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Respiratory protection program template

A written respiratory protection program for a US workplace under OSHA 1910.134, kept as a working record on a phone. Name the program administrator and the PLHCP, then add each work area with its contaminants, your exposure estimate and the respirators used there, including the NIOSH approval and either an end-of-service-life indicator or your own cartridge change schedule and the data behind it. List each wearer with medical evaluation and fit test dates: the form counts days since the fit test and flags anyone over a year. Log respirator inspections, the program evaluation and training.

For shop managers, EHS coordinators and safety consultants in body shops, factories, labs and maintenance teams where respirators are required, who need the written program and the records that show it is being followed.

Written for US OSHA rules. In Great Britain, use the COSHH assessment and HSE guidance on face fit testing for tight-fitting RPE.

  • Program administrator, PLHCP, fit tester and voluntary use with Appendix D
  • Work areas with contaminants, exposure estimate and the respirators used there
  • Your cartridge change schedule and the data it is based on, or an ESLI; Grade D air checks
  • Wearers with medical evaluation and fit test dates, days since, QNFT pass at 100 or 500
  • Inspection log, program evaluation, training topics, records, actions and two signatures
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What must a written respiratory protection program include?

A respiratory protection program is useful when it names the respirators used in each area, the cartridge change schedule and what it is based on, and each wearer's medical evaluation and fit test dates. The days since each fit test is what stops an annual test slipping.

Last updated . Facts checked by the SiteSurvey team on 27 October 2026 against OSHA 29 CFR 1910.134, respiratory protection (eCFR), HSE: Fit testing basics for respiratory protective equipment and HSE: Control of Substances Hazardous to Health (COSHH).

How to write a respiratory protection program

Write it before anyone is required to wear a respirator, and update it when conditions that affect respirator use change.

  1. Name the people

    Enter the employer, the program administrator and their training, the PLHCP who does medical evaluations and who does fit testing. Record whether any respirator use is voluntary.

  2. Add each work area

    List the contaminants and their physical form, and how you estimated exposure. Flag any area that could be IDLH, oxygen deficient or where exposure is unknown.

  3. Record the respirators

    For each respirator used in the area, add the make, model, type and NIOSH approval. For gas or vapor cartridges, record the ESLI or your change schedule and the data it rests on. For supplied air, record the Grade D air check.

  4. List the wearers

    For each wearer, enter the medical evaluation date and outcome, then the fit test date, type and result. The form counts days since the fit test and flags any over a year or before the medical evaluation.

  5. Log inspections

    Record respirator inspections: function, facepiece, straps, valves, cartridges, elastomeric parts, cleaning and storage, and whether a defective respirator was taken out of service.

  6. Evaluate and sign

    Record the program evaluation and what wearers said, the training topics and the records kept. Add actions with owners and dates, then sign.

What makes a respiratory protection program useful

Each wearer: respirator, medical evaluation, fit test date and result, days since

Auto body shop, Mesa, 13 October: prep technician J. Benally wears an HM-2 half mask, size M, with organic vapor cartridges changed every shift. Last QLFT 3 September 2025, 405 days ago, so overdue. Moved to booth helper duties and booked for a clinic fit test on 15 October.

Fictional example. Record the actual evidence and approved arrangements for your job.

A common recording mistake

Writing "change cartridges when you smell something" as the change schedule, with no data behind it.

What happens next

Book fit tests for anyone close to a year, and update the program when a new product, task or respirator comes into the shop.

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Every question in the respiratory protection program template

A US written respiratory protection program under OSHA 29 CFR 1910.134: program administrator, PLHCP and voluntary use, work areas with contaminants, exposure estimates and the respirators used (NIOSH approval, ESLI or your cartridge change schedule and its basis, Grade D air for supplied air), wearers with medical evaluation and fit test dates and days since, fit test results, an inspection log, program evaluation, training topics, records and actions. 6 sections and 138 questions. Follow-up questions and guidance appear only when an answer calls for them, so the person on site never sees the ones that do not apply.

