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Answers to questions in Section 1, and
to question 9 in Section 2 of Part A, do not require a medical examination. However, certain responses,
or patterns of response, may lead the reviewer to request further information, or a medical examination,
in order to reach a conclusion regarding the employee’s ability to safely use 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, and your employer
must tell you how to deliver or send this questionnaire to the healthcare professional who will review it.
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