Frequently Asked Questions About Respiratory Protection

Below are frequently asked questions and our answers. In some answers, we refer to materials on other pages. Be sure to visit those pages for more information.

Written Program

I got a different template from L&I. Do I have the right template, and how do I fill it out?

Here is the link to the WA L&I website where you can find their safety program templates: https://www.lni.wa.gov/safety-health/preventing-injuries-illnesses/create-a-safety-program/sample-safety-programs-plans.

On their website, scroll down to the “Respiratory Protection” section and click on “Respirator Program Template for COVID-19 Prevention Using Filtering Facepiece Respirators”. (Do not click on the link labeled “For employees required to wear respirators”. It is for other industries and includes topics that do not apply to long-term care facilities.)

Download the template to your device and save it. In the document, the instructions are on the first page. As you go through the template, modify it with your facility-specific information.

You will need to update your written respirator program with any changes. It needs to reflect your current practices.

How often do I need to review and update my written program?

The best practice is to review your written respirator program at least every year, like any other policy document. To keep up to date with changes that are happening in WA or the nation, subscribe to WA L&I notification system to get the latest changes.

Who should update the written program?

The Respirator Program Administrator should update the written program.

Medical Evaluation

Who are the licensed health care professionals (LHCP) that can do respirator medical evaluations?

Health professionals with a license in healthcare such as physician, physician assistant, nurse practitioner, etc.

Can an LPN or RN do the medical evaluation?

Though the WAC does not define the type of licensure that can review the medical evaluation, the LHCP reviewing the medical evaluation should be working within their scope of practice. An MD, PA, ARPN are licensed providers who have a broader scope of practice. They can make the determination to clear someone to use the N95. An RN or LPN will need to work within medical guidelines (i.e., standing orders) to screen medical evaluations, and they must stay within their scope of practice. Check with the State Board of Nursing for information on respirator medical evaluations and the scope of practice for nurses.

Can the worker use their own PCP for the respirator medical evaluation?

L&I requires the employer to provide and pay for the worker medical evaluations. There are two issues with sending the person to their own doctor: 1) The person’s medical insurance will be billed, and potentially the balance of the charge will be paid by the worker. 2) The worker’s doctor may not be familiar with respirator use.

To provide medical evaluations, your options are to:

Hire or contract with an occupational health clinic that provides respirator medical evaluations.
If possible, use an in-house licensed health care professional or employee health personnel to provide medical evaluations.
Find an online system to provide this service and designate a clinic for follow-up in-person evaluations if it is necessary.

How do I find a LHCP to do the medical evaluations?

You could do an online search for companies/clinics that provide safety/industrial exams including respirator medical evaluations, or search for online companies that do respirator medical evaluations. These LHCP will be familiar with the respirator medical evaluations.

You could set up a contract with a local clinic that does industrial exams, and they could do the medical evaluation and if needed, a medical exam. There are online services that will review the medical evaluation and will let the employer know if the worker needs to be seen in person.

If a worker is exempt from being fit tested based on the physician’s medical recommendation, what do they do if they work in healthcare and the facility requires they always wear an N95 the entire shift?

If the worker is not medically cleared/approved to use the N95, they cannot be fit tested. In this situation, the employer can make a type of job accommodation such as not assigning the worker to care for COVID-19 positive residents. Another option would be to assign the worker to another job task that does not require the use of an N95.

If the employer requires everyone to wear an N95 upon entering the building, the worker who is not medically cleared would not be able to enter the building because they cannot be fit tested and the employer is requiring N95 use upon entry.

On the letter of recommendation form, it says to repeat it in 5 years for some of our workers, but we were told it must be repeated yearly. Is that state law?

You do not have to do medical evaluations yearly unless the Licensed Health Care Professional (LHCP) recommends it be repeated in 1 year. If the LHCP clears a worker for 5 years, you can re-do it in 5 years. However, you will need to repeat it sooner than the due date when any of the following occur:

The worker has health changes
A supervisor/RPA indicates to repeat it
The worker experiences medical signs/symptoms while wearing a respirator
There are changes in the work conditions.

What if the worker has asthma?

The medical evaluation asks questions that will screen people for health conditions. Some conditions may require further medical evaluation. If the person with asthma has been cleared to use the N95 and then has problems while using it, they should re-take the medical evaluation. Or they should see the licensed health care professional in-person to discuss how the N95 is affecting their breathing.

