OSHA Respirator Questionnaire Display

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Quadrant Corporate Medical Manual

Table of Contents


Medical Department Objectives 1.1
Medical Services 1.2
Quality Assurance 1.3
Code of Ethics 1.4



The Medical Record 2.1



SECTION 3V Influenza Reassortant Strain Exposure Procedure

Emergency medical protocols 3A.1
First aid 3C.1
Antidote kit tracking 3C.2
Return to work evaluation 3C.3
Notification of use in the lab 3C.4
Emergency medical protocol vasovagal syncope 3D.1
Emergency response information 3D.2
First aid 3HF.1
First aid 3L.1
- Non-human primate worker surveillance and post exposure protocol 3M.1
- 2012 Sample collect and shipment 3M.2
- KEB intrasite-intersite shipping request form 3M.3
- Non-human primate bite shipping request form 3M.4
- Non-human primate exposure advice to employee 3M.5
Influenza Reassortant Strain Exposure Procedure 3V.1
Influenza Reassortant Virus Worker Exposure Flow Chart 3V.1a
Influenza Reassortant Virus Exposure Flow Chart – Workers Reporting Illness 3V.1b
Communications for Workers – Reassortant Virus Exposure 3V.1c
Communications for Family Menbers – Reassortant Virus Exposure 3V.1d
Communications for Medical Providers – Reassortant Virus Exposure 3V.1e
Current Influenza Vaccine Strain Exposure Procedure 3V.2
Current Influenza Vaccine Strain Virus Worker Exposure Flow Chart 3V.2a
Acute exposure to chemical and pharmaceutical hazards. 3.1
Flowchart for acute exposure 3.1a
Oxygen administration 3.2
Automatic external defibrillators 3.3
Episodic urgent care general guidelines. 3.4
Medical management of injury, illness, and hazardous exposure – Contractors. 3.5
First aid card – chemical exposures. 3.6
First aid decision tree for injuries and illnesses. 3.7


SECTION 4 Health Evaluation

Preplacement Medical Evaluations 4.1
Periodic Health Evaluations 4.2
Return to Work Following Illness or Injury 4.3
Wellness Evaluations 4.4


SECTION 5 Medical Surveillance Program

OSHA Medical Surveillance Standards 5.0
General Principles 5.1
Acrylonitrile – 1910.1045 5.4
Arsenic – Inorganic – 1910.1018 5.6
– Arsenic Urine Monitoring 5.6a
Asbestos – 1910.1001 5.7
Benzene – 1910.1028 5.9
Bloodborne Pathogens – 1910.1030 (also Sections 6 and 9) 5.11
Cadmium – 1910.1027 5.12
Chromium VI – 1910.10.26 5.14
Confined Space Entry 5.15
DOT Driver Medical Procedures 5.18
Powered Industrial Trucks and Mobile Equipment Operators 5.18.1
Ethylene Oxide – 1910.1047 5.19
Fire Brigade – 1910.156 5.20
Formaldehyde – 1910.1048 5.21
Hazardous Chemicals in Laboratories – 1910.1450 5.22
Hazardous Waste Operations and Emergency Response – 1910.1020 5.23
Laboratory Animal Surveillance 5.24
Lasers 5.25
Lead – 1910.10.25 5.26
Methemoglobin Producers 5.27
Methylene Chloride – 1910.1052 5.28
Non-Human Primate Surveillance 5.29
Occupational Noise Exposure – 1910.95 5.30
Respiratory Protection – 1910.134 5.31
Tuberculosis Surveillance 5.35
Near Visual Acuity and Color Vision for Pharma Product Inspection 5.40



- Biological Hazards – Bloodborne Pathogens
Bloodborne Pathogens Exposure Control Plan 6.1
Bloodborne Pathogens Medical Surveillance 6.2
Medical Waste Disposal 6.3


SECTION 7 Special Issues

Traveling Employees to Developing Countries 7.1
Emerging Infectious Diseases 7.2
Ergonomics 7.3
Administration of Allergy Shots 7.4
Workplace Evaluation of Reproductive Hazards 7.5
Workplace Evaluation of Repro Hazards – Form 7.5a
Letter to OB of Physician – Repro Eval 7.5b


SECTION 8 Drug Testing

Drug Testing – Collection Protocol 8.1



Compliance Review 9.1
Employee Exposure Determination Form 9.2
Engineering and Work Practice Controls 9.3
Health Care Professionals Written Opinion 9.4
Exposure History 9.5
Hepatitis B Vaccine Declination Form 9.6
Hepatitis B Vaccination Policy 9.7
Hepatitis B Vaccination Record 9.8
Housekeeping Plan 9.9
Personal Protective Equipment 9.10
Postexposure Evaluation Procedure 9.11
Postexposure Prophylaxis (PEP) Policy 9.12
Safer Medical Devices 9.13
Sharps Injury Log 9.14
BBP Training 9.15
Universal Precautions Sheet 9.16
BBP Attendance Sheet 9.17
BBP Training Record – 2013 9.18
Hepatitis B Vaccination Spreadsheet – Sample 9.19



