Purpose The purpose of this safety program is to aid business owners with their Federal OSHA compliance efforts. Each business is unique and each program will require customization. As the program is customized, remember to only include words, sections, concepts, procedures, etc. that are relevant to the operations. The purpose of any written safety program is to provide a clear and consistent plan for addressing safety in a particular area of focus. Use Use this wizard to customize your program Instructions To develop your customized plan, follow steps 1 through 3 in order, by clicking the buttons and following the instructions prompted by the program. Customize Review and Format Approve & Save

<CompanyName>

Respiratory Protection Program

Version <Version>

Updated: <Date>

Contents

1.	Program Purpose	3

2.	Employee Training	3

3.	Medical Evaluations	4

4.	Fit Testing	4

5.	Equipment	5

6.	Respirator Use	5

7.	Respirator Cleaning and Storage	5

8.	Maintenance of Respirators	6

9.	Issues Associated with Special Use Respirators	6

10.	IDLH Procedures	7

11.	Program Evaluation	7

12.	Recordkeeping	8

Appendix I: Tasks for Which Respiratory Protection Program is Required	9

Appendix II: Respirator Cartridge Change Schedule	12

Appendix III: Fit Testing Worksheet	14

Appendix IV: Voluntary Use of Respirators	16

Employee Acknowledgement	17

Program Purpose

The purpose of this program is to protect those employees performing operations for which exposures cannot be controlled by use of conventional engineering or administrative controls – prior to establishing a negative air exposure assessment – and to require that respiratory protective equipment is selected, used, maintained, and stored in accordance with acceptable practices.

This program defines responsibilities and procedures, and is applicable to operations that may require the use of respiratory protection. The conditions included are routine, immediately dangerous to life or health (IDLH), and emergency conditions. This program also addresses the voluntary use of respirators.

Employee Training

Implementation of this program is the responsibility of <ProgramAdmin> who will also ensure the program is reviewed annually.

Requirements

Determine if respirators are needed, or if they are going to be used for hazardous jobs, before assigning that job to an employee. An exposure assessment will be performed to determine whether respiratory protection is required. The first step is to gain an understanding of what activities may require respiratory protection and then conduct interviews and observe activities. Reviewing Safety Data Sheets (SDS) for any chemicals involved with the process may also be required.

Refer to Appendix I regarding activities requiring the use of respiratory protection.

Assign respirators accordingly.

Follow all the requirements of this procedure for employees who wish to voluntarily use tight-fitting (e.g., air-purifying) respirators.

Training

<ProgramAdmin> is responsible for ensuring all employees are trained:

Before they are assigned a respirator

Annually thereafter

Whenever a new hazard or job is introduced

Whenever employees fail to demonstrate proper use or knowledge

Training must address, at a minimum, the following:

Why the respirator is necessary, and what conditions can make the respirator ineffective

What the limitations and capabilities of the respirators are

How to use respirators effectively in emergency situations

How to inspect, put on and remove, and check the seals of the respirator

What the respirator maintenance and storage procedures are

How to recognize medical signs and symptoms that may limit or prevent effective use of the respirator

Medical Evaluations

<ProgramAdmin> is responsible for seeing that medical evaluations are conducted to determine that employees who are required to, or those who are allowed to voluntarily, wear respirators are medically able to do so.

<PHLP> of <ClinicName> will provide the medical evaluations.

Follow-up medical exams will be granted as found necessary by <PHLP>.

All employees will be granted the opportunity to speak with <PHLP> about their medical evaluation if they request to do so.

<ProgramAdmin> will provide <PHLP> with a copy of this program, a copy of the OSHA respirator standard, a list of hazardous substances in the work place, the employee’s job title, proposed respirator type and weight, length of time required to wear respirator, expected physical work load, potential temperature and humidity extremes, and protective clothing required.

After an employee has received clearance and begun to wear a respirator, additional medical evaluations will be provided when:

The employee reports signs/symptoms related to their ability to use a respirator, such as shortness of breath, dizziness, chest pains, and wheezing.

