation ..........
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9.1 Frequency ...........
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9.2 General Considerations ................................
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6
10 Special Testing.........................
esting....................................
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10.1 Spirometry ............
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Annexes
Annex
Annex A Exercise
Exercise Stress
Stress Testing..........
esting..............
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Annex
Annex B1 Respirato
Respiratorr Medical Examination
Examination Form/TForm/Tempor emporary ary Disqualificatio
Disqualification n Criteria........
Criteria...........1 ...11
1
Annex
Annex B2 Request
Request for
for Medical
Medical Clearan
Clearance ce for
for Respirato
Respiratorr Use Questio Questionnaire nnaire
PLHCP Determination of Class Form ............
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12
Annex
Annex B3 Example
Example of the Medical
Medical Questionnair
Questionnaire e for Respirat
Respirator or Users InitialInitial Form......
Form.......... ........
....13
13
Annex
Annex B4 Example
Example of the Medical
Medical Question
Questionnaire naire for for Respirato
Respiratorr Users Periodic Periodic Form Form .... ........
.....15
.15
Annex
Annex B5 Example
Example of Employee
Employee Copy
Copy of PLHCP’s
PLHCP’s Written Written Communicat
Communication ion Form .... ........
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.......16
...16
Annex
Annex C Spirometry
Spirometry (Guidance
(Guidance for
for Perf
Performance
ormance and and Interpretat
Interpretation)...ion).......
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17
Annex
Annex D Future
Future Research
Research Areas.........
Areas.............
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.19
 ANSI/AIHA Z88.6–2006

FOREWORD

A series of related American National Standards were identified after the development of ANSI
Z88.2–1980 “Respiratory Protection Programs” to address specialized technical elements of respi-
ratory protection programs. ANSI Z88.6–1984 “Respirator
“Respirator Use — Physical Qualifications for
Personnel” was
was the first of these standards to be developed. ANSI/AIHA Z88.10–2001 “Respirator
Fit Testing
Testing Methods” has also been developed and is available to provide detailed respiratory pro-
tection program guidance in the area of respirator fit testing.

American National Standard Z88.6-1984 contained general, rather than specific requirements
because it was the first standard to deal with this subject. It was intended that “more specific
requirements” would be provided in future editions that would provide more detailed guidance to
assist medical professionals in determining which individuals should and should not be medically
qualified to wear respirators. Annex C of the 1984 standard concluded with suggested “Areas of
Future Investigation.”
Investigation.” This standard addresses these and other areas and presents a process that
meets, and in many areas exceeds, the minimum requirements of the Occupational Safety and
Health Administration’s (“OSHA”) Respiratory Protection Standard (the “federal standard”) 29 CFR
1910.134, and:

• Includes all the questions required by the

the OSHA respirator
respirator questionnaire as well as additional
questions to assess the risk of cardiac disease,
• Recommends physician
physician review of all cases that fall outside certain parameters, and
• Considers the physiologic demand
demand of the type of work
work to be performed, and type of respirator for
for
which approval is granted.

The Committee has made the following determinations regarding the revised Standard:

• Any medical professional

professional authorized to evaluate respirator use should be required to know the
physiologic demands associated with various types of respirators.
• The impact of safe and reliable work performance
performance on fellow
fellow workers and the public should be
considered.
• The impact of medical factors on job performance
performance exclusive of respirator use should be considered.
• Conditional
Conditional approval
approval may
may be granted in appropriate
appropriate cases.
cases.
• A periodic medical questionnaire prior to to annual respirator
respirator fit testing should be administered.
• Clinical Exercise Stress Testing (EST) is a useful test for evaluating
evaluating the functional capacity (work
(work
capacity) of users of industrial respirators as respiratory reserve is normally greater than circulatory
system reserve and cardiac disease is more common as a disqualifier than pulmonary disease.
• The routine use of spirometry
spirometry to determine the suitability of individuals
individuals to use respiratory
respiratory protective
protective
devices is not required, although pulmonary function data (especially aggregate data) may be an
important measure of response to worker exposure.
• Workers are
are less likely to
to have clinically significant Coronary Artery Disease “CAD” and to be
heat intolerant if they achieve a negative EST to 10 METs.
• Specific blood pressure,
pressure, body weight,
weight, and pulmonary function values will require
require physician con-
sideration, and/or evaluation, and/or medical testing.
• The conservative definition of “heavy” work as suggested by “OSHA” should be adopted.
• A concise stateme
statement nt regarding
regarding facial
facial hair should
should be included.
included.
• Workers
Workers using contact
contact lenses,
lenses, and workers
workers with perforat
perforated
ed tympanic
tympanic membranes
membranes should not be
routinely excluded.
• A chest X-ray
X-ray should not be used routinely to determine suitability to use respirators.
• Spirometry should be interpreted in accordance with the recommendations of the American
Thoracic Society (ATS) and that ATS ATS recommendations for performing spirometry tests should be
considered as useful guidance by evaluators.

iii
ANSI/AIHA Z88.6–2006

There are four annexes in this standard. These annexes are informative and are not considered
part of the standard. Suggestions for the improvement of this standard will be welcome. They
should be sent to the ANSI Z88 Secretariat, American Industrial Hygiene Association, 2700
Prosperity Avenue, Suite 250, Fairfax VA. 22031.

