Breathe Better with a Good Respiratory Protection Plan

Your workers' respirators need to fit. Otherwise, they may as well not wear them at all.
By Jessica Perse
September 29, 2023

Construction employees are often exposed to various airborne contaminants that can cause serious health problems. Some of these contaminants include smoke, vapors, gases and dust from materials such as silica, asbestos and lead. Unprotected exposure to these hazards can lead to serious respiratory illness including silicosis, some lung cancers and chronic obstructive pulmonary disease. Other hazardous toxins such as lead can also be responsible for blood disorders, neurologic conditions and renal disorders. Many other conditions can result from working in these environments, including certain autoimmune conditions and mesothelioma—an asbestos-related cancer.

The Occupational Safety and Health Administration mandates that industries like construction develop and implement a written respiratory protection program. OSHA also requires these employers to provide respiratory protective equipment for their workforce as appropriate. However, data reveals an alarming trend of noncompliance across many impacted industries.

Failure to provide adequate respiratory protection was among the most cited OSHA violations for 2022. Two of the main causes of a violation are failure to conduct respirator medical evaluations and failure to provide respirator fit tests for their employees who wear tight-fitting facepiece respirators to protect them against these respiratory hazards. If an employee is required to wear a respirator, the employee should have a respirator fit test before wearing the respirator. But first, the employee must complete a respirator medical evaluation for respirator medical clearance.

It is common for some employers to confuse a respirator medical evaluation with a respirator fit test—requesting one while actually needing the other. So, while it’s important to detail why and how to conduct the respirator medical evaluation and fit test effectively, it is equally important to clarify their differences.


A respirator medical evaluation determines whether an employee is medically able to wear a respirator. The evaluation must be done confidentially and at no cost to the employee. As part of the medical evaluation, the employee must complete a mandatory health questionnaire that is reviewed by a physician or licensed health care professional. This questionnaire helps identify any underlying medical conditions that could make it challenging or risky to wear a respirator. Further evaluation may be required, including but not limited to a respirator physical exam, spirometry and chest X-ray—dependent upon findings after reviewing the questionnaire. Wearing a respirator can impact breathing by changing the amount of oxygen available or increasing breathing resistance, which can put strain on the heart and lungs or exacerbate an existing medical condition.

Not only is a respirator medical evaluation required before an employee is initially fit-tested or uses a respirator for the first time; it is also required whenever there is a change in the respirator type used, required job duties or employee’s physical health.


Respirator medical evaluation results are shared with the employer and employee when the PLHCP provides the employer and employee with a written medical opinion (WMO) for respirator use. If the employee is cleared, fit testing would be the next step. The PLHCP could also recommend further medical investigation or suggest alternative respiratory protection.


A respirator fit test is a procedure designed to check whether a respirator fits an employee’s face properly for an adequate seal against respiratory hazards. A good fit is essential to prevent leakage of contaminated air around the edges of the respirator. A poor fit can reduce the effectiveness of the respirator and expose the employee to respiratory hazards. There are two types of fit tests: qualitative and quantitative. The type of fit testing that is required depends on the exposures and the type of respirator that is in use.


A qualitative fit test uses a substance that has a distinct smell or taste, e.g., bitter or sweet, that is sprayed into a hooded environment. The employee wears the respirator and performs various exercises, such as breathing, talking and moving the head. If the employee can taste or smell the substance, it means that the respirator is leaking.

A quantitative fit test uses a device that measures the amount of particles or substances that get through the respirator. Similar to a qualitative fit test, the employee wears the respirator and performs various exercises, such as breathing, talking and moving the head. But the device compares the concentration of particles or substances inside and outside the respirator and calculates a fit factor. The higher the fit factor, the better the fit.