<PHLP> or supervisor informs the program administrator that the employee needs to be reevaluated.

Information from this program indicates the need for re-evaluation (this includes observations made during fit tests and program evaluation).

A change occurs in workplace conditions that may impose an additional physiological burden.

Fit Testing

Any employee who has been assigned a reusable respirator must be fit tested either on an annual basis (no more than one year may elapse between fit tests), or when an employee is assigned a respirator of a different make, type, or size from that previously tested.

<ProgramAdmin> is responsible, by contract, for conducting fit testing or arranging for them to be performed by qualified persons.

Obtain a signed written copy of the fit test results. They should include:

Employee’s name and social security number

Respirator brand, model, and size fitted for

Date fit tested

Method of fit testing used

Name and signature of fit tester

Statement that fit test protocol met the applicable requirements

Manufacturer and serial number of fit testing apparatus (for quantitative fit test)

Use Appendix III to document fit test results.

Equipment

Provide qualified employees with respirator(s) and an adequate amount of parts and cartridges.

Assign employees whose duties require respirators their own respirator for which they have been fit tested.

Provide special eyeglass inserts designed for the respirator if an employee must wear eyeglasses with a full face piece respirator. Contact lenses may be worn when wearing a full face respirator.

Respirator Use

Prohibit facial hair where the respirator-sealing surface meets the wearer's face.

Require employees to thoroughly inspect the respirator prior to each use.

Employees are to perform a positive and negative fit check every time the respirator is put on.

Employees will leave the area where respirators are being used:

Before removing the face piece for any reason

To change cartridges

If any of the following is detected:

Vapor or gas breakthrough

Leakage around the face piece

Changes in breathing resistance

Respirator Cleaning and Storage

Clean and disinfect respirators after each use

Respirators should be stored in a clean, dry place so as not to deform the face piece

Respirators for general use will be stored <LocationGU>

Emergency use respirators will be stored <LocationEU>

Inspect respirators before use and after cleaning

Maintenance of Respirators

Respirators for routine use must be inspected before each use and during cleaning.

Emergency use respirators must be inspected at least monthly and as recommended by the manufacturer.

Emergency escape-only respirators must be inspected before being placed in service.

Respirator inspection must include at least the following:

A check of respirator function; tightness of connections; and the condition of the face piece, head straps, valves, connecting tubes, and cartridges, canisters, or filters.

A check of elastic parts for pliability and signs of deterioration.

Self-contained breathing apparatuses (SCBAs) must be inspected monthly. Air and oxygen cylinders must be kept in a fully charged state and be recharged when the pressure falls to below 90%. Regulator and warning devices must be checked for proper working condition.

For emergency use respirators, a certificate documenting the date, signature of inspector, the required remedial action, and serial number of the respirator must be maintained.

Change Schedule

Use cartridges with end of service life indicators (ESLI) or determine the respirator cartridge change-out schedule. See Appendix II for guidance.

Issues Associated with Special Use Respirators

Self-Contained Breathing Apparatus

Inspect self-contained breathing apparatus and other emergency use respirators monthly and after each use in accordance with manufacturer's instructions.

Supplied Air Respirators

Air used for atmosphere-supplying respirators must meet or exceed the requirements for Type 1 - Grade D breathing air (O2 content 19.5 - 23.5%, Hydrocarbon content of 5 mg/m3, CO content of 10 ppm or less, CO2 content of 1,00 ppm or less, and lack of noticeable odor).

Never use pure oxygen.

A certificate of analysis must accompany bottled air

Compressors used to supply breathing air must:

Prevent entry of contaminated air into the air supply

Minimize moisture content

Have suitable in-line sorbent beds and filter to provide appropriate air quality

Have a high carbon monoxide alarm that sounds at 10 ppm

Couplings on air hose lines must be incompatible with other air and gas systems.

IDLH Procedures

Visual, voice, or signal line communication maintained.