Future revisions are anticipated to provide even more detailed guidance, especially as it applies to
workers with known serious medical issues.

iv
 ANSI/AIHA Z88.6–2006

This standard was processed and approved for submittal to ANSI by the Z88 Accredited Standards
Committee on Respiratory Protection. Committee approval of the Standard does not necessarily
imply that all committee members voted for its approval. At the time it approved this Standard the
Z88 Committee had the following members:

James S. Johnson, PhD, CIH, QEP, Chair

Stephen C. Graham, CIH, CSP, Vice Chair
Mili Mavely, Secretariat Representative

Organization Represented Name of Representative 

American Industrial Hygiene Association C. Co
Colton
American Iron and Steel Institute P. Hernandez
American Society of Safety Engineers R. Harley
American Welding Society S. Hedrick
BWXT, Y-12 M. Haskew
Con Edison of New York G. Slintak
EG&G Group R. Metzler
Ford Motor Company S. Mingela
Health Physics Society H. Cember
International Association of Firefighters R. Du
Duffy
International Brotherhood of Boilermakers D. H
Haagger ty
International Safety Equipment Association J. Co
C omer Bradley
Lawrence Livermore National Laboratory J. Jo
Johnson
Los Alamos National Laboratory B. Reiner t
National Fire Protection Association B. Teele
National Institute of Occupational Safety and Health R. Berry Ann
National Park Service J. Sahmel
Navy Environmental Health Center D. Spelce
Peach Bottom Atomic Power Station E. Gee
University of Cincinnati Medical Center R. Mc
McKay
University of Pittsburgh J. Schwerha
U.S. Depar tment of Energy D. Marsick
U.S. Depar tment of Labor J. Steelnack
U.S. Depar tment of the Army S. Graham

Individual Members 
C. Bien
Bien
D. Bevis
Bevis
T. Nelson
Nelson

At the time it approved this standard, the Z88 Committee had the following alternate members:

Organization Represented Name of Alternate Representative  

International Safety Equipment Association J. Bi
B irkner
NIOSH M. D’Alessandro
U.S. Depar tment of Energy D. Weitzman
U.S. Depar tment of the Army I. Richardson

v
ANSI/AIHA Z88.6–2006

The Z88.6 Subcommittee on Respirator Use – Physical Qualification for Personnel, which devel-
oped this Standard, had the following members:

Ronald J. Mack M.D., MPH, Chair

Ross L. Clay, MD, MPH Rober t K. McLellan. MD, MPH
William Dyson, PhD, CIH Roy T. Mc Kay, PhD
Richard Enkeboll Richard R. Reilly, PhD
Connie R. Freiberg, CSP James P. Seward, PhD
Andrew Jackson Mary C. Townsend, DrPH
Charles P. Lisa, MD Patrick Westerkamp
Michael G. Maroldo

vi
AMERICAN NATIONAL STANDARD ANSI Z88.6—2006

American National Standard for Respiratory Protection —

Respirator Use —
Physical Qualifications for Personnel

1 Scope and Purpose 2 Normative Re References. The following

standards contain provisions which,
1.1 Scope. This standard provides information through reference in this text, constitute
that is useful for the medical evaluation of provisions of this American National
respirator users. This standard does not Standard. At the time of publication, the
deal with medical surveillance or biologi- editions indicated were valid. All stan-
cal exposure monitoring. It is understood dards are subject to revision, and parties
that local circumstances vary, that no set to agreements based on this American
of guidelines can cover all situations, and National Standard are encouraged to
that specific programs and procedures investigate the possibility of applying the
should be modified for each individual most recent editions of the standards
workplace. Medical evaluation is only one indicated below.
below.
element of a complete respiratory protec-
tion program. A complete respiratory pro- ANSI Z88.2–1992, American National
tection program is defined in ANSI Standard for Respiratory Protection
Z88.2–1992. ANSI Z88.6–1984, Respiratory
Protection–Respirator
Protection–Respirator Use — Physical
1.2 Purpose. This standard provides informa- Qualifications for Personnel
tion and guidance to physicians or other ANSI/AIHA Z88.10–2001- Respirator Fit Test
licensed health care professionals Methods
(PLHCPs) to assist them in determining
the medical suitability of personnel for res- 3 Definitions
pirator use. It identifies the responsibility
of management to provide the PLHCP 3.1
3.1 Body
Body mass
mass inde
index
x (BM I):: A measure-
(BMI)
with supplemental information before the ment used to assess weight, relative to
PLHCP makes a recommendation con- height. BMI is calculated by dividing body
cerning an employee’s ability to use a res- weight in kilograms by height in meters
pirator (see Section 7.1 of this Standard). squared (kg/m2).
Evaluators shall use their clinical judgment
in the application of these guidelines and 3.2
3.2 Cani
Canist ster
er or ca
cart
rtri
ridge: A container with
dge:
require additional information or evalua- a filter, sorbent, or catalyst, or combina-
tion as necessary to permit certification or tion of these items, which removes spe-
classification for respirator use. cific contaminants from the air passed
through the container.
1.
1.3
3 “Sha
“Shallll”
” and
and “Sho
“Should.”” The provisions of
uld.
this standard are mandatory in nature 3.3
3.3 Emer
Emerge genc
ncy
y situ
situat
ation: Any occurrence
ion:
where the word “shall” is used and advi- such as, but not limited to, equipment
sory in nature where the word “should” is failure, rupture of containers, or failure of
used. control equipment that may,
may, or does,
result in an uncontrolled significant
1.4 Exceptions. Users of this standard release of an airborne contaminant.
should be aware that regulatory agencies
may have requirements that are different 3.4
3.4 Empl
Employ
oyee
ee expos
xposur e: An exposure to a
ure:
from this standard. concentration of an airborne contaminant

1
ANSI/AIHA Z88.6–2006

that would occur if the employee were 3.15 Interior

Interior structural
structural firefight ing: The
firefighting:
not using respiratory protection. physical activity of fire suppression, res-
cue or both, inside of buildings or
3.5
3.5 End-
End-ofof-s
-ser
ervi
vice
ce-l
-lif
ife
e indic
indicator:: A system
ator enclosed structures which are involved in
that warns the user of the approach that a fire situation beyond the incipient state
the end of adequate respiratory protec- (See 29 CFR 1910.155).
tion is imminent.
3.16
3.16 Loose-
Loose-fitfittin
ting
g facepiece:: A respiratory
facepiece
3.
3.6
6 Esca
Escape
pe-o
-onl
nly
y resp
respir
irator:: A respirator
ator inlet covering that is designed to form a
intended only for use during emergency partial seal with the face, does not cover
egress from a hazardous atmosphere. the neck and shoulders, and may or may
not offer head protection against impact
3.7
3.7 Exer
Exerci
cise
se stre
stress
ss test
test (EST ): A standard
(EST): and penetration.
graded exercise test used to assess an
individual’s ability to tolerate increasing 3.17
3.17 Metabo
Metabolic
lic equiv
equivale
alents (METs):: A unit of
nts (METs)
intensities of exercise while electrocar- energy expended: one MET is 3.5 mL
diographic (EKG), hemodynamic, and 02 /kg/min and represents the energy
symptomatic responses are monitored expended at rest. Standardized exercise
for manifestations of ischemia, electrical protocols express energy expended in
instability,
instability, or other exertion-related terms of multiples of resting metabolic
abnormalities. energy or METs.