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  • Project: the project name
  • Site address: the site address, from the space or the project
  • Site or owner: the project's customer

Program, administrator and use

  • ProjectShort answer

    Filled in from the project in SiteSurvey.

    Fills in from the project name
  • Site addressShort answer
    Fills in from the site address, from the space or the project
  • Site or ownerShort answer
    Fills in from the project's customer
  • Location (GPS)Short answer
  • Program date*Date
  • Prepared by*Short answer
  • Employer*Short answer
  • Program administrator*Short answer
  • Administrator training or experienceShort answer

    Qualified by training or experience that matches how complex the program is (1910.134(c)(3)).

  • Physician or other licensed health care professional (PLHCP) for medical evaluationsShort answer

    1910.134(e)(2)(i).

  • Who does fit testingShort answer
  • Respirator use at this workplace*Choose one
    • Required use only
    • Required use and voluntary use
    • Voluntary use only
  • Voluntary use is of*Tick all that apply
    • Filtering facepieces (dust masks) only
    • Other respirators (elastomeric, PAPR or other)
    Shown only when the answers above make it relevant
  • Voluntary users given the Appendix D information?*Yes or No

    1910.134(c)(2)(i), (k)(6).

    Shown only when the answers above make it relevant
  • Respirators, training and medical evaluations provided at no cost to employees?*Yes or No

    1910.134(c)(4).

  • Where the written program is keptShort answer
  • Next program review dueDate

    Your own date: the program is updated whenever conditions that affect respirator use change.

  • GuidanceWhat the written program contains (29 CFR 1910.134(c)(1)). Where respirators are necessary to protect health, or the employer requires them, a written program with worksite-specific procedures, including as they apply: how respirators are selected; medical evaluations; fit testing for tight-fitting respirators; use in routine and reasonably foreseeable emergency situations; cleaning, disinfecting, storing, inspecting, repairing, discarding and maintaining them; air quality, quantity and flow for supplied-air respirators; training in the respiratory hazards and in proper use; and regular evaluation of how well the program works. A qualified program administrator runs it (1910.134(c)(3)).
  • GuidanceVoluntary use: give users the Appendix D information. For voluntary use of anything other than filtering facepieces, the program also makes sure the user is medically able and the respirator is cleaned, stored and maintained. Employees whose only use is voluntary use of filtering facepieces (dust masks) do not need to be in the written program (1910.134(c)(2)).
    Shown only when the answers above make it relevant
  • GuidanceWorking in Great Britain? This form follows US OSHA rules. Use the COSHH assessment for the substances, and HSE guidance on face fit testing for tight-fitting RPE.

Hazards and respirator selection by area

  • GuidanceSelect a NIOSH-certified respirator for the hazards and the workplace and user factors, from enough models and sizes to fit each user (1910.134(d)(1)). For gases and vapors, an air-purifying respirator needs a NIOSH-certified end-of-service-life indicator for the contaminant or a change schedule based on objective data, described in the program (1910.134(d)(3)(iii)).
  • Work areas and tasks
    Repeat for each entry. Each one asks:
    • Work area or task*Short answer

      For example: Paint booth, Prep station, Body repair bay.

    • Tasks done hereShort answer
    • Contaminants*Notes

      From the safety data sheets and the task: for example, isocyanate clearcoat mist, solvent vapor, grinding dust.

    • Physical form*Tick all that apply
      • Particulates (dust, mist, fume)
      • Gases or vapors
    • Exposure estimate and how it was made*Notes

      A reasonable estimate of exposure, for example air sampling results or objective data (1910.134(d)(1)(iii)).

