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RespiratoryProtection —Respirator Use

PhysicalQualificationsfor Personnel

ANSI/AIHA Z88.6–2006

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American National Standard

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Notice of Withdrawal: ANS at least 10 years past approval date. The following American National Standard has not been revised or reaffirmed within ten years from the date of approval as an American National Standard and accordingly is withdrawn: ANSI/AIHA/ASSE Z88.6-2006, Respirator Use – Physical Qualifications for Personnel

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ANSI/AIHA Z88.6—2006

American National Standardfor Respiratory Protection —

Respirator Use —Physical Qualifications for Personnel

Approved: August 25, 2006

American Industrial Hygiene Association

Please note the American Society of Safety Engineers (ASSE) is now the Secretariat of the Z88 ASC and holds the copyright to this standard.

American Society of Safety Engineerswww.asse.org

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AmericanNationalStandard

Approval of an American National Standard requires verification by ANSI thatthe requirement for due process, consensus, and other criteria for approvalhave been met by the standard’s developer.

Consensus is established when, in the judgment of the ANSI Board ofStandards Review, substantial agreement has been reached by directly andmaterially affected interests. Substantial agreement means much more than asimple majority, but not necessarily unanimity. Consensus requires that allviews and objection be considered, and that a concerted effort be madetoward their resolution.

The use of American National Standards is completely voluntary; their exis-tence does not in any respect preclude anyone, whether he or she hasapproved the Standards, or not, from manufacturing, marketing, purchasing, orusing products, processors, or procedures not conforming to the Standards.

The American National Standards Institute does not develop standards andwill in no circumstances give an interpretation of any American NationalStandard. Moreover, no person shall have the right or authority to issue aninterpretation of an American National Standard in the name of the AmericanNational Standards Institute. Requests for interpretations should be addressedto the secretariat or sponsor whose name appears on the title page of thisstandard.

CAUTION NOTICE: This American National Standard may be revised or with-drawn at any time. The procedures of the American National StandardsInstitute require that action be taken to reaffirm, revise, or withdraw thisStandard no later than five years from the date of approval. Purchasers ofAmerican National Standards may receive current information on all standardsby calling or writing the American National Standards Institute.

Published byAmerican Industrial Hygiene Association2700 Prosperity Ave., Suite 250Fairfax, VA 22031www.aiha.org

Copyright © 2006 by the American Industrial Hygiene AssociationAll rights reserved.

No part of this publication may be reproduced in any form, in an electronic retrieval system or otherwise, without the prior written permission of the publisher.

Printed in the United States of America.

Stock No: SRPA06-716ISBN: 1-931504-71-7

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ContentsPage

Foreword .....................................................................................................................................iiiSubcommittee Members..............................................................................................................v

1 Scope and Purpose.....................................................................................................................1 1.1 Scope.................................................................................................................................11.2 Purpose .............................................................................................................................11.3 “Shall” and “Should” ...........................................................................................................11.4 Exceptions .........................................................................................................................1

2 Normative References.................................................................................................................1

3 Definitions....................................................................................................................................1

4 Respirator Characteristics ...........................................................................................................3

5 Medical Evaluation Rationale ......................................................................................................4

6 Qualification of Persons Who Conduct Medical Evaluations to Determine Suitability to Use Respiratory Protective Devices............................................................................................4

7 Evaluation Requirements ............................................................................................................4

8 Medical History............................................................................................................................5

9 Medical Evaluation ......................................................................................................................69.1 Frequency ..........................................................................................................................69.2 General Considerations .....................................................................................................6

10 Special Testing.............................................................................................................................810.1 Spirometry .........................................................................................................................8

AnnexesAnnex A Exercise Stress Testing ............................................................................................9Annex B1 Respirator Medical Examination Form/Temporary Disqualification Criteria...........11Annex B2 Request for Medical Clearance for Respirator Use Questionnaire

PLHCP Determination of Class Form....................................................................12Annex B3 Example of the Medical Questionnaire for Respirator Users Initial Form..............13Annex B4 Example of the Medical Questionnaire for Respirator Users Periodic Form .........15Annex B5 Example of Employee Copy of PLHCP’s Written Communication Form ...............16Annex C Spirometry (Guidance for Performance and Interpretation)...................................17Annex D Future Research Areas..........................................................................................19

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iii


FOREWORD

A series of related American National Standards were identified after the development of ANSIZ88.2–1980 “Respiratory Protection Programs” to address specialized technical elements of respi-ratory protection programs. ANSI Z88.6–1984 “Respirator Use — Physical Qualifications forPersonnel” was the first of these standards to be developed. ANSI/AIHA Z88.10–2001 “RespiratorFit Testing Methods” has also been developed and is available to provide detailed respiratory pro-tection program guidance in the area of respirator fit testing.