3.8 Filter: A component used in respirators 3.18

3.18 Negati
Negativeve pressur
pressure e respira tor:: A respi-
respirator
to remove solid or liquid aerosols from rator in which the air pressure inside the
the inspired air. respiratory inlet covering is negative dur-
ing inhalation with respect to the ambient
3.
3.9
9 Filt
Filter
erin
ing
g face
facepipiece: A negative-pressure
ece: air pressure.
respirator with an air-purifying element
as an integral part of the facepiece or 3.19
3.19 Oxygen
Oxygen defici
deficient
ent atmos
atmosphe re: An oxy-
phere:
with the entire facepiece composed of gen partial pressure of 96 to 122 mmHg
the air-purifying medium. shall be considered an oxygen-deficient
atmosphere that is not immediately dan-
3.
3.10
10 Fit
Fit fac
facto r: A numeric estimate of how
tor: gerous to life (IDLH). An oxygen partial
well a tight-fitting respirator facepiece fits pressure of 95 mmHg or less shall be
an individual during a quantitative fit test. considered IDLH. The oxygen deficiency
It is the ratio of the concentration outside may be caused by a reduction in the nor-
the facepiece (C out) to the concentration mal 20.9% oxygen content, by reduced
inside the facepiece (C in). (Fit factor = total atmospheric pressure, or by any
C out/C in ). combination of reduced percentage of
oxygen and reduced pressure.
3.
3.11
11 Fit
Fit test: The use of a challenge agent to
test:
evaluate an individual’s ability to obtain an 3.20
3.20 Physi
Physiciacian
n or other
other license
licensed d health
health
adequate seal with a specific respirator. care professional (PLHCP): An individ-
ual whose legally permitted scope of
3.
3.12
12 Helm
Helmetet:: A hood that offers head protec- practice (i.e., license, registration, or cer-
tion against impact and penetration. tification under state law) allows him or
her to independently provide, or be dele-
3.13 Hood: A respiratory inlet covering that gated the responsibility to provide, some
completely covers the head and neck or all of the health care services required
and may cover portions of the shoulders. by paragraph (e) of 29 CFR 1910.134.

3.14
3.14 Immedi
Immediateately
ly danger
dangerous
ous to life
life and 3.21
3.21 Positiv
ositive
e pressure
pressure respir
respirato r: A respira-
ator:
health (IDLH): Any atmosphere that tor in which the pressure inside the respi-
poses an immediate hazard to life or ratory inlet covering is normally positive
poses immediate irreversible debilitating with respect to ambient air pressure.
effects on health.

2
 ANSI/AIHA Z88.6–2006

3.22
3.22 Qualit
Qualitati
ative
ve fit
fit test (QLFT): A pass/fail
(QLFT): 4.1.3 Powered
Powered air-purif
air-purifying
ying respirator
respiratorss
test that relies on the subject’s sensory (PAPR): Powered units contain a blower
response to detect the challenge agent. to move the air through the filtering media.
Inhalation and exhalation resistance is
3.23
3.23 Quanti
Quantitat
tative
ive fit
fit test (QNFT): A fit test
(QNFT): negligible, similar to a continuous-flow air-
that uses an instrument to measure the line device. The weight of the blower
challenge agent inside and outside the varies from approximately 5 to 15 lb.
respirator.
4.2
4.2 Atmo
Atmosp
sphe
here
re-S
-Sup
uppl
plyi
ying
ng Resp
Respir
irat
ator
ors
s
3.24
3.24 Respir
Respirato
atory
ry inlet
inlet cover ing:: The portion
covering
of a respirator that connects the wearer’s 4.2.
4.2.1
1 Gene
Genera l. Atmosphere-supplying respira-
ral.
respiratory tract to an air-purifying device tors are either self-contained or airline
or respirable gas source, or both. It may units. The self-contained breathing appa-
be a facepiece, helmet, hood, suit, or ratus (SCBA) is completely portable. The
mouthpiece/nose clamp. airline apparatus requires the trailing of
an air hose from the wearer to the
3.25 Self-cont
Self-contained
ained breathing
breathing apparatus
apparatus source of breathing air.
(SCBA): An atmosphere supplying respi-
rator in which the respirable gas source Atmosphere-supplying respirators oper-
is designed to be carried by the user. ate in continuous- flow,
flow, demand, or pres-
sure-demand modes. Continuous-flow
3.26
3.26 Serv
Servic
ice life:: The period of time that a
e life respirators blow air continuously into the
respirator provides adequate protection mask. Demand-type apparatus require
to the wearer. the wearer to inhale and reduce the
mask pressure below atmospheric pres-
3.27
3.27 Tight-
Tight-fit
fittin
ting
g facepiece:: A respiratory
facepiece sure, before the regulator will supply air.
inlet covering that is designed to form a (This is similar to inhaling through an air-
complete seal with the face. A half-face-
half-face- purifying device). In a pressure-demand
piece (includes quarter masks, filtering (positive-pressure) device, a slight posi-
facepieces, and masks with elastomeric tive pressure is maintained in the face-
facepieces) covers the nose and mouth; piece at all times by the regulator. More
a full facepiece covers the nose, mouth, air is admitted to the mask as the posi-
and eyes. tive pressure decreases during inhala-
tion. Exhalation resistances are greater
3.28
3.28 User
User seal
seal chec k: A procedure conduct-
check: than for demand devices.
ed by the wearer to determine if the res-
pirator is properly sealed to the face. 4.2.2
4.2.2 Open-c
Open-cir ircui SCBA.. Open-circuit SCBA
cuitt SCBA
is available in demand or pressure-
4 Respirator Characteristics demand devices. In open-circuit devices,
breathing air is supplied from a cylinder to
4.1
4.1 Air-
Air-Pu
Puri
rify
fyin
ing
g Resp
Respir
irat
ator
ors
s the mask, and then dumped into the
atmosphere on exhalation. The nitrogen in
4.1.
4.1.1
1 Gene
Genera l. Air-Purifying Respirators (APR)
ral. the breathing air is excess weight that
remove specific air contaminants by does not contribute to the wearer’s metab-
passing ambient air through an air-purify- olism. The maximum allowed weight is 35
ing filter, cartridge, or canister. APR are lb, although modern half-hour units may
either non-powered or powered. APR are weigh 10 lb less. Significant reduction (up
not approved for fire-fighting efforts. to 20%) in work capacity of the wearer
can occur since the 35 lb load must be
4.1.2 Air-puri
Air-purifying
fying (nonpowere
(nonpowered) d) respira- carried. Heavy work rates may be
tors: Inhalation through the filtering required during fire-fighting and rescue sit-
media and exhalation through the valve uations while wearing SCBA.
depend only on the breathing action of
the lungs. Inhalation resistances are less Regulators on current SCBA may not
than 35mm H20 and exhalation resist- meet the high instantaneous demands of
ances are less than 25 mm H20. wearers at heavy work rates, and so may

