RP-001-VOL — Employer workplace instruction and verification

Blank means pending. This form does not save entries. Print or save the completed form before closing. Record actual evidence, correction and reassessment. Keep medical questionnaires, diagnoses and clinical details out of ordinary LMS and training records. A signature or quiz is not a medical evaluation, fit test or safe-use demonstration.

Learn the basics for voluntary respirator use. Your employer must first allow this use and check that it creates no hazard. The rules depend on the kind of device. The employer must give you the actual Appendix D information. Other medical and care steps may apply. This course is not for required use or entry into IDLH air.

Voluntary-use screening

Employer determines protection is not required by the rule or employer and the proposed use will not itself create a hazard.

Actual Appendix D information

Employer provides the actual advisory information in an understandable written or oral format. Course completion does not record employer delivery.

Device-specific program controls

Apply the filtering-facepiece exception only within its narrow scope. Other voluntary devices need the relevant written program, medical-ability and care arrangements; required medical evaluations are at employer cost.

Workplace limits and change review

Actual device instructions, safe-use conditions, reporting route and reassessment when task, exposure, control or required-use status changes.

Safe practice and teach-back

For the required-use track, confirm applicable medical prerequisites before worn practice. Use clean, suitable actual equipment in a protected area; do not create hazardous exposure. Follow manufacturer methods and appropriate accepted fit-test protocols through the actual provider. A completed form is not proof of an action that did not occur.

Confirm that use is truly voluntary

Separate permitted voluntary use from required protection.

Use the Appendix D information

Find the actual advisory information and explain its key precautions.

Check which voluntary-use path applies

Distinguish filtering facepieces from other respirators.

Use and care for the permitted device

Recognize unsafe condition, wrong protection and shared-use risks.

Report changes and keep the records honest

Explain when the voluntary-use decision must be reviewed.