American National Standard Z88.6-1984 contained general, rather than specific requirementsbecause it was the first standard to deal with this subject. It was intended that “more specificrequirements” would be provided in future editions that would provide more detailed guidance toassist medical professionals in determining which individuals should and should not be medicallyqualified to wear respirators. Annex C of the 1984 standard concluded with suggested “Areas ofFuture Investigation.” This standard addresses these and other areas and presents a process thatmeets, and in many areas exceeds, the minimum requirements of the Occupational Safety andHealth Administration’s (“OSHA”) Respiratory Protection Standard (the “federal standard”) 29 CFR1910.134, and:

• Includes all the questions required by the OSHA respirator questionnaire as well as additionalquestions to assess the risk of cardiac disease,

• Recommends physician review of all cases that fall outside certain parameters, and• Considers the physiologic demand of the type of work to be performed, and type of respirator for

which approval is granted.

The Committee has made the following determinations regarding the revised Standard:

• Any medical professional authorized to evaluate respirator use should be required to know thephysiologic demands associated with various types of respirators.

• The impact of safe and reliable work performance on fellow workers and the public should beconsidered.

• The impact of medical factors on job performance exclusive of respirator use should be considered.• Conditional approval may be granted in appropriate cases.• A periodic medical questionnaire prior to annual respirator fit testing should be administered.• Clinical Exercise Stress Testing (EST) is a useful test for evaluating the functional capacity (work

capacity) of users of industrial respirators as respiratory reserve is normally greater than circulatorysystem reserve and cardiac disease is more common as a disqualifier than pulmonary disease.

• The routine use of spirometry to determine the suitability of individuals to use respiratory protectivedevices is not required, although pulmonary function data (especially aggregate data) may be animportant measure of response to worker exposure.

• Workers are less likely to have clinically significant Coronary Artery Disease “CAD” and to beheat intolerant if they achieve a negative EST to 10 METs.

• Specific blood pressure, body weight, and pulmonary function values will require physician con-sideration, and/or evaluation, and/or medical testing.

• The conservative definition of “heavy” work as suggested by “OSHA” should be adopted.• A concise statement regarding facial hair should be included. • Workers using contact lenses, and workers with perforated tympanic membranes should not be

routinely excluded.• A chest X-ray should not be used routinely to determine suitability to use respirators.• Spirometry should be interpreted in accordance with the recommendations of the American

Thoracic Society (ATS) and that ATS recommendations for performing spirometry tests should beconsidered as useful guidance by evaluators.

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iv


There are four annexes in this standard. These annexes are informative and are not consideredpart of the standard. Suggestions for the improvement of this standard will be welcome. Theyshould be sent to the ANSI Z88 Secretariat, American Industrial Hygiene Association, 2700Prosperity Avenue, Suite 250, Fairfax VA. 22031.

Future revisions are anticipated to provide even more detailed guidance, especially as it applies toworkers with known serious medical issues.

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v


This standard was processed and approved for submittal to ANSI by the Z88 Accredited StandardsCommittee on Respiratory Protection. Committee approval of the Standard does not necessarilyimply that all committee members voted for its approval. At the time it approved this Standard theZ88 Committee had the following members:

James S. Johnson, PhD, CIH, QEP, ChairStephen C. Graham, CIH, CSP, Vice ChairMili Mavely, Secretariat Representative