3
ANSI/AIHA Z88.6–2006

impair work out-put further. The 6.1 Medical evaluation shall be performed by
increased exhalation resistance of pres- a physician or other licensed health care
sure-demand units may also degrade professional (LHCP) (e.g., nurse practi-
ability to perform heavy work. tioner, physician assistant, occupational
health nurse), provided that their license
4.2.3 Closed-cir
Closed-circuit SCBA. Closed-circuit
cuit SCBA. permits them to perform such evalua-
SCBA is available in demand or pres- tions. LHCPs are expected to consult
sure-demand devices. In closed-circuit with an appropriate physician when
units (also known as rebreathers), oxy- questions arise about an employee’s
gen is supplied from a compressed gas, physical condition and capability,
capability, such as
liquid, or chemical source. Exhaled air is those described in this standard.
scrubbed of carbon dioxide and returned
to the facepiece. Closed-circuit
Closed-circuit devices 7 Evaluation Re
Requirements
have a longer duration for their weight
than does open-circuit equipment. 7.1 The industrial hygienist, safety profes-
Breathing is into and out of a bag rather sional, or other employer representative
representative
than from a regulator. Oxygen concentra- shall provide the PLHCP with supple-
tions may range from 21 to 90 percent. mental information before the PLHCP
makes a recommendation concerning an
4.2.4 Supplied-a
Supplied-air ir respirator
respirators
s (SAR). employee’s ability to use a respirator. The
Supplied-air or airline respirators are following supplemental information shall
available as continuous-flow,
continuous-flow, demand, or be provided (see Annex B2):
pressure-demand devices. All supplied (a)
(a) The
The typ
typee and
and weigh
weightt of
of the
the resp
respirira-
a-
air respirators require a trailing air hose tor to be used by the employee.
that limits movement about the work- This should include (i) effort of
place. Duration of use is limited only by breathing, (ii) special features,
features,
the air source and the metabolic work such as size, shape, bulk, full face,
rate. Exhalation resistance is equal to or hood, etc.
lower than that of demand equipment, (b)
(b) The
The dur
durat
atio
ionn and
and freq
freque
uenc
ncyy of
of res
res--
since the exhalation valve is held open pirator use (including use for res-
by the continuous outward flow of air. cue and escape);
Demand and pressure-demand versions
(c)
(c) The
The exp
expec
ecte ted
d phy
physi
sica
call work
work effo
effort;
rt;
of airline units have physiological effects
similar to the SCBA, except for the addi- (d)
(d) Addit
Additioiona
nall pro
prote
tect
ctiv
ivee clot
clothi
hing
ng and
and
tional weight burden of the SCBA. equipment to be worn;
(e)
(e) Tem
empeperaratu
turere and
and hum
humididit
ity
y
5 Medical EvEvaluation Ra
Rationale extremes that may be encoun-
The effects of physical work effort, pro- tered;
tective clothing, temperature, humidity,
humidity, (f)
(f) A cop
copy y of
of the
the writ
writte
tenn res
respi
pira
rato
tory
ry
and the physiologic burden placed on a protection program; and,
worker using a respirator must be con- (g)
(g) A cop
copy y of
of 29
29 CFR
CFR Part 19101910.1.134
34 –
sidered during the medical evaluation for Respiratory Protection; Final Rule.
respirator use. PLHCPs shall provide
reasonable assurance that a worker can 7.1.1 Extent
Extent of usage should
should be defined
defined as as
endure these stressors without adverse follows:
medical consequences, and recommend
(1)
(1) On a dai
daily
ly basi
basis s (if
(if so,
so, sta
state
te ma
maxixi--
any limitations on respirator use related
mum hours a day of expected use).
to the medical condition of the employee
or the work place conditions in which the (2)
(2) Occa
Occasision
onall
ally
y, but
but prob
probab ably
ly mo
more
re
respirator will be used. than once weekly (as in mainte-
nance worker), if so state maxi-
6 Qualifications of
of Pe
Persons Who mum hours per week of expected
Conduct Medical Evaluations to use.
Determine Suitability to Use (3)
(3) Rare
Rarely
ly (if
(if so stat
statee ma
maxim
ximum um hour
hours s
Respiratory Protective Devices per year of expected use).
(4)
(4) For em
emererge
gencncyy sit
situa
uati
tion
onss onl
only
y.

