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The purpose of this respiratory program is to provide and maintain a safe and healthful work place for all employees who work in environments with airborne contaminants. This program establishes procedures and provides instructions in the selection, use and care of respiratory protective equipment. Supervisors of all employees who work in hazardous atmospheres must discuss the use of respiratory protective procedures and equipment with affected employees.
Respirator use is required when exposures exceed regulatory limits.
Work and contaminants that require respirator use due to exposure protocol or where exposures exceed regulatory limits include:
For the following work, voluntary use is permitted when exposures are below regulatory limits.
It is the supervisor’s responsibility to identify and evaluate the workplace and select the appropriate respirator for an employee based on the direction given below. The Environmental Health & Safety coordinator may assist with selection.
Supervisors who have the responsibility of overseeing the work activities of one or more persons who must wear respirators will arrange for the employee’s training in the proper use of respirators, initial medical evaluation, and respirator fit test. The Environmental Health & Safety coordinator may assist with this.
Supervisors are required to ensure that employees are using and maintaining their respirators correctly as dictated by the work and contaminant exposure level.
The supervisor shall also monitor employees for medical signs or symptoms, changes in the work place, changes in the employee, or other information that may indicate the need for additional medical evaluations.
Whenever possible, toxic levels of airborne contamination should be eliminated through administrative or engineering controls. An example of an administrative control is to reschedule work crews until contaminate levels are below regulatory thresholds. An example of an engineering control can be to eliminate the hazard by substituting a less toxic material or installing better ventilation. When administrative or engineering controls are not feasible, or while they are being instituted or evaluated, appropriate respirators will be used.
The Permissible Exposure Level (PEL) is an 8-hour Time Weighted Average (TWA) above which employees are not permitted to work without respiratory protection. The following formula may be used to determine whether employees are approaching the PEL during a shift on a particular job site:
C= concentration of contaminate based on test sampling data
t= length of time exposed (in hours)
8-hr TWA = C1t1 + C2t2 + C3t3...
(Shift exposure) 8 hours
The Short Term Exposure Limit (STEL) is a 15-minute TWA concentration to which employee exposure is limited to 15 minutes without respiratory protection.
Employees are not permitted to work at or above the Ceiling Limit without respiratory protection.
When an atmospheric environment is suspected of containing toxic levels of contaminants that could make it Immediately Dangerous to Life or Health (IDLH), employees may not enter the area for any period of time.
The TWA, STEL, Ceiling, and IDLH limits for each contaminant can be found in the Washington General Occupational Health Standards. Contact the Environmental Health & Safety coordinator for more information on exposure limits.
An atmosphere is considered oxygen deficient when the concentration of oxygen is less than 19.5%. It is unsafe to enter an oxygen deficient work area without an atmosphere-supplying respirator. One should investigate any environment with less than 21% oxygen even if higher than 19.5%. A lack of oxygen implies that something else is in the atmosphere that could be dangerous.
Worksite atmospheric testing is required whenever a hazardous material is present, the contaminant level is unknown, and the area cannot be thoroughly ventilated. Continuous testing (before entering and throughout the work shift) must be performed when there is a possibility that the area does or could contain an unknown toxic, be oxygen deficient, or contain another hazardous atmosphere. Contact the Environmental Health & Safety coordinator for assistance in conducting atmospheric monitoring.
Employees may voluntarily use their own or university-issued respirators when the supervisor has determined that such use will not in itself create a hazard. When voluntary use is permissible, the supervisor must present the employee with the information in Appendix A. The employee must also sign a copy of the information and the signed copy must be forwarded to the Environmental Health & Safety coordinator.
The supervisor is also responsible for ensuring the employee is medically fit (completes medical evaluation) to use the respirator and that it is used and cared for properly. Medical evaluations are not required for voluntary users of paper, filtering face piece respirators. Fit testing is not required for voluntary use of any respirator.
