Voluntary Respirator Use Agreement Form

Voluntary Respirator Use

  • Respirators are an effective method of protection against designated hazards when properly selected and worn. However, if a respirator is used improperly or not kept clean, the respirator itself can become a hazard to the worker.

    Sometimes, workers may wear respirators to avoid exposures to hazards, even if the amount of hazardous substance does not exceed the limits set by OSHA standards.

    When MSOE provides respirators for voluntary use, or if employees provide their own, there are certain precautions to be taken to be sure that the respirator itself does not present a hazard.

    Employees are instructed to follow these guidelines:

    1. Read and heed all instructions provided by the manufacturer on use, maintenance, cleaning and care, and warnings regarding the respirator’s limitations.
    2. Choose respirators certified for use to protect against the contaminant of concern. NIOSH certifies respirators. A label or statement of certification should appear on the respirator or respirator packaging. It will tell what the respirator is designed for and how much it will protect you.
    3. Do not wear your respirator into atmospheres containing contaminants for which the respirator is not designed to protect you. For example, a respirator designed to filter dust particles will not protect you against gases, vapors or very small solid particles of fumes or smoke.
    4. Keep track of your respirator so that you do not mistakenly use someone else’s.

    I have read and understand MSOE’s Voluntary Respirator Use Guidelines.