    • Respirators here are*Choose one
      • Required
      • Voluntary only
      • Not used
    • Could the atmosphere be IDLH, oxygen deficient, or is the exposure unknown?*Yes or No
    • WarningWhere exposure cannot be identified or reasonably estimated, the atmosphere is treated as IDLH, and all oxygen-deficient atmospheres are IDLH except as Table II allows. IDLH needs a full facepiece pressure demand SCBA certified for at least 30 minutes, or a combination full facepiece pressure demand supplied-air respirator with an auxiliary self-contained air supply (1910.134(d)(1)(iii), (d)(2)). Plan IDLH work separately.
      Shown when “Could the atmosphere be IDLH, oxygen deficient, or is the exposure unknown?” is Yes
    • Respirators used here
      Repeat for each entry. Each one asks:
      Shown only when the answers above make it relevant
      • Make and model*Short answer
      • Type*Choose one
        • Filtering facepiece (disposable)
        • Elastomeric half mask
        • Elastomeric full facepiece
        • PAPR with loose-fitting hood or helmet
        • PAPR with tight-fitting facepiece
        • Supplied-air (airline) respirator
        • SCBA
      • How many in useNumber
      • NIOSH approval numberShort answer

        From the approval label. Use the respirator within its certification (1910.134(d)(1)(ii)).

      • Scan the NIOSH approval labelScan a label: niosh approval number, filter or cartridge type

        Optional. Scan the data plate or label to capture the numbers.

      • Protects against*Choose one
        • Particulates
        • Gases or vapors
        • Both
      • Filters, cartridges or canistersShort answer
        Shown only when the answers above make it relevant
      • How cartridge or canister end of service life is managed*Choose one

        1910.134(d)(3)(iii)(B).

        • NIOSH-certified end-of-service-life indicator (ESLI)
        • Change schedule
        Shown only when the answers above make it relevant
      • Change schedule*Short answer

        Your schedule, for example: change cartridges at the end of each shift of spraying.

        Shown when “How cartridge or canister end of service life is managed” is “Change schedule”
      • Objective information or data the schedule is based on*Notes

        Describe the data relied on and why it can be relied on (1910.134(d)(3)(iii)(B)(2)).

        Shown when “How cartridge or canister end of service life is managed” is “Change schedule”
      • Breathing air shown to be at least Grade D?*Yes or No

        Compressor air test or the supplier certificate of analysis (1910.134(i)).

        Shown only when the answers above make it relevant
      • Air test or certificate datedDate
        Shown only when the answers above make it relevant
      • GuidanceGrade D breathing air (1910.134(i)(1)(ii)) includes oxygen 19.5 to 23.5%, condensed hydrocarbons 5 mg per cubic meter or less, carbon monoxide 10 ppm or less, carbon dioxide 1,000 ppm or less, and no noticeable odor.
        Shown only when the answers above make it relevant
      • Photos of the respirator and its labelPhotos
      • r_life_flagWorked out by the form
      • r_air_flagWorked out by the form
    • Photos of the area and taskPhotos
    • z_lifeWorked out by the form
    • z_airWorked out by the form
    • z_idlh_flagWorked out by the form
    • z_resp_countWorked out by the form
  • AreasWorked out by the form
  • Respirator models listedWorked out by the form
  • Gas or vapor cartridges with no ESLI or change scheduleWorked out by the form
  • Supplied air not shown to be Grade DWorked out by the form
  • Areas that could be IDLHWorked out by the form

Wearers: medical evaluation, fit testing and training

  • GuidanceEach wearer has a medical evaluation by a PLHCP before fit testing or use (1910.134(e)(1)). Each user of a tight-fitting facepiece passes a QLFT or QNFT with the same make, model, style and size before first use and at least once a year (1910.134(f)). 1910.134 sets no fixed repeat interval for medical evaluations: another is needed when the triggers in (e)(7) happen, such as reported symptoms or a change in work conditions that adds physical strain.
  • Respirator wearers
    Repeat for each entry. Each one asks:
    • Employee (name or ID)*Short answer
    • JobShort answer
    • Respirator (make, model, style and size)*Short answer
    • Tight-fitting facepiece?*Yes or No
    • Medical evaluation*Date
    • PLHCP written recommendation*Choose one

      Record the outcome only, not medical details (1910.134(e)(6)(i)).