4
 ANSI/AIHA Z88.6–2006

7.1.2 Special responsibilities should be restrictions, medical evaluations, or

defined, such as, individuals who have
responsibility for the safety of others and
consequently may be expected to have
special physical capabilities.
capabil ities. This would
include rescue workers, fire fighters,
security personnel, and the like.
7.1.3 The estimated frequency for each type of
“emergency situation” that may pose an
IDLH risk, should be provided.
7.1.4 Other special environmental conditions
(i.e., excessive heat, confined space
usage, hyperbaric or hypobaric environ-
ments) should be identified. Additional
requirements for protective clothing
should also be listed.
7.1.5 The above supplemental information
need not be provided for subsequent
medical evaluations if the information
remains the same and is transferred to
the new evaluator.
7.1.6 The agents to which a worker will be
exposed should be identified for regularly
scheduled work and during emergencies
when possible.
treatments. These work restrictions
should be identified to permit a
decision by the supervisor or safety
representative to determine suitabil-
ity for a specific task. Restrictions
may include moderate/light work
only, no SCBA use, PAPR only,
annual medical evaluation or
age–specific medical evaluation.
(3) Class 3: Permanent
3: Permanent restriction from
respirator use. No respirator use
permitted (permanent) under any
circumstances. The reason should
not be identified on the report to
the supervisor or to the safety
department or other groups respon-
sible for the respirator program.
(4) Class 4: T
4: Temporary restriction from
respirator use.
use. No respirator
respirator use
permitted
permitted (temporary)
(temporary) — worker
worker
requires additional medical evalua-
tion and/or treatment and physician
evaluation.
(5) Class 5: Additional
5: Additional temporary or
permanent non-respirator work
restrictions (e.g., no heavy lifting,
no climbing, no heat stress).

7.2 Based on this medical evaluation and the 7.3 Written respirator program standard
information provided, the PLHCP shall operating procedures shall include a writ-
certify whether the individual is permitted ten procedure describing the medical
to use a respirator under the circum- evaluation process for respirator users.
stances described. The physical
demands of the work shall be the limiting 8 Medical History
factor.
factor. The special characteristics of the
respirator(s) to be used for this work, in 8.1 A medical history (respirator question-
so far as they significantly increase the naire) should be utilized to identify the
work demands while in use, shall be following (See Annex B3):
considered. (1)
(1) Prev
Previou
iousl
sly
y diag
diagno
nosesed d dis
disea
ease
se,, par
par--
ticularly known cardiovascular or
7.2.1 In addition to the classification for respi- respiratory diseases.
rator use, the report to the employer rep- (2)
(2) Psyc
Psycho holo
logi
gica
call prob
problelems
ms oror symp
symp--
resentative should include any other toms including claustrophobia.
work limitations or restrictions found dur-
(3)
(3) Prob
Problem
lemss asso
associciat
ated
ed with
with brea
breathth--
ing evaluation even if they are not neces-
ing during normal work activities.
sarily related specifically to respirator
use. (4)
(4) Past
ast pro
probl
blem
ems s wit
withh rres
espi
pira
rato
torr u
use
se..
(5)
(5) Past
ast and
and curr
curren
entt usa
usage ge of me
medi dica
ca--
7.2.2 The PLHCP shall classify the examinee tion.
in a category as follows (see Annex B2). (6)
(6) Any
Any kno
known
wn phys
physicaicall def
deform
ormititie
ies
s or
or
(1) Class 1: No
1: No restriction on respira- abnormalities, including those
tor use. which may interfere with respirator
(2) Class 2: Conditional
2: Conditional respirator use use.
permitted, subject to specific use (7)
(7) Know
Known n cur
curre
rent
nt preg
pregna nanc
ncyy.

5
ANSI/AIHA Z88.6–2006
8.2 The PLHCP shall review the medical
questionnaire.
Conditions that may possibly disqualify
personnel for respirator use as identified
by a positive response on the respirator
questionnaire must be followed by an
interview with a PLHCP.
If indicated, following an interview
inter view,, the
PLHCP shall refer or perform an evalua-
tion of the individual (see Annex B1). The
PLHCP will determine the scope of the
evaluation and what testing, if any, shall
be required to determine medical suit-
ability to use a respirator.
In certain cases, following an evaluation,
additional medical tests, consultation, or
diagnostic procedures (such as, a car-
diac exercise stress test (EST), spirome-
try,
try, an audiogram, an ophthalmology
consultation) may be necessary to make
a final determination.
deter mination. Only the PLHCP’s
determination shall be communicated to
the supervisor/manager (see Annex B2,
Section B); no medical information shall
be communicated.
9 Medical Evaluation
9.1 Frequency. An initial medical evaluation
shall be performed using a medical histo-
ry (respirator questionnaire) or interview
and examination that obtain the same
information as the medical questionnaire.
Additional evaluations
evaluations shall be required if:
a) the employee reports medical signs or
symptoms that are related to the ability to
use a respirator; b) a PLHCP, supervisor,
or the respirator program administrator
informs the employer that an employee
needs to be reevaluated; c) information
from the respiratory protection program
including observations made during fit
testing and program evaluation indicates
a need for employee reevaluation, or, d) a
change occurs in workplace conditions
(e.g., physical work effort, protective
clothing, temperature) that may result in a
substantial increase in the physiological
burden placed on an employee.
9.1.1 In addition, a follow-up questionnaire or
interview should be used periodically to
identify medical conditions that develop
6
after the initial
i nitial evaluation. This question-
naire could be administered prior to an
annual fit test (see Annex B4). The fre-
quency of this follow-up could be age-
specific (e.g., every 5 years up to age
35), then every 2 years until age 45, and
annually thereafter.
9.1.2 Annual evaluations for SCBA users of all
ages shall be required.
9.1.3 Following review of the periodic question-
naire and/or interview
inter view,, and/or limited
medical testing, the PLHCP may deter-
mine that certain individuals require addi-
tional evaluation (such as, all or part of
the physical examination and testing
described in Annex B1) and/or medical
testing, consultation, or diagnostic proce-
dures.
9.2
9.2 Gene
Ge nera
rall Cons
Consid ider
erat
atio ns.. The PLHCP’s
ions
evaluation of suitability of the individual
examinee for respirator use shall be
based on the unique medical status of the
individual (in light of the work load to be
performed while wearing the respirator).
9.2.1 Following the initial or a subsequent eval-
uation the PLHCP may determine that
periodic medical re-evaluation (examina-
(examina-
tion, or testing, or consultation) is appro-
priate for a certain individual.
The PLHCP shall provide the worker-
employee and the employer with a writ-
ten recommendation regarding the work-
er’s medical ability to use a respirator
(see Annex B2, Section B). The PLHCP
shall also notify the worker-employee of
any medical conditions, actions recom-
mended, and the frequency of necessary
periodic-evaluations. (See Annex B5).
9.2.2 The following conditions shall be consid-
ered temporarily disqualifying for most
respirator use. These conditions may
require medical evaluation or treatment
and may result in permanent restriction
from respirator use. Additional communi-
cation with the treating physician and/or
a consultant physician, and monitoring of
health status may help to disposition
workers with these conditions.
(1)
(1) Facial
acial def
deformit
ormities
ies and
and fac
facia
iall hair
hair or
other conditions that interfere
i nterfere with
 ANSI/AIHA Z88.6–2006