What information needs to be on the medical evaluation letter of recommendation?

The worker’s name, the date the evaluation was done, whether or not the worker is able to use the respirator, any limitations the worker may have while using the N95, when the next medical evaluation is due, and a statement that the worker has been given a copy of the recommendation letter.

What is a respirator job accommodation?

A respirator job accommodation is a way to allow a worker to continue working but do job tasks that do not require respirator use. For example, if a caregiver cannot wear a respirator, they could be assigned to work in areas where there are no respiratory hazards. Another option may be to assign them to a non-caregiving job if they are qualified for it.

Fit Testing

Am I doing a valid fit test?

Remember, it is the facility’s responsibility to be sure the fit testers are performing a valid fit test. You can use the checklist to evaluate fit testers. Send completed checklists to the facility’s Respirator Program Administrator.

Can I fit test more than one person at a time?

For qualitative fit testing, DOH recommends fit testing 1, possibly 2, people at a time. You can fit test more than one person at a time, but it takes practice to do this and still perform a valid fit test.

How long does it take to fit test someone?

Allow 15-30 minutes per fit test. If the worker being fit tested is new to using the N95, or they are being fit tested due to a physical change, expect that it may take longer to complete a valid fit test.

What do I need to have in place before fit testing?

Before fit testing, you will need to have the following in place:

A Respirator Program Administrator – This person is in charge of your facility’s respirator program.
A facility-specific written respirator program – This is like a policy or procedure for respirator use at the facility.
Worker N95 User Training program – This is to train your workers on respirator use.
Medical evaluations – Workers who need to use respirators must have medical clearance before they can wear a respirator.
Select people to become fit testers, and train them to do it. They need the following:
- General understanding of your facility’s respirator program
- Expert knowledge of your facility’s N95 user training program
- Be an expert in how to use each type of N95 at your facility
- Training in how to do a valid fit test according to Washington L&I rules.
At least 1 fit test kit (for qualitative fit testing)
Space
- A room large enough to hold the fit testers and workers comfortably, and away from distractions.
- Tables and chairs
- Trash cans
- Water, cups, and napkins
- A sink in the room or a bathroom nearby
Paperwork
- Medical evaluation letter of recommendation for each person being fit tested. These need to be current and must indicate the person has clearance to wear a respirator.
- Blank fit test record forms
- If the person has been fit tested in the past, it may be helpful to have their previous fit test record on hand.
Printed handouts that may be helpful:
- DOH – Reminder sheet (PDF)
- List of fit test exercises
- Rainbow passage (PDF)
- CDC – Acceptable facial hair

How do I get a certificate to show I know how to do a fit test?

Currently, there is no certification or required training for learning to conduct a fit test. It is the employer’s responsibility to be sure the person doing the fit testing is doing it correctly. An employer can do this by using the DOH Evaluating the Fit Tester checklist with the fit tester to be sure the fit tests they provide are valid.

Facial Hair

Not for a tight-fitting respirator! Facial hair cannot be in the area where the edges of the N95 seal on the face. See the CDC Facial Hairstyles and Filtering Facepiece Respirators document for options.

If the person will not shave, you may want to consider a loose-fitting respirator such as a powered air-purifying respirator (PAPR) or a controlled air-purifying respirator (CAPR).

Worker Training

What training do I need to provide for workers who need to use N95s?

Workers need training in respirator use so they know when and how to use the N95. The training content must cover the following:

Obligations and responsibilities for both the employer and the worker
Why it is necessary to use the N95
How the N95 works (what it can and cannot do)
How to properly inspect, put on, seal check, use, and remove the N95
Disposal/storage of the N95
What to do in case of an emergency
Medical signs and symptoms that can change the effectiveness of the N95 to protect the worker.

What are ways I can provide respirator user training?

To do respirator training for workers, you can use audiovisuals, slide presentations including self-paced learning modules, formal classroom-style instruction, etc., or a combination.

How often should workers take the facility’s respirator user training?

Provide respirator training for your workers initially (upon hire), and repeat it every year (it’s due within 12 months of the last training date).

Record Keeping

What documents do we need to keep?

You need to keep the following records:

The current fit test record. It will need to be renewed yearly.
The current respirator user training record. It will need to be renewed yearly.
The current medical evaluation letter of recommendation. It will need to be renewed as indicated by the LHCP.
Updated written respirator program.