A respirator fit test is required by OSHA whenever an employee uses a tight-fitting facepiece respirator, such as an N95 type, half-mask or full-face respirator. Construction firms should authorize a fit test for each employee wearing a respirator at least annually at no cost to the employee. Also, a new fit test is required when:

  1. Employee changes respirator types
  2. Employee’s face changes size or shape
  3. Employee’s facial feature(s) change, potentially affecting fit, e.g., facial hair, glasses, dentures

Part of the decision-making process for choosing the right fit test involves understanding which type(s) of respirators will be used at a particular worksite. Of the two types of respirator fit tests, the quantitative fit test is more commonly used for the N95 and half-face cartridge respirators. The qualitative fit test is required for self-contained breathing or full-face respirators.


There are diverse types of respirators used in construction depending on the level and type of respiratory hazard. Some common types include:

  • N95 respirators
  • Half-face, air-filtered masks that use replaceable cartridges
  • Full-face masks
  • Powered-air purifying respirator
  • Supplied-air respirator


The following factors should be considered when selecting a respirator:

  1. Respiratory hazard level and type: The employer must identify and assess the respiratory hazards at the worksite, such as the type, concentration and duration of exposure to dust, gas or vapor. The employer must also monitor the permissible exposure level of the hazards. The PEL is the maximum amount of a substance an employee can be exposed to without adverse health effects. Several factors can affect the PEL, such as the work area, e.g., indoor or outdoor worksite, and ventilation, i.e., ventilated or unventilated area
  2. Respirator type and size: The employer must select a respirator that is certified by the National Institute for Occupational Safety and Health to adequately protect against a specific respiratory hazard. The employer must also select a respirator that fits the employee’s face properly and provides an adequate seal.
  3. Employee’s comfort level: If medically cleared for a respirator, the employee should provide feedback on how comfortably the respirator fits. Factors such as physical activity level, temperature and humidity can affect the employee’s comfort level and safety.


Construction companies have a responsibility to monitor the air construction crews breathe. Conducting respirator medical evaluations and respirator fit tests both routinely and as required by OSHA help mitigate the associated risks. Implementing OSHA respiratory protection standards is not only essential for compliance purposes; it is also critical to a company’s overall reputation from a workforce safety and health perspective.


  1. De Matteis, S., Heederik, D., Burdorf, A., Colosio, C., Cullinan, P., Henneberger, P. K., Olsson, A., Raynal, A., Rooijackers, J., Santonen, T., Sastre, J., Schlünssen, V., Van Tongeren, M., and Sigsgaard, T. (2017). Current and new challenges in occupational lung diseases. European Respiratory Review, 26(146), 170080.
  2. Lead. Overview. Occupational Safety and Health Administration. (n.d.).
  3. Pfau, J. C., Serve, K. M., and Noonan, C. W. (2014). Autoimmunity and Asbestos Exposure. Autoimmune Diseases, 2014, 1–11.
  4. OSHA. (2011). 1910.134 - Respiratory Protection. Occupational Safety and Health Administration.
  5. Fall Protection again tops OSHA’s “Top 10” list of most frequently cited standards. 2022-09-20. Safety+Health. (n.d.).
  6. Fit Test FAQs. NPPTL. NIOSH. CDC. (2021, December 28).
  7. OSHA Infosheet. Respirator Medical Evaluation Questionnaire. (n.d.).
  8. Respiratory Fit Testing. Occupational Safety and Health Administration. (n.d.).
  9. A Guide to Respirators Used for Dust in Construction. Blogs. CDC. (n.d.).
  10. NIOSH-approved Respirators Used in Construction Respirator Selection Guide for the Construction Industry. (n.d.).

by Jessica Perse
Jessica Perse, MD, FACS, JD, is the director of medical operations for Concentra® medical centers in Wisconsin and Minnesota, and a member of Concentra’s Regulatory, Testing and Examination Medical Expert Panel. She specializes in occupational medicine and urgent care with years of experience in occupational medicine practice and training in general surgery. Perse is a certified medical examiner for the DOT and is board-certified in general surgery.

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