proper sealing of the respirator (if D.B.P. greater than or equal to 90

the respirator has a face seal) shall shall be referred for physician eval- eval-
disqualify the applicant. A fit test uation. The evaluating physician
shall not be conducted if there is will disposition the worker after
any hair growth between the skin consideration of the medical infor-
and the facepiece sealing surface, mation provided and the work
such as stubble beard growth, effort anticipated.
beard, mustache or sideburns (7)
(7) In case
cases s whe
wherere the
the ev
evalua
aluati
ting
ng
which cross the respirator sealing physician has concerns about a
surface.
worker’s
worker’s ability to use respiratory
(2)
(2) Acut
Acute e resp
respir
irat
atory
ory dise
diseas
ases
es whic
whichh protective devices due to abnormal
are anticipated to resolve (includ- pulmonary function testing, (see
ing acute pneumonia, acute bron- Section 10.1 and Annex C), a his-
chitis, and acute asthma) may pre- tory of Coronary Artery Disease,
vent respirator use. obesity [body mass Index (BMI) of
(3) “Mode
“Modera rate
te to seve
severe”
re” restri
restricti
ctive
ve or greater than 30], or a combination
obstructive
obstructive pulmonary disease or of these or other medical prob-
perfusion disorders may require fur- lems, the worker may be medically
ther evaluation. The worker’s med- cleared for respirator use at a
ical history, physical examination, known level of work (light, moder-
and spirometry results may be ate, heavy) by use of an Exercise
used as a basis for temporary dis- Stress Test (EST). The demonstra-
qualification pending further med- tion of greater than or equal to 10
ical evaluation (see Annex B 1-
Metabolic Equivalents (METs)
Temporary Disqualification Criteria).
functional capacity absent
Spirometry may also be useful for
ischemia, arrhythmia, or abnormal
medical surveillance purposes with
BP response, on a physician
certain workplace exposures.
supervised Exercise Stress Test
(4)
(4) Symp
Sympto toma
matitic
c coro
corona
nary
ry art
arter
eryy dis-
dis- (EST) — (See Section
Section 10.1
10.1 and
ease (CAD), significant arrhyth- Annex A) is considered adequate
mias, (e.g., premature ventricular for clearance to perform most
contractions (PVCs), tachycardia,
heavy physical work and to work in
or bradycardia), or a history of
heat stress environments. (See
myocardial infarction may require
Annex B1.)
further evaluation. If an EKG is
performed it should be interpreted (8)
(8) Neur
Neurololog
ogicical
al Disa
Disabi
bilit
lity
y. Certa
Certain
in
using informed clinical judgment neurologic disorders that affect
with consideration of the workers movement and/or consciousness
overall health status. may be aggravated by the work
(5)
(5) The
The dete
determi
rmini
ning
ng phys
physicician
ian,, using
using environment associated with respi-
clinical judgment, shall decide if rator use (heat, humidity, protective
individuals with treated or untreat- clothing, strenuous work). Workers
Workers
ed hypertension, individuals using with such a disorder shall be tem-
cardiovascular medications, and porarily disqualified pending physi-
individuals with multiple risk factors cian evaluation.
or a single extreme risk factor (9)
(9) Medi
Me dica
cati
tion
ons.
s. PLHC
PLHCPsPs shal
shalll use
use
require further medical evaluation. clinical judgment to determine if an
(6)
(6) Worker
orkerss wit
withh a syst
systol
olic
ic bloo
blood d pre
pres-
s- individual should be denied use of
sure (S.B.P.) greater than or equal a respirator due to medication use
to 180 or a diastolic blood pressure (including prescription and non-pre-
(D.B.P.) greater than or equal to scription drugs) that may affect an
110 treated or untreated, shall be employee’s ability to perform his or
temporarily restricted from respira- her job. This decision may involve
tor use. Workers with a S.B.P. communication with a treating
greater than or equal to 140 or a physician or consultant physician.

7
ANSI/AIHA Z88.6–2006
(10)
(10) Psycho
Psycholog logica
icall Condit
Condition
ions.
s. The
PLHCP shall decide if an employ-
ee with a psychological condition
that may impair judgment or relia-
bility should be disqualified (e.g.,
claustrophobia, severe anxiety).
The decision may involve commu-
nication with the treating physician,
or a consultant physician. The
PLHCP may recommend observed
fit testing for the examinee.
(11)
(11) Hearing
Hearing should
should be ade
adequa
quate
te to
ensure response to instructions
and alarm systems or hearing defi-
ciencies should be otherwise
accommodated. In certain work
environments, olfaction may be an
important sense to warn respirator
users of poor face seal or other
causes of respirator failure.
Workers who report trouble
smelling odors may require work
restriction or additional medical
evaluation (which may include
8
olfactory testing) and these work-
ers may be unsuitable for fit testing
methods that rely on odor detec-
tion. Workers shall have adequate
vision to perform their assigned job
duties.
(12)
(12) If a worker
worker has suffe
suffered
red a sud
sudden
den
loss of consciousness or response
capability,
capability, a physician shall deter-
mine if the employee may use a
respirator.
10 Special Testing
10.1 Spirometry or Exercise Stress Testing
Testing
(EST) may be used if the PLHCP needs
information in addition to a history and
physical. Spirometry results do not in
themselves indicate fitness or lack of fit-
ness to use a respirator For accurate
accurate
assessment, spirometry should be per-
formed in accordance with the most
recent recommendations of the American
Thoracic Society (See Annex C).
 ANSI/AIHA Z88.6–2006

Annex A: Exercise Stress Testing

Clinical exercise testing, or the exercise stress test (E.S.T.),
(E.S.T.), is a useful test for evaluating the func-
tional capacity (work capacity) of users of industrial respirators as respiratory reserve is normally
greater than circulatory system reserve and cardiac disease is common in working populations. (1)
Cardiac disease is a common cause of sudden incapacity,
incapacity, and decreased functional capacity.
capacity. For
normal humans, it appears there is no single exercise-limiting factor; the heart with contributions of
muscle, rather than lungs and blood is largely responsible for exercise limitations, training effects,
effects,
and differences in exercise capacity between people.(2)

