Medical Evaluation Questionnaire

Per OSHA guidelines, employees must pass a preliminary "Medical Evaluation Questionnaire" (MEQ) in order to be fit tested. Upon completion, this MEQ must be certificated by a physician or other licensed health care professional (PLHCP) in compliance with HIPAA's Privacy Rule and OSHA's 29 CFR 1910.134.

Please download and complete the questionnaire below to determine if you are able to wear a respirator as part of your routine job function. Please do not submit these forms back to OccuMed - Bring the completed form to a PLHCP for medical clearance.