PPE GUIDELINE

Guidelines on the Use of PPE Against Chemical Hazards
Benzyl chloride 10 ppm
3
Beryllium compounds (as Be) 4 mg Be/m
3
Boron oxide 2,000 mg/m
Boron trifluoride 25 ppm
Bromine 3 ppm
Bromoform 850 ppm

1,3-Butadiene 2,000 ppm [LEL]
2-Butanone 3,000 ppm
2-Butoxyethanol 700 ppm
n-Butyl acetate 1,700 ppm [LEL]

sec-Butyl acetate 1,700 ppm [LEL]
tert-Butyl acetate 1,500 ppm [LEL]
n-Butyl alcohol 1,400 ppm [LEL]

sec-Butyl alcohol 2,000 ppm
tert-Butyl alcohol 1,600 ppm
n-Butylamine 300 ppm
3
tert-Butyl chromate 15 mg Cr(VI)/m
n-Butyl glycidyl ether 250 ppm
n-Butyl mercaptan 500 ppm
p-tert-Butyltoluene 100 ppm
3
Cadmium dust (as Cd) 9 mg Cd/m
3
Cadmium fume (as Cd) 9 mg Cd/m
3
Calcium arsenate (as As) 5 mg As/m
3
Calcium oxide 25 mg/m
3
Camphor (synthetic) 200 mg/m
3
Carbaryl 100 mg/m
3
Carbon black 1,750 mg/m
Carbon dioxide 40,000 ppm
Carbon disulfide 500 ppm
Carbon monoxide 1,200 ppm
Carbon tetrachloride 200 ppm
3
Chlordane 100 mg/m
3
Chlorinated camphene 200 mg/m
3
Chlorinated diphenyl oxide 5 mg/m
Chlorine 10 ppm
Chlorine dioxide 5 ppm
Chlorine trifluoride 20 ppm

Department of Occupational Safety & Health, Ministry of Human Resources, Malaysia ™October 2005 51

Guidelines on the Use of PPE Against Chemical Hazards
Chloroacetaldehyde 45 ppm
3
alpha-Chloroacetophenone 15 mg/m
Chlorobenzene 1,000 ppm
3
o-Chlorobenzylidene malononitrile 2 mg/m
Chlorobromomethane 2,000 ppm
3
Chlorodiphenyl (42% chlorine) 5 mg/m
3
Chlorodiphenyl (54% chlorine) 5 mg/m
Chloroform 500 ppm
1-Chloro-1-nitropropane 100 ppm
Chloropicrin 2 ppm

beta-Chloroprene 300 ppm
3
Chromic acid and chromates 15 mg Cr(VI)/m
3
Chromium (II) compounds [as Cr(II)] 250 mg Cr(II)/m
3
Chromium (III) compounds [as Cr(III)] 25 mg Cr(III)/m
3
Chromium metal (as Cr) 250 mg Cr/m
3
Coal tar pitch volatiles 80 mg/m
3
Cobalt metal, dust and fume (as Co) 20 mg Co/m
3
Copper (dusts and mists, as Cu) 100 mg Cu/m
3
Copper fume (as Cu) 100 mg Cu/m
3
Cotton dust (raw) 100 mg/m
3
Crag (r) herbicide 500 mg/m
Cresol (o, m, p isomers) 250 ppm
Crotonaldehyde 50 ppm
Cumene 900 ppm [LEL]
3
Cyanides (as CN) 25 mg/m (as CN)
Cyclohexane 1,300 ppm [LEL]
Cyclohexanol 400 ppm

Cyclohexanone 700 ppm
Cyclohexene 2,000 ppm
Cyclopentadiene 750 ppm
3
2,4-D 100 mg/m
3
DDT 500 mg/m
3
Decaborane 15 mg/m
3
Demeton 10 mg/m
Diacetone alcohol 1,800 ppm [LEL]
Diazomethane 2 ppm
Diborane 15 ppm

Department of Occupational Safety & Health, Ministry of Human Resources, Malaysia ™October 2005 52

Guidelines on the Use of PPE Against Chemical Hazards
Dibutyl phosphate 30 ppm
3
Dibutyl phthalate 4,000 mg/m
o-Dichlorobenzene 200 ppm

p-Dichlorobenzene 150 ppm
Dichlorodifluoromethane 15,000 ppm
3
1,3-Dichloro 5,5-dimethylhydantoin 5 mg/m
1,1-Dichloroethane 3,000 ppm
1,2-Dichloroethylene 1,000 ppm
Dichloroethyl ether 100 ppm
Dichloromonofluoromethane 5,000 ppm

1,1-Dichloro 1-nitroethane 25 ppm
Dichlorotetrafluoroethane 15,000 ppm
3
Dichlorvos 100 mg/m
3
Dieldrin 50 mg/m
Diethylamine 200 ppm
2-Diethylaminoethanol 100 ppm
Difluorodibromomethane 2,000 ppm