One or more employee(s) is located outside ILDH atmosphere that is trained and equipped with:

Pressure demand or other positive pressure SCBAs

Or a pressure demand or other positive pressure supplied air respirator with auxiliary SCBA

And appropriate retrieval equipment for removing the employee(s) who enter

The employer is notified before the standby person enters the IDLH atmosphere to provide emergency rescue.

The employer must provide assistance appropriate to the situation.

Employees engaged in interior structural firefighting use SCBAs.

Only Grade D breathing air must be used in cylinders supplied for air respirators.

Program Evaluation

<ProgramAdmin> is responsible for ensuring that the written respiratory protection program is being followed and for consulting employees to see if they are using the respirators properly.

<ProgramAdmin> is responsible for assessing the effectiveness of the respiratory protection program by:

Consulting employees required to use respirators to identify any problems and corrective measures necessary.

Determining if appropriate respirator selection is made for the hazards to which the employee is exposed.

Determining if respirator fit allows the use of the respirator without interfering with effective workplace performance.

Determining if respirators are being maintained properly.

Recordkeeping

A written copy of this program is kept in <LocationR>.

<ProgramAdmin> keeps copies of the medical evaluations.

<ProgramAdmin> has copies of fit test results that show the employees’ names, type of fit test performed, specific make, model, style, and size of respirator tested, date of test, and results.

Appendix I: Tasks for Which Respiratory Protection Program is Required

DRAFT – MUST BE REVIEWED FOR TASKS PERFORMED

The following table designates the requirements for the use of the respiratory protection program.

Tasks	Type of Respirator Required
Abrasive Blasting
Outdoors Indoors Confined spaces	Full face air purifying respirator with HEPA cartridges Supplied air with abrasive blasting hood Supplied air respirator with pressure demand full face piece and adequate escape air supply as needed
Acids (Liquid or powder acids used in a situation where acid vapors, mists, or dust may be breathed.)
Outdoors Indoors Confined spaces	Full face air purifying respirator with combination acid gas/HEPA cartridges Supplied air with pressure demand full face piece Supplied air respirator with pressure demand full face piece and adequate escape air supply as needed
Adhesives
Aerosol-propelled adhesives used outdoors Two-part or any use of adhesives in confined spaces	Half face air purifying respirator with combination Organic Vapor/HEPA cartridges Supplied air respirator with pressure demand full face piece and adequate escape air supply as needed
Alkalis/Bases/Caustics
Powdered alkalis used in a situation where an airborne dust may be breathed	Half face air purifying respirators with HEPA cartridge
Cleaning Compounds
Organic degreasers or carbon removers used in areas where local exhaust ventilation is not provided Aerosol propelled cleaning compounds will be used in areas where there is no local exhaust ventilation Degreasers or carbon removers will be used in voids, tanks, or other confined spaces	Half face air purifying respirator with organic vapor cartridge Half face air purifying respirator with organic vapor cartridges Supplied air respirator with pressure demand full face piece and adequate escape air supply