Organization Represented Name of RepresentativeAmerican Industrial Hygiene Association C. ColtonAmerican Iron and Steel Institute P. HernandezAmerican Society of Safety Engineers R. HarleyAmerican Welding Society S. HedrickBWXT, Y-12 M. HaskewCon Edison of New York G. SlintakEG&G Group R. MetzlerFord Motor Company S. MingelaHealth Physics Society H. CemberInternational Association of Firefighters R. DuffyInternational Brotherhood of Boilermakers D. HaggertyInternational Safety Equipment Association J. Comer BradleyLawrence Livermore National Laboratory J. JohnsonLos Alamos National Laboratory B. ReinertNational Fire Protection Association B. TeeleNational Institute of Occupational Safety and Health R. Berry AnnNational Park Service J. SahmelNavy Environmental Health Center D. SpelcePeach Bottom Atomic Power Station E. GeeUniversity of Cincinnati Medical Center R. McKayUniversity of Pittsburgh J. SchwerhaU.S. Department of Energy D. MarsickU.S. Department of Labor J. SteelnackU.S. Department of the Army S. Graham

Individual MembersC. BienD. BevisT. Nelson

At the time it approved this standard, the Z88 Committee had the following alternate members:

Organization Represented Name of Alternate RepresentativeInternational Safety Equipment Association J. BirknerNIOSH M. D’AlessandroU.S. Department of Energy D. WeitzmanU.S. Department of the Army I. Richardson

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vi


The Z88.6 Subcommittee on Respirator Use – Physical Qualification for Personnel, which devel-oped this Standard, had the following members:

Ronald J. Mack M.D., MPH, ChairRoss L. Clay, MD, MPH Robert K. McLellan. MD, MPHWilliam Dyson, PhD, CIH Roy T. Mc Kay, PhDRichard Enkeboll Richard R. Reilly, PhDConnie R. Freiberg, CSP James P. Seward, PhDAndrew Jackson Mary C. Townsend, DrPHCharles P. Lisa, MD Patrick WesterkampMichael G. Maroldo

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1

1 Scope and Purpose

1.1 Scope. This standard provides informationthat is useful for the medical evaluation ofrespirator users. This standard does notdeal with medical surveillance or biologi-cal exposure monitoring. It is understoodthat local circumstances vary, that no setof guidelines can cover all situations, andthat specific programs and proceduresshould be modified for each individualworkplace. Medical evaluation is only oneelement of a complete respiratory protec-tion program. A complete respiratory pro-tection program is defined in ANSIZ88.2–1992.

1.2 Purpose. This standard provides informa-tion and guidance to physicians or otherlicensed health care professionals(PLHCPs) to assist them in determiningthe medical suitability of personnel for res-pirator use. It identifies the responsibilityof management to provide the PLHCPwith supplemental information before thePLHCP makes a recommendation con-cerning an employee’s ability to use a res-pirator (see Section 7.1 of this Standard).Evaluators shall use their clinical judgmentin the application of these guidelines andrequire additional information or evalua-tion as necessary to permit certification orclassification for respirator use.

1.3 “Shall” and “Should.” The provisions ofthis standard are mandatory in naturewhere the word “shall” is used and advi-sory in nature where the word “should” isused.

1.4 Exceptions. Users of this standardshould be aware that regulatory agenciesmay have requirements that are differentfrom this standard.

2 Normative References. The followingstandards contain provisions which,through reference in this text, constituteprovisions of this American NationalStandard. At the time of publication, theeditions indicated were valid. All stan-dards are subject to revision, and partiesto agreements based on this AmericanNational Standard are encouraged toinvestigate the possibility of applying themost recent editions of the standardsindicated below.

ANSI Z88.2–1992, American NationalStandard for Respiratory Protection

ANSI Z88.6–1984, RespiratoryProtection–Respirator Use — PhysicalQualifications for Personnel

ANSI/AIHA Z88.10–2001- Respirator Fit TestMethods

3 Definitions

3.1 Body mass index (BMI): A measure-ment used to assess weight, relative toheight. BMI is calculated by dividing bodyweight in kilograms by height in meterssquared (kg/m2).

3.2 Canister or cartridge: A container witha filter, sorbent, or catalyst, or combina-tion of these items, which removes spe-cific contaminants from the air passedthrough the container.

3.3 Emergency situation: Any occurrencesuch as, but not limited to, equipmentfailure, rupture of containers, or failure ofcontrol equipment that may, or does,result in an uncontrolled significantrelease of an airborne contaminant.

3.4 Employee exposure: An exposure to aconcentration of an airborne contaminant

American National Standard for Respiratory Protection —Respirator Use —Physical Qualifications for Personnel

AMERICAN NATIONAL STANDARD ANSI Z88.6—2006

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