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Respirator Medical Evaluation Questionnaire


Before using this form, your safety coordinator must obtain a reference code from T K Group.

Don't have a code? Your safety coordinator may apply for one. Apply for Reference Code

A T K Group medical professional will review your questionnaire as part of the process to determine eligibility to wear a respirator.

Your employer must allow you to answer this questionnaire during normal working hours, or at a time and place that is convenient to you. To maintain your confidentiality, your employer or supervisor must not look at or review your answers.