Diglycidyl ether 10 ppm
Diisobutyl ketone 500 ppm
Diisopropylamine 200 ppm

Dimethyl acetamide 300 ppm
Dimethylamine 500 ppm
N,N-Dimethylaniline 100 ppm
3
Dimethyl 1,2-dibromo 2,2-dichlorethyl phosphate 200 mg/m
Dimethylformamide 500 ppm
1,1-Dimethylhydrazine 15 ppm
3
Dimethylphthalate 2,000 mg/m
Dimethyl sulfate 7 ppm
3
Dinitrobenzene (o, m, p isomers) 50 mg/m
3
Dinitroocresol 5 mg/m
3
Dinitrotoluene 50 mg/m
3
Di sec-octyl phthalate 5,000 mg/m
Dioxane 500 ppm
3
Diphenyl 100 mg/m
Dipropylene glycol methyl ether 600 ppm
3
Endrin 2 mg/m
Epichlorohydrin 75 ppm

Department of Occupational Safety & Health, Ministry of Human Resources, Malaysia ™October 2005 53

Guidelines on the Use of PPE Against Chemical Hazards
3
EPN 5 mg/m
Ethanolamine 30 ppm
2-Ethoxyethanol 500 ppm

2-Ethoxyethyl acetate 500 ppm
Ethyl acetate 2,000 ppm [LEL]
Ethyl acrylate 300 ppm

Ethyl alcohol 3,300 ppm [LEL]
Ethylamine 600 ppm
Ethyl benzene 800 ppm [LEL]
Ethyl bromide 2,000 ppm

Ethyl butyl ketone 1,000 ppm
Ethyl chloride 3,800 ppm [LEL]
Ethylene chlorohydrin 7 ppm

Ethylenediamine 1,000 ppm
Ethylene dibromide 100 ppm
Ethylene dichloride 50 ppm
3
Ethylene glycol dinitrate 75 mg/m
Ethyleneimine 100 ppm
Ethylene oxide 800 ppm
Ethyl ether 1,900 ppm [LEL]

Ethyl formate 1,500 ppm
Ethyl mercaptan 500 ppm
N-Ethylmorpholine 100 ppm
Ethyl silicate 700 ppm
3
Ferbam 800 mg/m
3
Ferrovanadium dust 500 mg/m
3
Fluorides (as F) 250 mg F/m
Fluorine 25 ppm
Fluorotrichloromethane 2,000 ppm
Formaldehyde 20 ppm
Formic acid 30 ppm

Furfural 100 ppm
Furfuryl alcohol 75 ppm
Glycidol 150 ppm
3
Graphite (natural) 1,250 mg/m
3
Hafnium compounds (as Hf) 50 mg Hf/m
3
Heptachlor 35 mg/m
Department of Occupational Safety & Health, Ministry of Human Resources, Malaysia ™October 2005 54

Guidelines on the Use of PPE Against Chemical Hazards
n-Heptane 750 ppm
Hexachloroethane 300 ppm
3
Hexachloronaphthalene 2 mg/m
n-Hexane 1,100 ppm [LEL]
2-Hexanone 1,600 ppm
Hexone 500 ppm

sec Hexyl acetate 500 ppm
Hydrazine 50 ppm
Hydrogen bromide 30 ppm
Hydrogen chloride 50 ppm

Hydrogen cyanide 50 ppm
Hydrogen fluoride (as F) 30 ppm
Hydrogen peroxide 75 ppm

Hydrogen selenide (as Se) 1 ppm
Hydrogen sulfide 100 ppm
3
Hydroquinone 50 mg/m
Iodine 2 ppm
3
Iron oxide dust and fume (as Fe) 2,500 mg Fe/m
Isoamyl acetate 1,000 ppm
Isoamyl alcohol (primary and secondary) 500 ppm

Isobutyl acetate 1,300 ppm [LEL]
Isobutyl alcohol 1,600 ppm
Isophorone 200 ppm
Isopropyl acetate 1,800 ppm

Isopropyl alcohol 2,000 ppm [LEL]
Isopropylamine 750 ppm
Isopropyl ether 1,400 ppm [LEL]

Isopropyl glycidyl ether 400 ppm
Ketene 5 ppm
3
Lead compounds (as Pb) 100 mg Pb/m
3
Lindane 50 mg/m
3
Lithium hydride 0.5 mg/m
L.P.G. 2,000 ppm [LEL]
3
Magnesium oxide fume 750 mg/m
3
Malathion 250 mg/m
3
Maleic anhydride 10 mg/m
3
Manganese compounds (as Mn) 500 mg Mn/m
Department of Occupational Safety & Health, Ministry of Human Resources, Malaysia ™October 2005 55

