Respirator Medical Evaluation


A respirator medical evaluation is an examination of a candidate’s medical fitness before using a respirator. A respirator is provided to employees who work within designated hazards. Such equipments are worn by divers for instance. However, it is necessary that a thorough medical evaluation is conducted for an employee by a respirator medical expert. This evaluation mainly focuses on the respiratory history of the candidate.

Sample Respirator Medical Evaluation:

Name: Juis Borges

Age: 26

Occupation: Professional Diver

Please answer the following questions carefully, attaching documents recording prior medical history along with this evaluation report.

1. Have you had any history of respiratory ailments?

  • Yes, I have had chronic respiratory ailments
  • I have had moderate respiratory ailments like shortness of breath, coughing, phlegm.
  • No, I have never had major respiratory ailments.

2. Does anyone in your immediate family have a history of lung cancer or chronic asthma?

  • Yes, I do have a family history of lung cancer and chronic asthma
  • No, I do not have a family history of these diseases.

3. Do you smoke or chew tobacco or nicotine in any form?

  • Yes, I smoke AND chew tobacco
  • Yes, I smoke OR chew tobacco
  • No, I do not do either

4. How often do you submit to medical checkups? When was the last time you had a complete medical checkup?

  • Once in a year
  • Once in two years
  • Irregular

5. Have you ever had any of the following ailments?

  • Emphysema
  • Tuberculosis
  • Diabetes
  • Epilepsy
  • Pneumothorax

Category: Medical Evaluation

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