The EST is a convenient means of determining exercise tolerance and precipitating symptoms and
signs in a controlled environment. Standardized
Standardized protocols, reduced equipment costs, and comput-
erized interpretations have greatly enhanced the practicality and availability of this testing.
Observations of heart rate are easily available data to compare performance on an EST with
demands of job activities. At sub-maximal workloads, the relationship between heart rate and oxy-
gen uptake (workload) is almost linear.(3)

Maximal testing with the aim of establishing safe levels of exercise or work performance can be
performed on any person and aerobic capacity reported as METs (1 MET = metabolic equivalent =
energy expended at rest = 3.5 mL 0 2 /Kg/min).(3)

It is prudent to selectively perform supervised EST in respirator users who are expected to engage
in heavy work if the evaluating PLHCP suspects deconditioning or coronary disease on the basis
of signs, symptoms, or risk factors.
factors. EST for cardiovascular fitness may be necessary, especially if
the work requires strenuous exertion, heat stress will be present, or a clinical indication of a cardio-
vascular abnormality is present. The use of respirators in conjunction with water-impermeable
water-impermeable pro-
tective clothing can impose significant thermal stress. Such situations occur in the hazardous
waste, nuclear,
nuclear, and other industries. EST may also be advisable in the first two situations for work-
ers older than 45 years of age regardless of clinical status. Resting ECGs are not predictive of risk
from respirator use during exertion.(4)

EST requires the active cooperation and informed consent of the participant. Stress testing may
not detect significant coronary disease, especially in asymptomatic workers.(5) Although this test-
ing cannot reliably identify all persons at risk of an acute event it may increase the margin of safe-
ty. Workers should be evaluated on an individual basis and additional testing such as imaging stud-
ies may be recommended for those considered to be at higher risk. (3)

Supervision during EST should be provided by a physician with appropriate training and experi-
ence.(6)

Many protocols and types of equipment (treadmill, cycle ergo meter) are available to perform EST.
The choice of equipment and protocol should be the decision of the testing physician.

Workers are less likely to have clinically significant CAD if they achieve a level of 10 METs func-
tional capacity(7) with absence of arrhythmia, abnormal blood pressure response, or ischemia and
are usually capable of performing heavy physical work and work in high heat stress situations. (8)

9
ANSI/AIHA Z88.6–2006

References
1) Evalu
Evaluati
ations
ons of Impair
Impairmen
ment/D
t/Disab
isabilit
ility
y Seconda
Secondary
ry to Respira
Respiratory
tory Disor
Disorder
ders,
s, Offic
Official
ial
Statement – American Thoracic Society, Adopted March, 1986
2) ATS/ACCP
TS/ACCP Statement
Statement on Cardiop
Cardiopulmon
ulmonary
ary Exercise
Exercise Testing,
esting, Adopted
Adopted by the American
American
Thoracic Society (ATS) on March 1, 2002 and the American College of Chest
Physicians (ACCP) on November, 1, 2002
3) Temte, J.V.: Cardiovascular Conditions and Worker Fitness and Risk. Occ. Med. State 
of the Art Reviews 3(2) :241–254
:241–254 (1988).
4) American Thoracic Society: Respiratory Protection Guidelines, Am. J. Respir. Crit.
Care Med. 154 :1153–1165
:1153–1165 (1996).
5) Gibbons, R.J., G.J. Balady, J.W. Beasley, J.T. Bricker, W.F. Duvernoy, Froelicher
V.F., et al: ACC/AHA guidelines for exercise testing. A report of the American College
of Cardiology/American Heart Association Task
Task Force on Practice Guidelines
(Committee on Exercise Testing). J. Am. Coll. Cardiol. 30 :260–311
:260–311 (1997).
6) Rodgers, G.P., J.Z. Ayurum, et al.: American College of Cardiology/American Heart
Association Clinical Competence Statement
S tatement on Stress Testing:
Testing: A Report of the
American College of Cardiology/American Heart Association/American College of
Physicians, American Society of Internal Medicine Task
Task Force on Clinical Competence
Circulation J02:1726–1738 (2000).
7) Whaley, M.H., (ed.): ACSM’s
ACSM’s Guidelines for Exercise Testing
Testing and Prescriptions,
American College of Sports Medicine, 7th edition, Baltimore, Lippincott – Williams &
Wilkins 2006
8) Criteria for a Recommended Standard Occupational Exposure to Hot Environments
Revised Criteria, 1986 DHHS (NIOSH) Publication No. 86-113, 1986.

10
11
12
13
14
15
16
 ANSI/AIHA Z88.6–2006

Annex C: Spirometry
Introduction

Spirometry is the most frequently performed test of ventilatory function. However

However,, since it is effort-
dependent and requires attention to detail, failure to follow current American Thoracic Society
(ATS) Guidelines often results in false positive test results.(1) The below-referenced ATS state-
(ATS)
ments on equipment and test performance (2,3), interpretation of results(4), and screening for respira-
tor use(5) are recommended as guidance. Since ATS Spirometry statements are periodically updat-
ed, e.g., the 2005 ATS update (2,4) is In Press , users should consult the most recent versions of the
ATS Spirometry statements, available at http://www.thoracic.org. Similarly, the most current version
of the American College of Occupational and Environmental Medicine (ACOEM) Guidelines can be
found at http://www.acoem.org.

Specific Criteria

Spirometry is not routinely required for medical clearance of respirator users. The respiratory sys-
tem’s large reserve permits most healthy workers to tolerate the small respiratory impact of many
respirators. However, moderate or severe reduction of ventilatory capacity may limit a subject’s
ability to use a respirator. “In the absence of other factors limiting the worker’s overall ability to tol-
erate the demands of the job and the respiratory protective equipment, FEV1 (and FVC) of 60% or
greater of the predicted value suggest that a trial of respirator use is allowable. For light duty work
using low resistance respirators, even lower levels of function may not be disqualifying, but a more
done.””(5) Because of their variability, forced expiratory
thorough clinical evaluation should be done. expiratory flow
rates (FEF25-75 and instantaneous flows) should not be used in the evaluation of medical fitness for
respirator use.