Accuracy Test BAC 10.1
Acute Episodic Visit 10.2
AED Checklist 10.3
Allergy Shot Checklist 10.4
Allergy Shot Referral Letter 10.5
Animal Facilities and Respirator Medical Clearance Certificate 10.6
Animal Facilities Medical Surveillance Questionnaire 10.7
Animal Facilities Visitor’s Questionnaire 10.8
Asbestos Medical Questionnaire – Initial (Part 1- Mandatory) 10.9
Asbestos Medical Questionnaire – Periodic (Part 2 – Mandatory) 10.10
Audiometric Record 10.11
Blood Pressure Record 10.12
Cadmium Exposure – Questionnaire Instructions 10.13
Cadmium Exposure – Questionnaire 10.14
Cadmium Exposure – Surveillance Results 10.15
Calibration Log for Equipment 10.16
Contractor Report of Occupational Illness or Injury 10.17
Contractor’s Illness-Injury Return to Work Status Note 10.18
Cyanide – Notification of use in laboratory 10.19
Daily Log 10.20
Declination of Care – Work Related Injury 10.21
Declination of Emergency Treatment or Transport 10.22
Emergency Contact Information 10.23
Environmental/Occupational History 10.24
Ergonomic Assessment – Office 10.25
Ergonomics – Computer Station Check List 10.26
Examination Authorization Order Sheet 10.27
Flu Vaccination Check List 10.28
Flu Vaccinations Supply List 10.29
Formaldehyde Questionnaire 10.30
HIPAA Patient Privacy Notice 10.31
HIV Testing Consent 10.32
Incident Report – Quadrant Employees 10.33
International Travel Questionnaire 10.34
Laser Medical Surveillance Ophthalmologist Referral Form 10.35
Laser Safety Medical Surveillance Declination Form 10.36
Medical Review Officer Punch-list 10.37
Medical Status Determination 10.38
Meeting Template 10.39
Methylene Chloride Questionnaire 10.40
Non-Human Primate Exposure Advice to Employee 10.41
Occupational Hearing Loss – Final Determination Documentation Form 10.42
Occupational Injury Case Log 10.43
Patient Flow Sheet 10.44
Periodic Surveillance Exam Questionnaire 10.45
Physical Activity Readiness Questionnaire (PAR-Q) 10.46
Physical Requirements and Work Conditions 10.47
Physical Examination Form 10.48
PortaCount Daily Checks 10.49
Pre-Placement Health Examination Questionnaire 10.50
Progress Note 10.51
Provider’s Report of Asbestos Exam 10.52
Provider’s Report of Confined Space Entry Evaluation 10.53
Provider’s Report of Distance Visual Acuity and Peripheral Vision 10.54
Provider’s Report of Fit Test Results 10.55
Provider’s Report of Methylene Chloride Exam 10.56
Provider’s Report of Near Visual Acuity and Color Testing 10.57
Provider’s Report of OSHA Surveillance Exam 10.58
Provider’s Report of Powered Industrial Trucksand Mobile Equipment Operators Testing 10.59
Provider’s Report of Pre-Employment Urine Drug Screen Results 10.60
Provider’s Report of Respirator Clearance 10.61
Provider’s Report of Surveillance Exams – All Programs 10.62
Provider’s Report to Employee – Results of Medical Evaluation 10.63
Provider’s Report of Near Visual Acuity and Color Testng 10.64
Provider’s Report to Employee – Results of Medical Evaluation 10.65
Release of Employee Medical Record Information 10.66
Respirator – Medical Evaluation Questionnaire – Periodic 10.67
Respirator – OSHA Medical Evaluation Questionnaire – Initial (Mandatory) 10.68
Respirator Form (non-mandatory use) 10.69
Return to Work Form 10.70
Tuberculosis Screening Questionnaire 10.71
UA Dip Report 10.72
Vaccination record 10.73
Visit Record 10.74
Vital Signs Flow Sheet 10.75
Wellness Exam Check-list 10.76
Wellness Exam Questionnaire 10.77
Wellness Physical Examination Form 10.78


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Examination Authorization Order Sheet 11.1
Periodic Surveillance Exam Questionnaire 11.2
Physical Examination Form 11.3
Pre-Placement Health Examination Questionnaire 11.4
Wellness Exam Check-List 11.5
Wellness Exam Questionnaire 11.6
Wellness Physical Examination Form 11.7