Employees who are likely to be exposed to hazardous levels of airborne contaminants will be issued a NIOSH-certified respirator, appropriate replacement parts, and cartridges or filters, at no cost to the employee. Assigned respirators must be properly fitted as described later in this program.
The employee shall evaluate the potential for a respiratory exposure given the work environment. Identify the hazard. Are particles being generated? Are chemicals being used? What does the MSDS advise? Is the work area a confined space? Is there ventilation?
If the employee suspects a respiratory exposure or the atmosphere is unknown, the employee must cease operations or entry.
Employees authorized to wear respirators that will protect against the potential hazard may renew operations and/or initiate sampling of the atmosphere.
If the atmospheric concentration of the contaminant is found to be below the PEL, then re-entry is permitted without using a respirator unless it is reasonably foreseeable that the atmosphere could again or intermittently surpass the PEL or STEL.
SU requires the use of respirators, regardless of the PEL for tuberculosis exposure.
A second employee shall be assigned to work with any employee using an airline respirator to ensure that the line is kept free of kinks or other blockages and to monitor the alarms and carbon monoxide levels.
The employee shall evaluate the patient’s medical history and symptoms before entering the area of the patient.
If the patient is known to have tuberculosis (TB) or is symptomatic of TB, then the employee shall wear a respirator while treating the patient.
WAC 296-842-190 details standby procedures that are required when respirators are used in IDLH conditions. Generally, one or two employees, who are trained and equipped to provide emergency rescue, must be located outside of the respirator use area. SU employees are not expected to work in IDLH conditions.
An unanticipated spill of a large quantity of any highly toxic chemical could produce a toxic and/or oxygen deficient atmosphere. In such a case the building must be immediately evacuated and Campus Public Safety and Seattle Fire personnel called in to assist.
Only “NIOSH-certified” respirators, filters, cartridges, and canisters may be selected and used. The choice between respirator types and cartridge types is dependent upon the airborne contaminant present, the hazardous operation performed, and the comfort and ease of obtaining a proper individual fit.
An atmosphere-supplying respirator or an air-purifying respirator must be used for protection against gases and vapors. For protection against particulates, an atmosphere-supplying respirator or an air-purifying respirator with a NIOSH-certified HEPA or particulate filter will work.
Refer to WAC 296-842-130 or the Environmental Health & Safety coordinator for more guidance on selecting the proper respirator.
Each respirator will have some limitations. Refer to the respirator instructions for respirator limitations. Air-purifying respirators may only be used in atmospheres of at least 19.5% oxygen (The normal atmospheric oxygen content of air is about 21%). They may not be used in oxygen deficient atmospheres.
Every respirator has an Assigned Protection Factor (APF), which is a measure of the degree of protection provided by the respirator to the respirator wearer.
To ensure that a particular respirator will be adequate for use in a particular atmosphere, one must complete an analysis of the contaminant exposure and the assigned protection factor (APF) of the respirator before selection. The Environmental Health & Safety coordinator can assist with this analysis.
Type of Work or Potential Exposure
(Bellarmine Nursing Clinic)
Air-purifying, half-face piece w/ N, R, P, or HEPA filters or filtering face piece
Air-purifying, half-face piece w/ R, P, or HE filters or filtering face piece.
Supplied-air, continuous-flow hood or air purifying, half-mask with organic and HEPA cartridges.
Preparing glaze and clay from powdered
Air-purifying, half-face piece w/ N, R, P,
Type of Work or Potential Exposure Respirator
Wood and/or Metal Shop
(Facilities Operations, Lee Center Theater)
Air-purifying, half-face piece w/ N, R, P, or HE filters or filtering face piece
Asbestos Brake Work
Air-purifying, half-face piece w/ N, R, P, or HE filter
Air-purifying, half-face piece w/ organic vapor cartridges.
