Respiratory Protection Program for Long-Term Care Facilities

The written respiratory protection program describes your facility’s procedures for respiratory protection. It serves as a reference for the facility workers and helps them understand how to protect themselves from exposure to respiratory hazards while at work.

• A Respiratory Protection Program template for COVID-19 in Long-Term Care Facilities (docx) – This template was designed by L&I for Long Term Care Facilities

The required elements of your written respirator program should include:

• How your worker’s can select a N95
• How the medical evaluation for respirator use will be done
• Who will provide the fit testing and what type of fit testing
• How the training will be done to learn how to properly use the N95 and who will provide the training
• When the N95 will be used
• Where the N95s supply will be kept and any exceptions for storing them
• How you will evaluate your program for effectiveness

The respirator medical evaluation questions help decide if it is safe for workers who may have health issues to use the N95. The questions must be reviewed by a licensed health care professional to make that determination.  

The licensed health care professional reviewing the questions should have knowledge or understanding on how respirators work and how it can affect the body while working, taking into consideration the person’s current and past health history.

Health care facilities/agencies may do the following to complete the medical evaluation requirement:

• Hire a qualified contractor (such as an occupational health clinic)
• Have someone in your facility to do this in-house
• Use an online respirator medical evaluation program

The answers provided by the worker will determine if they need to see a medical professional in person to make the final decision. This referral appointment must be done on paid time and at the cost of the employer.

If your worker is not medically cleared to wear the N95, visit job accommodations on the FAQ webpage for more information.

The medical questionnaire (paper form) is available in:
Amharic, Cambodian-Khmer, Chinese (simplified and traditional), English, Korean, Russian, Somali, Spanish, Tagalog, Tigrinya, and Vietnamese.

Please contact us if you require an additional language. Please see our resources page for links to these documents.

The N95 protects the user when the seal around the person’s nose and mouth is tight enough to prevent the respiratory hazards from leaking into their breathing space. To see if the seal is tight enough to protect the person, it will need to be tested before going into a hazardous environment.

There are two types of fit testing, quantitative and qualitative, both will test the seal of the N95 on the person’s face.

The exercises done in the fit test simulate the activities the worker may do. If the seal on the worker’s face breaks while doing a qualitative fit test, the person will taste the solution. If it breaks while doing a quantitative fit test, the machine will detect an increase in particles in the person’s breathing space in the N95. The break in the seal means that specific make and model N95 does not fit the worker and they should not use it in a hazardous environment. The worker will need to fit test another manufacturer and model N95.

Fit testing needs to be done before using the N95 and then at least every year after that.

NOTE: While users must perform a seal check upon donning a respirator each time, this is not a substitute for fit testing, see resources page for more information.

It is the best practice to have your written respirator program completed before you start fit testing your staff.

The medical evaluation must be completed and reviewed before fit testing can be done.

Learning how to do your own fit testing (this is to distinguish that it is a different topic under fit testing)

You can perform your own respirator fit tests to maintain and sustain your Respirator Program. There is no L&I required certification for conducting a fit test currently.

Employees must have the time to learn and understand how the N95 will protect them, and how to use it properly. The training should be designed specifically for the facility and must be done before using the N95 and every year after that. Below is a list of what the training should include. 

Training includes:

• Why the respiratory is necessary 
• The respirator’s capabilities and limitations
• How improper fit, use, or maintenance can compromise the respirator’s effectiveness and reliability
• How to properly inspect, put on, seal check, use and remove the respirator 
• Storing the respirators
• How to use the respirator effectively in emergency situations, and what to do when a respirator fails
• Medical signs and symptoms that may limit or prevent the effective use of respirators 

Employees that supervise N95 users also need to take the facility’s training. If there is any question about respiratory protection, the employee will first go to their supervisor and their supervisor must be knowledgeable enough to troubleshoot any issue that may come up.

To help create your respirator training program, please see DOH Resources for Respirator Training Program.

There are 4 items that must be kept and available for your workers to review:

1. An up to date written respirator program
2. Each worker’s current fit test record (must be done yearly)
   • The fit test record must include:
     • The worker’s name
     • Test date
     • Type of fit test performed
     • Description of the N95 (manufacturer, model, style, and size)
     • Results of the fit test
3. Each worker’s current training record (must be done yearly)
   • The record must include:
     • The worker’s name
     • Date the training was done
4. The written recommendations from the licensed health care professional that reviewed the worker’s medical evaluation (must be done as indicated by the person reviewing the questions)

NOTE: If your facility’s medical evaluations are being reviewed in house, the questions and answers will need to be stored for 30 years after the worker has terminated employment. It must be kept separate from their HR records because the questions are HIPPA protected.

Evaluating your program will assist you in keeping your program effective in protecting your workers. The following are examples on how you could evaluate your program for its effectiveness:

• Worker compliance with using the N95
  • Are the chosen types of N95 comfortable to use?
  • Are they following your written program on when to use the N95?
  • Is using the N95 affecting work performance?
• No supply chain or procurement issues
• You must keep your Respirator Program up to date by ensure that it is current with any regulatory changes and implement any required changes that will help protected your workers from injury or illness.