Tasks	Type of Respirator Required
Chlorine
Work in paper mills or other facilities where chlorine releases are possible and emergency protection is required	Bite type chlorine escape respirators unless client has a more stringent requirement
Fuels (including regular or unleaded gasoline, kerosene, diesel fuel, JP-5)
Employees inside unventilated fuel cells or other confined spaces containing fuels	Supplied air respirator with pressure demand full face piece and adequate escape air supply
Grinding, Cutting, Sanding
Cutting, grinding, or sanding surfaces that have coatings containing lead, cadmium, chromium, zinc, or beryllium Cutting, grinding, or sanding surfaces that are concrete or glass without use of ventilation or water	Requires initial exposure assessment (see SMS for Lead in Construction). Full face air purifying respirator with HEPA cartridges required until air monitoring deems otherwise Full face air purifying respirator with HEPA cartridges
Paint Materials (including paints, primers, thinners, enamels, lacquers, strippers, coatings, and varnishes)
Paint materials spray applied outside of spray finishing booth Two part (mix Part A with Part B; let set; then apply) polyurethane or epoxy polyamide paints will be brush or spray applied Paints containing lead, chromium, cadmium, beryllium, and zinc (refer to the SDS) Paint materials will be applied in confined spaces	Half face air purifying respirator with combination organic vapor/HEPA cartridges Full face supplied air respirator Requires initial exposure assessment (see SMS for Lead in Construction) Full face supplied air respirator with adequate escape air supply
Solvents
See Fuels above
Welding/Brazing/Torch Cutting
Welding will be performed in confined spaces Welding galvanized metal or stainless steel Brazing or silver soldering with cadmium or lead	Minimum 2000 cfm exhaust ventilation as per confined space standard for each welder/hot operation Half face air purifying respirator with HEPA cartridge unless otherwise determined by air monitoring Half face air purifying respirator with HEPA cartridge unless otherwise determined by air monitoring Requires initial exposure assessment (see SMS for Lead in Construction). Full face air purifying respirator with HEPA cartridges required until air monitoring deems otherwise

In addition, respiratory protection will be required for any of the above listed activities where any of the following applies:

An employee will be in the immediate area, i.e., within 10 feet of the job or operation.

The employee will be inside a confined space where activities are taking place.

The employee will be inside a "controlled area" such as found in asbestos abatement, lead abatement, radiation control area, or a hazardous waste site.

Respirators will also be required whenever required by a:

Safety Data Sheet

Product label

Product use instruction

Standard Operating Procedure

Appendix II: Respirator Cartridge Change Schedule

Cartridge change schedule

A cartridge change schedule must be developed for cartridges or canisters used with air purifying respirators that do not have an end of service life indicator (ESLI).

The purpose of this is to prevent contaminants from breaking through the respirators sorbent cartridges, and thereby over-exposing employees.

NIOSH has approved ESLIs for only four cartridges or canisters:

Mercury vapor

Carbon monoxide

Ethylene oxide

Hydrogen sulfide

Historically, we have relied on the warning properties such as odor or irritation of a contaminant to dictate cartridge change. OSHA no longer allows this as the sole basis for changing respirator cartridges.

In developing a change schedule, the following factors should be considered:

Contaminants

Concentration

Frequency of use – continuously or intermittently throughout the shift

Temperature and humidity

Work rate

The presence of potentially interfering chemicals

Multiple chemical exposures

The worst case conditions should be assumed to avoid early breakthrough. This must be documented in the project health and safety plan or, in the cases of office or labs, in the site-specific Respiratory Protection Program.

Sources of Help

Manufacturers

3M has an interactive “Cartridge Service Life” program that can be downloaded for free here.

This program will estimate cartridge service life only for 3M products against many contaminants.

The program does not evaluate the service life against mixtures (multiple contaminants).

Other respirator manufacturers have similar tools for their cartridges.

Because of the complexity in evaluating mixtures, OSHA offers the following guidance:

When the individual compounds in the mixture have similar breakthrough times (i.e., within one order of magnitude), service life of the cartridge should be established, assuming the mixture stream behaves as a pure system of the most rapidly migrating component with the shortest breakthrough time (i.e., sum of the concentration of the components).

Where the individual compounds in the mixture vary by two orders of magnitude or greater, the service life may be based on the contaminant with the shortest breakthrough time.

Rule of Thumb

The Occupational Environment: Evaluation and Control

If the chemical’s boiling point is >70oC and the concentration is less than 200 ppm you can expect a service life of eight hours at a normal work rate.

Service life is inversely proportional to work rate.

Reducing concentration by a factor of 10 will increase service life by a factor of five.

Humidity above 85% will reduce service life by 50%.

OSHA Interpretation

The OSHA inspection procedures for the respiratory protection standard specify that:

Where contaminant migration is possible, respirator cartridges/canisters should be changed after each work shift where exposure occurs, unless there is objective data to the contrary (desorption studies) showing the performance in the conditions and schedule of use/non-use found in the workplace.

