Respirator: Fit Testing – What to Expect

Respirator fit testing is a critical part of protecting workers from inhalation hazards in industries where airborne contaminants are present. A properly fitted respirator ensures a secure seal, reducing the risk of exposure to harmful substances. This fact sheet breaks down OSHA’s requirements, outlines qualitative and quantitative testing methods, and explains how employers can implement an effective respiratory protection program that meets compliance standards.

Why is Workplace Respirator Use Regulated? 

The federal Occupational Safety and Health Administration (OSHA) and related state agencies enforce respiratory protection standards to help prevent work-related exposures to airborne materials that can be hazardous to employees’ health. OSHA Standard 1910.134 – Respiratory Protection describes the rules that apply to general industry, shipyards, marine terminals, longshoring, and construction industries. 

Exposure to airborne contaminants can trigger allergies or asthma, damage the lungs, or spread disease. In some cases, repeated exposure is linked to the development of certain types of cancer. In acute situations, airborne toxins may cause unconsciousness or death.  

OSHA requires covered employers to select and pay a licensed healthcare provider – often an occupational health physician – to assess a prospective or current employee’s ability to safely tolerate the use of a respirator under specific work-related conditions. After reviewing medical findings, the provider submits a written opinion to the employer, stating whether an examinee is: 

• Medically fit to wear a respirator 

• Fit to wear a respirator with limitations, such as for a restricted time period 

• Not fit for respirator use   

Answers to questions and medical exam results are confidential, legally protected personal health information and may not be given to an employer.  

What is a Respirator? 

A respirator is a device that filters out particles, chemically cleans or purifies air, or supplies clean air from an outside source. It may be used to prevent the inhalation of potentially harmful dusts, particles, and toxins contained in smoke, fumes, or vapors. Some devices are designed to prevent exposure to infectious pathogens. 

The National Institute for Occupational Safety and Health certifies respirators and facepieces for use in specific work environments. Refer to the National Personal Protection Technology Laboratory for cautions and limitations and a certified equipment list that applies to devices including self-contained breathing apparatuses, closed-circuit escape respirators, gas masks, supplied-air respirators, chemical cartridges, non-powered air-purifying particulate filter respirators, and powered air-purifying respirators. 

What is a Respirator Medical Questionnaire? 

To obtain approval to use a respirator, an employee must first complete a medical evaluation questionnaire. The reviewing provider has the discretion to add certain questions. Less frequently, an employee may undergo a preliminary exam that is considered equivalent to completion of the questionnaire. Questions are used to collect: 

• General health information (e.g., medical history, underlying medical conditions) 

• Work and respirator use history 

• Information specific to the type of respirator to be used 

• Information on physical activity levels related to respirator use 

Depending on how questions are answered, an employee may be approved to use a respirator without further evaluation or scheduled for a medical examination. 

What is a Respirator Medical Exam? 

A qualified provider must conduct a follow-up medical exam on any employee who responds in the affirmative to questions that indicate respirator use might diminish personal health and affect workplace safety. Exam components may include but not limited to: 

• Pulmonary function test, e.g., spirometry 

• Blood pressure check 

• Assessment of cardiovascular or respiratory symptoms 

• Selected lab tests 

• Chest X-rays 

• Electrocardiogram  

Spirometry is a commonly used pulmonary function test that measures lung capacity when a person inhales and exhales through a device called a spirometer. Spirometry may be part of a respirator exam or used for medical surveillance purposes. Pulmonary function tests are collectively used to establish health baselines that can be compared to subsequent test results over time. When a change in respiratory health is detected, steps can be taken to prevent further exposure, diagnose a condition, and develop a treatment plan, as necessary.  

The examining provider also considers factors such as the type and weight of the respirator, duration and frequency of use, workplace conditions such as temperature, humidity, confined space, and physical effort required during respirator use. In some cases, WorkCare providers who review results contact examinees to further clarify their answers to questions and certain medical findings. 

Routine annual respiratory protection exams are discretionary, not mandatory. However, an additional evaluation is required when there are changes in an employee’s medical condition, the employee reports symptoms, or if the employer or a healthcare professional deems it necessary.  

What is a Respirator Fit Test? 

A respirator fit test is performed to ensure that individuals who wear respirators have an airtight protective seal against their face. Certain types of respirators have specific test protocols. OSHA-approved fit-testing procedures are described in Part 1910.134, Appendix A.  

Test subjects are legally allowed to try on numerous models and sizes to help achieve an optimal fit. The selected, fitted respirator and facepiece must be the same model that will be worn at work. Employees are expected to perform a tight-seal check before each use. 

The fit-test process includes: 

1. Instructions on what to expect prior to testing.  

2. A requirement to wear job-specific safety gear during the test. Apparel that interferes with a satisfactory fit must be altered or removed, nullifying a test. 

3. Exercises that may be required to be performed for one minute each. For example:  
   • Normal breathing in a standing position without talking 
   • Slow, deep breathing in a standing position 
   • Turning one’s head from side to side and up and down  
   • Talking loudly enough to be clearly heard by the test administrator 
   • Bending at the waist or jogging in place  
   • Making facial expressions such as grimacing, smiling, or frowning (15-second limit) 

Fit testing may be quantitative or qualitative depending on the type of respirator. Quantitative testing uses specialized equipment to detect and measure any leaks. Qualitative fit testing is a pass/fail test method used to detect a poor seal using sense of taste or smell and reactions to an irritant.  

An annual fit test is recommended. A fit test is required when a different type of respiratory protection is needed, or the wearer has physical changes that affect the facepiece seal. Men with facial hair are only allowed to use respirators that do not rely on a tight seal, such as loose-fitting helmets and hoods.  

What is a Respiratory Protection Program? 

In workplaces with airborne exposure hazards, employers must establish and implement a written program that addresses all aspects of respiratory protection, including equipment selection, medical evaluation, fit testing, and employee training on proper use, maintenance, and limitations. 

Employees must be allowed to complete the questionnaire and medical exam, as needed, during their regular working hours or at a time and place that is convenient for them. Employers or their third-party designees must securely maintain records of medical evaluations, fit test results, and related documentation. 

Summary  

Breathing through a respirator is more difficult than breathing in the open air regardless of a person’s overall fitness. People with lung diseases, such as asthma or emphysema, or who are claustrophobic, may not be able to wear a full facepiece or hooded respirator. People with vision problems may have trouble seeing while wearing a mask or hood.  

Like other occupational health and safety protective measures, one size does not fit all. There are multiple variables to consider when evaluating employees for respirator use. Employers and respirator wearers can rely on the occupational health professionals at WorkCare to help ensure regulatory compliance, maximum protection, and ease of use as a best-practice solution.