Medical Surveillance Spreadsheet – Blank 12.1
Site First Aid Program Documentation 12.2
Site Medical Program Documentation 12.3
Site Substance Abuse Program Compliance 12.4


SECTION 13 – Client Specific SOPs


SECTION 14 – Standing Orders

Emergency Medical Protocol for Management of Anaphylactic Reactions/Adults 3A.1
Nursing Care Guidelines 14.1
Routine Venipuncture Procedure 14.3
Standing Orders for Vaccine Handling and Administration 14.4
Standing Order for Respirator Clearance by Registered Nurses 14.6
Standing Orders for Vaccines
Standing Order – Hepatitis A Vaccine – Adults 14.7
Standing Order – Hepatitis B Vaccine – Adults 14.8
Standing Order – Medical mgmt of Vaccine Reactions in Adults 14.9
Standing Order – Medical mgmt of Vaccine Reactions in Children and Teens 14.10
Standing Order – Meningococcal Vaccine – Adults 14.11
Standing Order – Meningococcal Vaccine – Children and Teens 14.12
Standing Order – MMR Adults 14.13
Standing Order – Pneumonia Vaccine – Adults 14.14
Standing Order – Tdap or TD – Adults 14.15
Standing Orders – Influenza Vaccine – Adults 14.16
Standing Orders – Influenza Vaccine – Children and Adolescents 14.17


SECTION 15 – Chart Reviews and Collaborative Agreements

Physician and Nurse Practitioner or Physician Assistant Collaboration Procedure 15.1
Physician and NP or PA Chart Review Procedure 15.2
Standardized Procedures for Nurse Practitioners (California) 15.3
Quadrant Chart Review Form 15.4
Quadrant Collaborative Practice Agreement – NP 15.5
Quadrant Collaborative Practice Agreement for NP in Massachusetts 15.6
Quadrant Collaborative Practice Agreement – PA 15.7


SECTION 16 – Templates

Sample Immunotherapy Template 16.1
Sample Hazard Communication Template 16.2
Sample Physical Exam Template 16.3
Sample Non-Occupational Illness/Injury Template 16.4
Sample Occupational Illness/Injury Template 16.5


Employee Login

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OSHA Respirator Questionnaire

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OSHA Respirator Questionnaire List

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Our Company

Quadrant Health Strategies Inc.

Quadrant provides healthcare services at corporate worksites nationwide.  Our clients include global companies, local governments, and organizations from every business sector.  We focus on cost avoidance, cost management, superior quality and service.  To help our clients succeed in the most demanding markets, we collaborate with them to improve efficiency, reduce costs and plan for the future.

Quadrant is a national leader in research donor programs. We have over a decade of experience designing, supporting, and implementing research requiring the collection of blood, sputum, urine, hair and other biological substances. Our experience includes protocol development, recruiting, screening, donation, Institutional Review Board submission, and medical oversight to assure compliance with all applicable chain-of-custody, local, and federal regulatory standards.

Quadrant’s onsite healthcare facilities are located at companies in every region of the United States and are staffed with physicians, nurse practitioners, nurses, phlebotomists, physical therapists, and administrators as required to provide site specific comprehensive occupational medicine, ergonomics and wellness needs. In addition, Quadrant possesses one of New England’s largest, freestanding occupational medicine facilities, located in Beverly, MA. This site services employees from over 100 Boston-area organizations.


Corporate Employee Health

Corporate Employee Health

Quadrant’s workplace-based health services transform the intent of promoting a healthy, productive workforce into a daily reality. Our Board-certified professionals, located throughout the U.S., utilize prevention and early intervention strategies to resolve your employees’ health-related issues. Effective healthcare management and employees’ expedited, yet safe, return-to-work result in lower healthcare-related costs. Quadrant offers the complete range of tools and personnel necessary to measure and improve employee health.

Our Multidisciplinary Staff

  • Board certified Occupational Medicine Physicians
  • Board Certified Medical Specialty Physicians
  • Certified Occupational Health Nurses
  • Registered Nurse Certified Case Managers
  • Licensed Physical Therapists
  • Certified Personal Trainers
  • Registered Dieticians
  • Certified Phlebotomists

Quadrant offers the following Occupational and Environmental Health Services

  • Medical Examinations
  • Pre-placement and Return to Work Fitness-For-Duty Assessments
  • Medical Screenings
  • Emergency Medical Response
  • Injury & Illness Management
  • Episodic urgent care
  • HRA (Health Risk Assessment)
  • Biometric Screening
  • Health and Wellness Plans
  • Travel planning and vaccinations
  • Employee flu shots and vaccinations
  • Immunizations


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