Voluntary Use of a Respirator
Department of Safety and Environmental Management
Created: 4/30/19
Revision: New 1 | Page
City of Bangor employees may choose to use a respirator or a filtering face piece (N95 or N99 disposable dust
mask) on a voluntary basis during activities that involve an exposure to low-level, non-hazardous nuisance
dust or other contaminants. Voluntary users of filtering face piece respirators are not required to undergo a
medical clearance. However, voluntary users of all other respirators are required to provide SEM with a
medical clearance from a medical provider. According to City of Bangor Respiratory Protection Program
and OSHA regulation 29 CFR 1910.134, the City of Bangor is required to provide the following information
to any employee who voluntarily uses respiratory protection. The supervisor is responsible for providing this
form to the employee and sending a completed copy to Safety and Environmental Management.
29 CFR 1910.134 Appendix D: Information for Employees Using Respirators When Not
Required Under the Standard
Respirators are an effective method of protection against designated hazards when properly selected and
worn. Respirator use is encouraged, even when exposures are below the exposure limit, to provide an
additional level of comfort and protection for workers. However, if a respirator is used improperly or not
kept clean, the respirator itself can become a hazard to the worker. Sometimes, an employee may wear a
respirator to avoid an exposure, even if the amount of hazardous substance does not exceed the limits set
by OSHA standards. If your supervisor provides respirators for your voluntary use, or if you provide your
own respirator, you need to take certain precautions to be sure that the respirator itself does not present a
hazard. You should do the following:
1. Read and follow all instructions provided by the manufacturer on use, maintenance, cleaning and
care, and warnings regarding the respirators limitations.
2. Choose respirators certified for use to protect against the contaminant of concern. NIOSH, the
National Institute for Occupational Safety and Health of the U.S. Department of Health and Human
Services, certifies respirators. A label or statement of certification should appear on the respirator or
respirator packaging. It will tell you what the respirator is designed for and how it will protect you.
3. Do not wear your respirator into atmospheres containing contaminants for which your respirator is
not designed to protect against. For example, a respirator designed to filter dust particles will not
protect you against gases, vapors, or very small solid particles of fumes or smoke.
4. Keep track of your respirator so that you do not mistakenly use someone else's respirator.
Please Complete the Section Below:
Medical Clearance Completed: Yes No
Choose Type of Respirator
