Have you ever had any of the following pulmonary / arrhythmia / or chemical allergies / Do you currently have any of the following symptoms of pulmonary or lung illness / Eye irritation / Pneumonia / Lung cancer / Asbestosis / Chronic bronchitis / disease / Silicosis / Skin allergies / injury / Seizures / Angina / Are you currently being treated by a doctor for any illness / Emphysema / Unusual weakness or fatigue / Have you ever had a back injury / Pneumothorax / Stroke / Diabetes / Coughing / Wheezing / Claustrophobia / Tuberculosis / Asthma / /
Microsoft Word - Respirator Questionnaire 510.docx