      • Medically able to use the respirator
      • Able, with limitations
      • Not able to use this respirator
      • Waiting for the recommendation
    • Limitations*Short answer
      Shown when “PLHCP written recommendation” is “Able, with limitations”
    • WarningIf the respirator is negative pressure and the PLHCP finds a condition that puts the employee at increased risk, provide a PAPR if the PLHCP finds the employee can use one (1910.134(e)(6)(ii)). Do not let the employee use this respirator meanwhile.
      Shown only when the answers above make it relevant
    • Last fit test*Date
      Shown when “Tight-fitting facepiece?” is Yes
    • Fit test type*Choose one
      • Qualitative (QLFT)
      • Quantitative (QNFT)
      Shown when “Tight-fitting facepiece?” is Yes
    • Fit test result*Choose one
      • Pass
      • Fail
      Shown when “Tight-fitting facepiece?” is Yes and “Fit test type” is “Qualitative (QLFT)”
    • Facepiece*Choose one
      • Half facepiece
      • Full facepiece
      Shown when “Tight-fitting facepiece?” is Yes and “Fit test type” is “Quantitative (QNFT)”
    • Fit factor*Number
      Shown when “Tight-fitting facepiece?” is Yes and “Fit test type” is “Quantitative (QNFT)”
    • QNFT resultWorked out by the form
      Shown when “Tight-fitting facepiece?” is Yes and “Fit test type” is “Quantitative (QNFT)” and “Fit factor” is answered and “Facepiece” is answered
    • GuidanceA QNFT is passed at a fit factor of 100 or more for a tight-fitting half facepiece and 500 or more for a full facepiece. A QLFT may only be used for negative pressure air-purifying respirators that must achieve a fit factor of 100 or less (1910.134(f)(6), (7)).
      Shown when “Tight-fitting facepiece?” is Yes
    • Days since the fit testWorked out by the form
      Shown when “Tight-fitting facepiece?” is Yes and “Last fit test” is answered and “Program date” is answered
    • Annual fit testWorked out by the form
      Shown when “Tight-fitting facepiece?” is Yes and “Last fit test” is answered and “Program date” is answered
    • WarningFit test before first use, whenever a different facepiece (size, style, model or make) is used, and at least once a year (1910.134(f)(2)). More than a year: the employee does not use this respirator until fit tested again.
      Shown only when the answers above make it relevant
    • WarningThe fit test date is before the medical evaluation. The medical evaluation comes before the employee is fit tested or required to use the respirator (1910.134(e)(1)).
      Shown only when the answers above make it relevant
    • No facial hair under the seal or in the valve?*Yes or No

      1910.134(g)(1)(i)(A).

      Shown when “Tight-fitting facepiece?” is Yes
    • Does a user seal check each time the respirator is put on?Yes or No

      1910.134(g)(1)(iii).

      Shown when “Tight-fitting facepiece?” is Yes
    • Last respirator trainingDate
    • Days since trainingWorked out by the form
      Shown when “Last respirator training” is answered and “Program date” is answered
    • CheckTraining before first use, then at least once a year (1910.134(k)(3), (5)).
      Shown only when the answers above make it relevant
    • NotesNotes

      For example: changes that need a new fit test (facial scarring, dental changes, cosmetic surgery, an obvious change in body weight), 1910.134(f)(3).

    • w_fit_overdueWorked out by the form
    • w_fit_failWorked out by the form
    • w_orderWorked out by the form
    • w_med_flagWorked out by the form
    • w_hair_flagWorked out by the form
    • w_train_dueWorked out by the form
  • WearersWorked out by the form
  • Fit test overdueWorked out by the form
  • Fit test failedWorked out by the form
  • Fit tested before the medical evaluationWorked out by the form
  • Not cleared or waiting for the PLHCPWorked out by the form
  • Facial hair under the sealWorked out by the form
  • Training more than a year ago or not recordedWorked out by the form