Welding & metal foundry
(Facilities Operations, Performance Stage/Event Services)
Air-purifying, half-face piece w/ welding fume cartridge filters or N95 filtering face piece
Crawl Space Work
(OIT, Facilities Operations)
Filtering Face piece
Half mask with HEPA filters
A physician or other licensed health care professional (PLHCP) must evaluate each employee who is permitted or required to use a respirator to ensure that they are physically fit to wear it. This does not apply to those who use filtering face piece respirators voluntarily. The supervisor may schedule the evaluation through the Environmental Health & Safety coordinator. The Environmental Health & Safety coordinator, with the help of the supervisor, must provide the PLHCP with:
The employee must complete the Seattle University adapted “WISHA Respirator Medical Evaluation Questionnaire” (Appendix B) and submit it directly to the PLHCP. The Environmental Health & Safety coordinator may facilitate the confidential submission of the questionnaire from the employee to the PLHCP. A medical examination may still be required when advised by the PLHCP based on the questionnaire. The cost of the medical evaluation will be borne by the department for which the employee is employed. There will be no charge to the employee.
The medical evaluation and completion of the questionnaire will be administered during the employee’s normal working hours or at a time and place convenient to the employee.
The PLHCP must submit a written recommendation using the “Health Care Provider Respirator Recommendation Form” found in Appendix C. The recommendation must include
any limitations on respirator use related to the medical condition of the employee, or relating to the workplace conditions in which the respirator will be used, and a statement that the PLHCP has provided the employee with a copy of the written recommendation. The recommendation will be forwarded to the employee’s supervisor and maintained by the Environmental Health & Safety coordinator. The PHLCP shall also recommend the frequency of subsequent evaluations for each employee.
Proper fitting of negative or positive pressure tight-fitting respirators is essential, if employees are to receive the protection for which this program is designed. Air that passes around the face piece of the respirator, rather than through it, is not filtered air. In order to ensure a good face seal, the manufacturer’s fitting instructions and the rules below must be followed.
The employee must perform the following pressure fit check every time a tight-fitting respirator is worn. The employee is permitted to perform a fit check as recommended by the manufacturer of the respirator in different than this procedure.
A more elaborate fit test will be conducted:
The respirator must be tested using the WISHA-accepted qualitative or quantitative protocols. The employee’s supervisor may arrange employee fit testing with the Environmental Health & Safety coordinator.
If an employee passes a fit test and subsequently notifies the supervisor that the fit is unacceptable, the employee must be permitted to select a different respirator face piece and be re-tested.
Annual re-testing of required respirators will be conducted to verify the condition of respirators and quality of seal. Defective equipment or parts will be replaced. Voluntary users may make use of this service during the re-testing period, if they wish.
The results of the fit test shall be documented on the form in Appendix D. The documentation includes:
The Environmental Health & Safety coordinator will maintain a copy of the record.
Respirators must be cleaned frequently enough to be maintained in a sanitary condition and placed in a plastic bag or stored in another container provided for this purpose (zip-lock bags or clean coffee can). DO NOT leave them in the work area or hung on a nail. Respirators that are shared by employees must be cleaned and disinfected before being worn by another person.
Respirators should be completely cleaned and disinfected by carrying out the following procedures.
Remove the cartridge from the respirator body. Cartridges must never be washed or disinfected. Also, remove speaking diaphragms, hose and valve assemblies or other parts recommended by the manufacturer.
Immerse the respirator body in a warm soap and water solution. The respirator face piece and parts may be scrubbed gently with a cloth or soft brush. Make sure that all foreign matter is removed from all surfaces of the rubber exhalation valve flap and plastic exhalation valve seats.
When the soap used in the first step does not contain a disinfectant, the respirator parts must be disinfected with a commercial solution. Alcohol solutions are NOT recommended by WISHA because they are known to degrade the plastic.
After washing and disinfecting the respirator, rinse it with warm water and then allow it to air-dry. Do not store the respirator with wet straps. Mildew will result. The face piece, inhalation, and exhalation valves must be in a normal position during storage to prevent the abnormal “set” of the elastomer parts.