Program Evaluation

What do I need to do to evaluate my respirator program?

Below are a few examples of ways to evaluate your Respiratory Protection Program (see WAC 296-842-12005 for more information):

Talk with workers who wear respirators to get their feedback – how it fits, do they feel the respirator adequately protects them, do they notice any difficulties in breathing while wearing the N95, etc.
Periodically check job duties for changes that may require respirators other than a disposable filtering facepiece respirator.
For those who supervise respirator users, do daily checks to ensure workers demonstrate proper use and disposal.
Make sure procedures and program specifications are appropriate
Make sure workers follow procedures
Review records to be sure workers are current with their medical evaluations, fit testing, and N95 user training.

Detecting the Solution

What if someone has lost their sense of smell or taste and they cannot taste the spray?

During the Sensitivity Test, if the worker does not taste the solution after 30 sprays, you can try a different solution. For example, if they did not taste sweet solution, try using the bitter solution. If they do not taste either the bitter or the sweet solutions, you could wait a week and try again. If the person still does not taste the solution, your options are:

Quantitative fit test method
Powered air-purifying respirator (PAPR, CAPR)
Consider a job accommodation (where you assign the worker to care for residents who are not in isolation for COVID-19).

What if you have a worker that had COVID and they can barely taste the solution, can you still fit test them?

If they can taste the solution (at or before 30 sprays of the sensitivity test solution), you can proceed with the fit test. See the answer above.

What do you do if the person says they feel it or taste it in the back of their throat?

If they feel or taste it in their throat, they are probably breathing through their nose and the seal was not adequate to keep the fit test solution out of their breathing space. You will need to stop the fit test and have the person try another N95.

Throughout the fit test, frequently remind them to breathe through their mouth so they will be able to taste the solution if the respirator seal breaks.

What is the purpose of having the user wear the N95 for 5 minutes prior to starting the fit test?

The purpose of the 5-minute wear time is to:

Be sure the respirator is comfortable, and that the worker can tolerate it being on their face. It needs to be comfortable for the worker to use it when required.
Let the N95 'seat' on the person’s face and adjust it if it does not fit well. The wait period allows the wearer to get familiar with how the N95 sits on their face, as well as the effort it takes to breathe through it.

The 5-minute wait time applies to each N95 the person tries during the fit test.

Does the person need to have the N95 on and be in the hood for 5 minutes?

No, the hood should not be on during the 5-minute waiting period. The 5-minute waiting period is to see if the N95 is comfortable on the person's face.

What if someone has to have a head covering?

The straps should be under the head coverings. However, there may be situations where it is not feasible. In these cases, it is recommended to do fit testing the way the N95 would be worn at work. For example, if the person uses a hair covering for surgery, they will need to be fit tested with the hair covering on. The required fit test exercises simulate activities of work. If the N95 slips and breaks the seal, it would be best to catch it during the fit test.

What happens if the N95 fails the fit test?

If the person can taste the solution during a qualitative fit test, it means the seal broke. You should remove the hood. Then, have the worker doff the respirator, rinse their mouth if they want to, and wipe their lips. Choose a different make/model N95, and then start a new fit test.

What happens if someone does not fit to any of the N95s at your facility?

If the N95s you carry do not fit the worker, you have a few choices:

Obtain a different type of N95 in a minimum quantity. For example, if you provide the round cone-shaped type of N95 and it fails the fit test, you could try a duckbill type, or a 3-panel type.
Provide a respirator job accommodation. For example, assign the worker to care for residents who are not in isolation precautions for respiratory hazards (such as SARS-CoV-2).
Provide a powered air purifying respirator (PAPR or CAPR). This type of respirator does not require fit testing.

N95

Where can we get more N95s?: Purchase respirators from reputable distributors. Check with the N95 manufacturer to find authorized distributors. Be sure to purchase respirators approved by the National Institute for Occupational Safety and Health (NIOSH). Respirator filters must bear the NIOSH stamp and approval number.
Can we use the N95 beyond the expiration date?: Some N95 manufacturers extended their expiration dates. Please check with the manufacturer for the most current expiration dates. Do not provide expired N95s to workers who will be in areas that require N95 use (e.g., isolation precautions for COVID-19).
Do we throw away the N95s with the TC number containing “PH” that were manufactured during the pandemic?: You can use those for source control. They are no longer approved for use in an isolation room or other area with respiratory hazards.