Respiratory Protection Program for Long-Term Care Facilities

WAC 296-842-12005 requires employers to have a written respirator program. The written respirator program is like a policy or plan for how you will provide respiratory protection at your facility.

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

L&I developed a template for a Written Respirator Program. Long-Term Care facilities can use this template to develop their program. Click this link to access the template: Respirator Program template for COVID-19 Prevention (docx) The required elements of your written respirator program should include:

• How your workers can select an N95
• How your facility provides medical evaluations for respirator use
• How your facility will fit test workers (i.e., who will do it), and what type of fit testing you will provide.
• How your facility will train workers in respirator use, and who will provide that training
• When the N95 will be used
• Where you will keep your supply of N95s, and any exceptions about storage
• How you will evaluate your program for effectiveness

Before your workers can wear a respirator, they need to complete a respirator medical evaluation (see WAC 296-842-14005 and WAC 296-842-22005). Workers must complete the medical evaluation during work hours, and at the cost of the employer.

The respirator medical evaluation questions help determine if it is medically safe for workers 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 of how respirators work and how they can affect the body while working, taking into consideration the person’s current and past health history.

Here are some ways to complete the medical evaluation requirement:

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

The answers provided by the worker will help determine if the worker is cleared to use a respirator, or if they will need to see a medical professional in-person to make the final decision. This referral appointment must occur during paid time and at the cost of the employer.

If your worker is not medically cleared to wear the N95, visit the Job Accommodations section 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.
Go to L&I’s ‘Respirators’ webpage , and click on the ‘Training & Resources’ tab.  

The N95 protects the worker by making a seal around the worker’s nose and mouth. The seal needs to be tight enough to prevent respiratory hazards from leaking into the breathing space. To see if the seal is tight enough to protect the worker, the N95 needs to be fit tested. The fit test needs to occur before the worker can use the N95 in a hazardous environment.

For tight-fitting respirators such as the N95, fit testing is due initially, before using the N95 (e.g., upon hire), and then at least every year (within 12 months of the last fit test date). See WAC 296-842-15005, and WAC 296-842-22010. There are two types of fit testing methods, quantitative and qualitative. Both can test the seal of the N95 on the worker’s face. The qualitative method uses a solution sprayed into a hood; the quantitative method uses a machine to measure particles.

The exercises done during the fit test simulate the activities the worker may do. If the N95 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.

When the N95 seal breaks, it means that specific make and model of N95 does not fit the worker. They cannot use it in a hazardous environment. The worker will need to fit test a different make and model of N95 until they find one that fits.

NOTE: While users must perform a seal check each time they don a respirator, the seal check is not a substitute for fit testing. See our Resources page for more information.

L&I requires workers to have annual training on respirator use (WAC 296-842-16005). This training is due initially (upon hire), and then again every year (within 12 months of the last training date).

Workers must have the time to learn and understand how the N95 will protect them, and how to use it properly. The training needs to be specific to the facility. Below is a list of what the training should include. 

Respirator user training includes content on:

• 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
• The employer’s general obligations (e.g., about developing a written program, respirator selection, providing medical evaluations, etc.)

Workers who supervise N95 users also need to complete the facility’s respirator training program. If there is any question about respiratory protection, the worker should first go to their supervisor. Their supervisor must be knowledgeable enough to answer questions that may come up.

L&I requires employers to keep Respirator Program records (WAC 296-842-12010). There are four items that you must keep and have available for workers to review:

• An up-to-date written respirator program
• Each worker’s current fit test record (must be done yearly)
  • The fit test record must include at least:
    • 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
• Each worker’s current respirator training record (must be done yearly)
  • The record must include at least:
    • The worker’s name
    • Date the training was done
• Each worker’s medical evaluation written letter of recommendation from the licensed health care professional who did the review.

NOTE: Also, if your facility has a licensed healthcare professional to do the medical evaluations (e.g., they review paper-copy questionnaires in-house), the questions and answers will need to be:

• Kept secure and stored separately from employee/HR records. The questionnaire information falls under HIPAA rules.
• Store the questionnaires for 30 years after the worker terminates employment (see WAC 296-802-20005).

L&I requires you to have procedures to evaluate your program on a regular basis (see WAC 296-842-12005, Table 3). Evaluating your program helps keep your program effective in protecting your workers.

The following are a few examples of how you can evaluate your program for its effectiveness:

• Review regulations (e.g., WAC, RCW, DOSH Directives) for any changes and update your Written Respirator Program as needed. Be sure to implement any required regulatory changes.
• Worker compliance with using the N95
  • Are the chosen types of N95 comfortable to use?
  • Are workers following your written program on when to use the N95?
  • Is using the N95 affecting work performance?
• Are there any supply chain or procurement issues?