Respirator inspection and maintenance log

  • GuidanceRoutine-use respirators are inspected before each use and during cleaning; emergency respirators at least monthly; escape-only respirators before they are carried into the workplace (1910.134(h)(3)(i)). Add an entry for the inspections you record.
  • Inspection log
    Repeat for each entry. Each one asks:
    • Respirator (model and ID)*Short answer
    • Inspected on*Date
    • Inspected by*Short answer
    • Kept for*Choose one
      • Routine use
      • Emergency use
      • Escape only
    • GuidanceEmergency respirators: inspected at least monthly and to the manufacturer's recommendations, checked before and after each use, and the date, inspector, findings, remedial action and respirator ID recorded on a tag or label or in the inspection reports. SCBA is inspected monthly and cylinders recharged when pressure falls to 90% of the maker's recommended level (1910.134(h)(3)).
      Shown when “Kept for” is “Emergency use”
    • Function and tightness of connectionsChoose one
      • Acceptable
      • Action needed
      • Not checked
      • Not applicable
    • What needs doing, or why not checkedNotes
      Shown only when the answers above make it relevant
    • Facepiece, head straps, valves and connecting tube in good conditionChoose one
      • Acceptable
      • Action needed
      • Not checked
      • Not applicable
    • What needs doing, or why not checkedNotes
      Shown only when the answers above make it relevant
    • Cartridges, canisters or filters in date for the change schedule, NIOSH label on and legibleChoose one

      1910.134(h)(3)(ii)(A), (j).

      • Acceptable
      • Action needed
      • Not checked
      • Not applicable
    • What needs doing, or why not checkedNotes
      Shown only when the answers above make it relevant
    • Elastomeric parts pliable, no signs of deteriorationChoose one

      1910.134(h)(3)(ii)(B).

      • Acceptable
      • Action needed
      • Not checked
      • Not applicable
    • What needs doing, or why not checkedNotes
      Shown only when the answers above make it relevant
    • Cleaned and disinfected as the program saysChoose one

      Shared respirators before a different person wears them (1910.134(h)(1)).

      • Acceptable
      • Action needed
      • Not checked
      • Not applicable
    • What needs doing, or why not checkedNotes
      Shown only when the answers above make it relevant
    • Stored away from damage, dust, sunlight, heat, moisture and chemicals, facepiece and valve not deformedChoose one

      1910.134(h)(2)(i).

      • Acceptable
      • Action needed
      • Not checked
      • Not applicable
    • What needs doing, or why not checkedNotes
      Shown only when the answers above make it relevant
    • What was found and doneNotes
    • Removed from service until discarded or repaired?*Yes or No

      Repairs only by trained people with the maker's NIOSH-approved parts (1910.134(h)(4)).

      Shown only when the answers above make it relevant
    • PhotosPhotos
    • i_failsWorked out by the form
    • i_ncWorked out by the form
    • ResultWorked out by the form
    • i_not_removedWorked out by the form
  • Inspections loggedWorked out by the form
  • Problems foundWorked out by the form
  • Defective and not removed from serviceWorked out by the form

Program evaluation, training and records

  • Last program evaluationDate
  • Evaluated byShort answer
  • Wearers consulted on how well the program works?*Yes or No

    1910.134(l)(2).

  • Covered with wearersTick all that apply
    • Respirator fit
    • Right respirator for the hazards
    • Proper use in the workplace conditions
    • Proper maintenance
    Shown when “Wearers consulted on how well the program works?” is Yes
  • Problems foundNotes
  • Problems found corrected?Yes or No
    Shown when “Problems found” is answered
  • Training covers*Tick all that apply

    Each wearer can show they know these (1910.134(k)(1)).

    • Why the respirator is needed and how poor fit, use or maintenance reduces protection
    • Limitations and capabilities
    • Use in emergencies, including if the respirator malfunctions
    • How to inspect, put on, remove, use and seal check it
    • Maintenance and storage
    • Medical signs and symptoms that may limit or prevent use
    • General requirements of 1910.134
  • Training topics not yet coveredWorked out by the form
  • Fit test records kept: name or ID, test type, make, model, style and size, date and result?*Yes or No

    Kept until the next fit test (1910.134(m)(2)).