The (ATS)
(ATS) recommends spirometry testing for: 1) workers > 45-years-old who use SCBA with
strenuous exertion; 2) younger workers using SCBA with strenuous exertion who report respiratory
symptoms, or have abnormalities on the screening questionnaire; 3) all respirator users > age 55;
and 4) workers reporting respiratory symptoms with the level of exertion required by their job. (5)

Unless recommended differently by the most current version of the ATS Spirometry Guidelines,
spirometer performance should be documented by daily checks of the spirometer’s calibration.
When testing a subject, the technician should describe and demonstrate the
demonstrate the maneuver, enthusias-
tically coach the subject, and try to record at least three “acceptable” curves (as defined by the
ATS) with up to 8 attempts if necessary,
necessary, achieving repeatability (“reproducibility”) for both the FVC
and the FEV1. The largest FVC and FEV 1 are reported from the acceptable curves even if they are
not from the same maneuver, and FVC and FEV 1 are corrected to body temperature (BTPS).
Spirometry technicians should be highly motivated to conduct good tests and trained so that they
can judge the subject’s degree of effort and cooperation. ACOEM and the American Thoracic
Society recommend that technicians initially complete a NIOSH-approved (or similar) spirometry
training course and periodically attend spirometry refresher courses. (1,2)

In the screening setting, spirometry test results are interpreted by comparing the observed FVC
and FEV1, and their ratio, FEV 1 /FVC% with predicted average values and Lower Limits of Normal
(LLN) derived from reference populations of non-smokers. The goal is i s to determine whether the
worker’s results fall within the normal range, or below it, indicating possible respiratory impairment.
Several prediction equations are referenced in the ACOEM Position
Position Statement, and both ACOEM
ATS recommend use of the NHANES III prediction equation(1,4) if other prediction equations
and ATS
are not required by applicable regulations. A flow chart for interpreting
inter preting results following ATS
ATS recom-
mendations is included in the ACOEM Statement. (1)

17
ANSI/AIHA Z88.6–2006

Finally, it is becoming routine for individuals over 45 years of age engaged in strenuous activities to
undergo an Exercise Stress Test
Test in addition to Spirometry.
Spirometry.

1. American College of Occupational and Environmental Medicine: ACOEM Position

Statement: Spirometry in the Occupational Setting.
S etting. J. Occup. Env. Med. 42 :228–245
:228–245
(2000).
2. American Thoracic Society: European Respiratory Society: General Considerations
for Lung Function Testing. Eur. Respir. J. 26(1) :153–161
:153–161 (2005).
3. American Thoracic Society: European Respiratory Society: Standardisation of
Spirometry, Eur. Respir. J. 26 :319–338
:319–338 (2005).
4. American Thoracic Society: European Respiratory Society: Soci ety: Interpretative Strategies
for Lung Function Tests, Eur. Respir. J. 26(5) :948–968
:948–968 (2005).
5. American Thoracic Society: Respiratory Protection Guidelines. Am. J. Respir. Crit.
Care Med. 154 :1153–1165
:1153–1165 (1996).

18
 ANSI/AIHA Z88.6–2006

Annex D: Future Research Areas

Introduction

The final respiratory protection standard (29 CFR Parts 1910 and 1926 – Respiratory Protection)
covers an estimated 5 million respirator wearers working in an estimated 1.3 million work places.
There exists a wide variety of workers, work environments, physical stressors, and perceptions of
risk. A recent well designed and executed retrospective analysis reported only 1.3 % of over 5000
workers evaluated received limitations on respirator use.

Spirometry has become strongly associated with respirator use as many users are in respiratory
surveillance programs that involve periodic reevaluation to monitor the adverse effects of exposure.
This secondary prevention/surveillance monitoring represents a major contribution of occupational
medicine to society and has also resulted in the use of pulmonary function testing to determine job
suitability. Careful studies of ventilation, resistance, hypoxia, tidal volume, expiratory time, inspiratory
muscle fatigue, and pleural pressures have resulted. More recently the cardiopulmonar y relation-
ship has emerged with recognition that angina and arrhythmias may be aggravated by hypoxia or
hypercarbia.

Rationale

This standard considers functional capacity a cardiopulmonary issue. The presence or absence of
a “disease” may be almost incidental to work performance. An individual may be “disease free”, but
unable to perform essential job functions or even climb a flight of stairs without interruption.

There is little “evidence based” science that applies directly to job suitability.
suitability. There are, however,
however,
large bodies of literature that deal with Medical Screening, Pre Exercise Risk Stratification, Cardiac
Rehabilitation, and Pulmonary Rehabilitation. The guidelines developed by these emerging disci-
plines seem applicable to job-suitability evaluation given the caveat that the predictive value of any
medical testing has limits. We suggest that these disciplines can contribute much to the assess-
ment of job suitability, and that this standard represents a humble beginning.

Any proposed process must also deal not only with science, but also with perceived risk to the
worker,
worker, co-workers, and the public. Escalation of risk
ri sk should not necessarily mean more medical
tests but may lead to increased scrutiny of the work force and a more conservative interpretation of
results. This standard did consider the recommendations of certain consensus standards (DOT, (DOT,
FAA, NFPA)
NFPA) and attempted to use them to “benchmark” risk. “Evidence” is being slowly assembled
by these agencies and guidelines are periodically modified. The consensus recommendations in
this standard must also be modified periodically as our ability to analyze and quantify risk evolves.

Research for Consideration:

Adoption of the OSHA questionnaire (or modifications of it) should be encouraged. An effective-
ness survey program/process should then be developed that addresses the following:
• How are positive
positive questionnair
questionnaire e responses
responses dispositioned,
dispositioned, and by who?
• How are employees with (common) established diseases (e.g., (e.g., post myocardial infarction)
infarction)
evaluated?
• Could a “functional
“functional capacity” standard be developed
developed and included in job descriptions similar to
that developed for lifting as contained in the Dictionary of Occupational Titles?
• Could a smaller
smaller questionnaire consisting
consisting of “critical items” be developed?
developed?

19
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