Abbreviated respiratory questionnaire

Under 1910.1043 App B-III the Abbreviated Respiratory Questionnaire is a screening tool employers can use to identify workers who report respiratory symptoms or risk factors that may require further medical evaluation.

• The form collects identification data and asks brief questions about cough, phlegm, chest tightness, and tobacco smoking so that employers or a physician/licensed healthcare professional (PLHCP) can spot workers who need a more detailed medical exam. See the sample questionnaire in Appendix B-III to 1910.1043 and the overall medical-surveillance context in 1910.1043.

Under 1910.1043 App B-III the questionnaire should be used as a screening step in a medical-surveillance program—for example at baseline (pre-placement), periodically, or whenever an employee reports respiratory symptoms or a relevant exposure.

• Use the form to quickly identify employees who need a full medical evaluation or follow-up under the medical-surveillance provisions of 1910.1043. See the sample screening tool in Appendix B-III to 1910.1043.

Under 1910.1043 App B-III the employee should complete the questionnaire (or answer its questions verbally if necessary) so the PLHCP or employer can assess symptoms and exposures.

• The sample form in Appendix B-III to 1910.1043 is laid out for direct employee responses (identification, cough, phlegm, tightness, tobacco history). Employers should ensure answers are accurate and available to the reviewing medical professional under the medical-surveillance provisions of 1910.1043.

Under 1910.1043 App B-III the questionnaire does not replace a full medical examination; it is a brief screening tool to identify employees who need a more complete medical evaluation.

• If the screening identifies symptoms or risk factors, the employer must arrange follow-up medical evaluation per the medical-surveillance requirements of 1910.1043. The sample screening form is available in Appendix B-III to 1910.1043.

Under 1910.1043 App B-III the employer should refer the employee for a full medical evaluation by a physician or licensed healthcare professional (PLHCP) when the screening indicates respiratory symptoms such as cough, phlegm, or chest tightness.

• The Abbreviated Respiratory Questionnaire is designed to flag symptoms so the employer can follow the medical-surveillance and follow-up procedures in 1910.1043. See the screening items in Appendix B-III to 1910.1043.

Under 1910.1043 App B-III the questionnaire includes tobacco-smoking questions because smoking is an important risk factor when evaluating respiratory symptoms and worker fitness for exposure. Employers may collect this information as part of the screening process.

• The tobacco questions appear on the sample screening form in Appendix B-III to 1910.1043. Employers should use smoking history to inform medical decisions and follow the medical-surveillance requirements in 1910.1043.

Under 1910.1043 App B-III completed questionnaires contain medical information and should be handled confidentially and only shared with the PLHCP and others who need the information for medical-surveillance purposes.

• The sample form in Appendix B-III to 1910.1043 is part of the record set used to meet the medical-surveillance provisions of 1910.1043; employers should protect employees’ medical privacy consistent with those obligations.

Under 1910.1043 App B-III the questionnaire may be administered in a way that obtains accurate answers—this can include reading the questions aloud or using a translator so the employee understands and responds truthfully.

• The sample screening tool in Appendix B-III to 1910.1043 is a template; employers must ensure the screening meets the intent of the medical-surveillance provisions in 1910.1043 by obtaining accurate medical information from the employee.

Under 1910.1043 App B-III the sample questionnaire is a recommended template; employers may use this form or an equivalent screening method that obtains the same information to meet the medical-surveillance needs of 1910.1043.

• The appendix provides a model screening tool in Appendix B-III to 1910.1043, but employers can implement alternative written forms or interview procedures so long as they capture the relevant symptoms and risk-factor information required by the standard.

Under 1910.1043 App B-III the questionnaire collects identification data such as the employee’s name, job, and date so medical reviewers can link symptoms to the individual’s exposure history and medical record.

• The identification block is part of the sample form in Appendix B-III to 1910.1043 and supports compliance with the medical-surveillance and recordkeeping expectations in 1910.1043.

Under 1910.1043 App B-III the sample form includes fields for identification and responses and may include an employee attestation or signature; employers may request a signature to confirm the answers were provided and accurate.

• Any signed questionnaire is still medical information and must be handled according to the medical-surveillance and confidentiality expectations in 1910.1043 and the sample in Appendix B-III to 1910.1043.

Under 1910.1043 App B-III employers should use the questionnaire at baseline and at intervals appropriate to the medical-surveillance program or whenever an employee reports new respiratory symptoms or a change in exposure.

• The sample in Appendix B-III to 1910.1043 supports periodic screening; actual frequency should follow the medical-surveillance and follow-up provisions of 1910.1043.

Under 1910.1043 App B-III the completed questionnaire should be reviewed by a physician or licensed healthcare professional (PLHCP) or other designated medical reviewer who determines whether a full medical evaluation or further testing is needed.

• The form in Appendix B-III to 1910.1043 is a screening aid; final medical judgments and decisions about work fitness and follow-up belong to the PLHCP under the medical-surveillance framework of 1910.1043.