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HealthWorks A Service of Lehigh Valley Physician Group Appendix C to[removed]:OSHA Respirator Medical Evaluation Questionnaire (Mandatory) To the employer: Answers to questions in Section 1, and to question 9 in Section
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Document Date: 2013-04-12 13:29:18


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IndustryTerm

hazardous chemicals / gas masks / chemical agents / hazardous airborne chemicals / chemicals / /

MedicalCondition

Heart arrhythmia / Eye irritation / pain / Pneumonia / fatigue / Lung cancer / back injury / injury / Asbestosis / lung illness / Heart failure / indigestion / Heart attack / Allergic reactions / Chest pain / Silicosis / Seizures / Angina / Skin allergies / Shortness of breath / High blood pressure / dizziness / Emphysema / Pneumothorax / Back pain / Stroke / sugar disease / chest injuries / Chronic bronchitis / Diabetes / Coughing / Wheezing / Tuberculosis / Claustrophobia / Asthma / /

MedicalTreatment

surgeries / /

Organization

Service of Lehigh Valley / Occupational Safety and Health Administration / /

Position

Physician / supervisor / /

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