After the respirator is dry, reassemble the face piece.
Test the respirator to ensure that all the components work properly.
When a respirator is found to have faulty or damaged parts, the respirator must be removed from service. Repairs or adjustments to the respirator must be performed by persons who are trained to do so. ONLY NIOSH-approved parts designed for the specific respirator may be used and repairs must be made according to the manufacturer’s instructions. ONLY the manufacturer or a technician trained by the manufacturer may repair, replace, or adjust reducing and admission valves, regulators, and alarms.
Each person required to use a respirator must maintain and routinely inspect it before and after each use. Employees should also conduct monthly inspections to assure that they are clean and in satisfactory working condition. The respirator inspection will include:
NOTE: Stretching and manipulating rubber or elastomer parts with a massaging action will keep them pliable and flexible and prevent them from setting during storage.
When a respirator is found to be damaged or worn, the employee shall tag and removed it from service. Any malfunction or damage of the respirator shall be immediately reported to the supervisor, who will supply replacement parts or send it to the manufacturer’s representative for repair. If it is not possible to repair the respirator, it must be discarded and replaced.
The useful life of respirators, filters, and cartridges will vary depending on the job duties and the actual time in use. As a general rule, dust or particle cartridges should be changed according to the manufacturer’s recommendation or when filter resistance makes breathing difficult.
Organic vapor cartridges shall be changed after each use, regardless of the length of time it is worn. If the employee detects vapor or gas breakthrough or changes in breathing resistance before the prescribed change out schedule, the employee must leave the work area and replace the cartridge.
End-of-Service-Life-Indicators (ESLI) must be used whenever available for the contaminant of concern. When an ESLI is not available for a particular contaminant cartridge, a change-out schedule must be pre-determined based on objective data.
Please refer to WAC 296-842 for atmosphere-supplying respirator breathing gas requirements. Generally, breathing gas must meet the requirements for Grade D breathing air described in ANSI/Compressed Gas Association Commodity Specification for Air, G-7.1-1989.
Compressors must be constructed, maintained, and placed in a location that will ensure that carbon monoxide exhaust and other atmospheric contaminants are not permitted to enter the air supply system. The breathing air must not exceed 10 ppm of carbon monoxide. Oil-lubricated compressors must have a high-temperature or carbon monoxide alarm.
Compressors must have a tag indicating the most recent filter change date. The designated “competent person” authorized by the supervisor to perform the change must also sign the tag. Breathing air couplings must not be compatible with outlets for non-respirable worksite air or other gas systems.
Employees that are required to use respirators, supervisors of employees who are required to wear respirators, and any person issuing respirators will be trained in the use and maintenance of respirators before performing functions related to respirator use.
Employees will also be trained by their supervisor to understand the respiratory hazards that require them to use a respirator before being permitted to use hazardous materials or work in hazardous conditions. All safety training will be provided at no cost to the employee.
Training must enable employees to demonstrate:
Affected employees shall be retrained as necessary to assure effective respirator use. Refresher training shall be given at least annually.
Training records shall be forwarded to and maintained by the Environmental Health & Safety coordinator. Employees must understand and be able to apply the information in this respirator program including the daily use, care, and safekeeping of respirators.
The Environmental Health & Safety coordinator and each supervisor will monitor the effectiveness of this program by:
The university’s PHLCP may also recommend further surveillance to ensure that employees who are using respirators are being adequately protected.
The program will be updated as necessary to reflect changes in workplace conditions that may affect respirator use.
Fit Test Tight-Fitting Face Pieces
Contaminant over PEL
(Required by Regulation)
(Not Required for Filtering Face pieces)
Read and Sign Advisory Information for Employees
Appendix A. Advisory Information for Voluntary Users
Advisory Information for Employees Who Voluntarily Use Respirators