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.
Using a shared computer? In order to better protect your personal data we recommend you:
- Verify no one is present who can view your responses as you type
- Disable browser form autocompletion
- Disable browser history storage
- Clear browser cache after use
See your browser vendor's instructions to configure these settings.
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.