  • Medical evaluation records kept under 29 CFR 1910.1020?*Yes or No

    1910.134(m)(1).

  • Written copy of the current program kept and available to employees on request?*Yes or No

    1910.134(m)(3), (4).

  • ev_flagsWorked out by the form
  • rec_flagsWorked out by the form
  • p1_flagsWorked out by the form

Result, actions and sign-off

  • Items needing actionWorked out by the form
  • ResultWorked out by the form
  • Actions
    Repeat for each action. Each one asks:
    • Action*Notes
    • PriorityChoose one
      • Now: before the next use
      • This week
      • Within 30 days
      • Before the next review
    • Who will do it*Short answer
    • Due byDate
    • Status*Choose one
      • Open
      • In progress
      • Done, checked
    • Photo when donePhotos
      Shown when “Status” is “Done, checked”
  • Actions still openWorked out by the form
  • Decision*Choose one
    • Program in place and up to date
    • In place: actions to finish
    • Stop respirator use where listed until fixed
  • Next check or re-inspection dateDate
  • Summary for the clientNotes
  • Program administrator nameShort answer
  • Program administrator signature*Signature
  • Employer representative nameShort answer
  • Employer representative signatureSignature

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Respiratory protection program FAQs

How often is fit testing required?

Each user of a tight-fitting facepiece is fit tested before first use, whenever a different facepiece size, style, model or make is used, and at least once a year, with the same make, model, style and size they will wear. A QNFT is passed at a fit factor of 100 or more for a half facepiece and 500 or more for a full facepiece (1910.134(f)). The form counts the days since each fit test and flags any over a year.

Source: OSHA 29 CFR 1910.134, respiratory protection (eCFR).

Does the medical evaluation come before the fit test?

Yes. The employer provides a medical evaluation by a PLHCP before the employee is fit tested or required to use the respirator, and gets a written recommendation on whether the employee can use it. 1910.134 sets no fixed repeat interval; another evaluation follows triggers such as reported symptoms or a change in work conditions that adds physical strain (1910.134(e)). The form flags a fit test dated before the medical evaluation.

Source: OSHA 29 CFR 1910.134, respiratory protection (eCFR).

What is a cartridge change schedule?

For gases and vapors, an air-purifying respirator needs either a NIOSH-certified end-of-service-life indicator for the contaminant or a change schedule based on objective information or data, with the data and the basis described in the program (1910.134(d)(3)(iii)). The form does not supply service life figures: you enter your schedule and what it is based on.

Source: OSHA 29 CFR 1910.134, respiratory protection (eCFR).

Do employees who wear dust masks voluntarily need to be in the program?

Not if their only use is voluntary use of filtering facepieces (dust masks). They get the Appendix D information. Voluntary use of other respirators, such as elastomeric half masks, needs the program elements that make sure the user is medically able and the respirator is cleaned, stored and maintained (1910.134(c)(2)).

Source: OSHA 29 CFR 1910.134, respiratory protection (eCFR).

What records does the program keep?

Fit test records with the employee, type of test, respirator make, model, style and size, date and result, kept until the next fit test; medical evaluation records under 29 CFR 1910.1020; and a written copy of the current program, available to affected employees on request (1910.134(m)). The form records these; it does not make you compliant or medically clear anyone.

Source: OSHA 29 CFR 1910.134, respiratory protection (eCFR).

Can I use this on a UK site?

No. It follows US OSHA rules. In Great Britain, assess the substances under COSHH with the COSHH assessment. HSE guidance says tight-fitting facepieces need to fit the wearer's face, fit testing should be done by a competent person, ideally at initial selection, and facial hair makes a good seal impossible.

Sources: HSE: Control of Substances Hazardous to Health (COSHH) and HSE: Fit testing basics for respiratory protective equipment.

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