Appendix III: Fit Testing Worksheet

Employee name:	Employee number:
Office location:	SSN:
Last medical exam:	Corrective lenses?:

INFORMATION	RESPIRATOR 1	RESPIRATOR 2	RESPIRATOR 3
Equipment type
Manufacturer
Model
Size
Material

TEST RESULTS	RESPIRATOR 1	RESPIRATOR 2	RESPIRATOR 3
Negative pressure check	Pass Fail	Pass Fail	Pass Fail
Positive pressure check	Pass Fail	Pass Fail	Pass Fail
Qualitative Fit Test
Isoamyl acetate	Pass Fail	Pass Fail	Pass Fail
Saccharin mist	Pass Fail	Pass Fail	Pass Fail
Irritant smoke	Pass Fail	Pass Fail	Pass Fail
Quantitative Fit Test
Overall fit factor achieved
Printout/strip chart attached (include mfg. and serial no. of unit)
Was the Employee:
Briefed on fundamental principles of respiratory protection, use, inspection, cleaning, maintenance, and storage of equipment?	Yes No
Briefed on the procedure for obtaining a lens kit for use with a full face respirator?	Yes No N/A

I hereby certify that the subject employee has been fit tested according to procedures specified in SMS 25, “Respiratory Protection,” and in accordance with 29 CFR 1910.134, App. A. The results of the test indicate that the subject employee attains a satisfactory fit on the above respiratory protective equipment.

Examiner’s Name (print):
Examiner’s Signature:
Date:
Employee’s Signature:
Date:

Distribution: (1) Employee (2) Project/Shop Health and Safety File

Appendix IV: Voluntary Use of Respirators

Instructions: Have the employee that is opting to use a respirator for non-overexposure conditions read this page and then sign on the bottom of the page. Forward a copy of the signed form to the <RecordsAdmin> and maintain a copy in the employee's personnel file.

Respirators are an effective method of protection against designated hazards when properly selected and worn. Respirator use is encouraged, even when exposures are below the exposure limit, to provide an additional level of comfort and protection for employees. However, if a respirator is used improperly or not kept clean, the respirator itself can become a hazard to the employee.

Sometimes employees may wear respirators to avoid exposures to hazards, even if the amount of the hazardous substance does not exceed the limits set by OSHA standards. If your employer provides respirators for your own voluntary use, or if you provide your own respirator, you need to take certain precautions to be sure that the respirator itself does not pose a hazard.

You should do the following:

Read and follow all instructions provided by the manufacture on use, maintenance, cleaning and care, and warnings regarding the respirator’s limitations.

Choose respirators certified for use to protect against the contaminant of concern. NIOSH, the National Institute for Occupational Safety & Health of the U.S. Department of Health and Human Services, certifies respirators. A label or statement of certification should appear on the respirator or respirator packaging. It will tell you what the respirator is designed for and how it will protect you.

Do not wear your respirator into atmospheres containing contaminants for which your respirator is not designed to protect against. For example, a respirator designed to filter dust particles will not protect you against gases, vapors, fumes, smoke, or very small solid particles.

Keep track of your respirator so that you do not mistakenly use someone else's respirator.

If you have any health conditions (e.g., asthma, high blood pressure, emphysema, heart disease) that could be aggravated by using a respirator, you should check with your doctor before using one.

I have read and understand this information.

Employee Name:
Employee Signature:
Date:

Employee Acknowledgement

I have received information on <CompanyName>’s Respiratory Protection Program. By signing below, I agree to abide by the procedures in this document and bring to the attention of my supervisor any questions or concerns had.

Employee Name:
Employee Signature:
Date:

icwgroup.com ICW Group is the marketing name for ICW Group Holdings, Inc. For a list of all ICW Group Holdings, Inc. subsidiaries, please visit our website www.icwgroup.com.
Not all products and coverages are available in all states.