Guidelines on the Use of PPE Against Chemical Hazards
Mercury compounds [except (organo) alkyls, as 10 mg Hg/m
3
Hg]
3
Mercury (organo) alkyl compounds(as Hg) 2 mg Hg/m
Mesityl oxide 1,400 ppm [LEL]
3
Methoxychlor 5,000 mg/m
Methyl acetate 3,100 ppm [LEL]
Methyl acetylene 1,700 ppm [LEL]
Methyl acetylenepropadiene mixture 3,400 ppm [LEL]

Methyl acrylate 250 ppm
Methylal 2,200 ppm [LEL]
Methyl alcohol 6,000 ppm
Methylamine 100 ppm

Methyl (namyl) ketone 800 ppm
Methyl bromide 250 ppm
Methyl Cellosolve (r) 200 ppm

Methyl Cellosolve (r) acetate 200 ppm
Methyl chloride 2,000 ppm
Methyl chloroform 700 ppm
Methylcyclohexane 1,200 ppm [LEL]

Methylcyclohexanol 500 ppm
o-Methylcyclohexanone 600 ppm
3
Methylene bisphenyl isocyanate 75 mg/m
Methylene chloride 2,300 ppm
Methyl formate 4,500 ppm
5-Methyl 3-heptanone 100 ppm
Methyl hydrazine 20 ppm

Methyl iodide 100 ppm
Methyl isobutyl carbinol 400 ppm
Methyl isocyanate 3 ppm

Methyl mercaptan 150 ppm
Methyl methacrylate 1,000 ppm
Methyl styrene 700 ppm
3
Mica 1,500 mg/m
3
Molybdenum (insoluble compounds, as Mo) 5,000 mg Mo/m
3
Molybdenum (soluble compounds, as Mo) 1,000 mg Mo/m
Monomethyl aniline 100 ppm

Morpholine 1,400 ppm [LEL]

Department of Occupational Safety & Health, Ministry of Human Resources, Malaysia ™October 2005 56

Guidelines on the Use of PPE Against Chemical Hazards
Naphtha (coal tar) 1,000 ppm [LEL]
Naphthalene 250 ppm
Nickel carbonyl (as Ni) 2 ppm
3
Nickel metal and other compounds (as Ni) 10 mg Ni/m
3
Nicotine 5 mg/m
Nitric acid 25 ppm

Nitric oxide 100 ppm
3
p-Nitroaniline 300 mg/m
Nitrobenzene 200 ppm
3
p-Nitrochlorobenzene 100 mg/m
Nitroethane 1,000 ppm
Nitrogen dioxide 20 ppm
Nitrogen trifluoride 1,000 ppm
3
Nitroglycerine 75 mg/m
Nitromethane 750 ppm
1-Nitropropane 1,000 ppm
2-Nitropropane 100 ppm

Nitrotoluene (o, m, p isomers) 200 ppm
Octachloronaphthalene Unknown
Octane 1,000 ppm [LEL]
3
Oil mist (mineral) 2,500 mg/m
3
Osmium tetroxide (as Os) 1 mg Os/m
3
Oxalic acid 500 mg/m
Oxygen difluoride 0.5 ppm

Ozone 5 ppm
3
Paraquat 1 mg/m
3
Parathion 10 mg/m
Pentaborane 1 ppm
Pentachloronaphthalene Unknown
3
Pentachlorophenol 2.5 mg/m
n-Pentane 1,500 ppm [LEL]

2-Pentanone 1,500 ppm
Perchloromethyl mercaptan 10 ppm
Perchloryl fluoride 100 ppm

Petroleum distillates (naphtha) 1,100 ppm [LEL]
Phenol 250 ppm
3
p-Phenylene diamine 25 mg/m
Department of Occupational Safety & Health, Ministry of Human Resources, Malaysia ™October 2005 57

Guidelines on the Use of PPE Against Chemical Hazards
Phenyl ether (vapor) 100 ppm
Phenyl etherbiphenyl mixture (vapor) 10 ppm
Phenyl glycidyl ether 100 ppm

Phenylhydrazine 15 ppm
Phosdrin 4 ppm
Phosgene 2 ppm

Phosphine 50 ppm
3
Phosphoric acid 1,000 mg/m
3
Phosphorus (yellow) 5 mg/m
3
Phosphorus pentachloride 70 mg/m
3
Phosphorus pentasulfide 250 mg/m
Phosphorus trichloride 25 ppm
3
Phthalic anhydride 60 mg/m
3
Picric acid 75 mg/m
3
Pindone 100 mg/m
3
Platinum (soluble salts, as Pt) 4 mg Pt/m
3
Portland cement 5,000 mg/m
Propane 2,100 ppm [LEL]
n-Propyl acetate 1,700 ppm
n-Propyl alcohol 800 ppm

Propylene dichloride 400 ppm
Propylene imine 100 ppm
Propylene oxide 400 ppm
n-Propyl nitrate 500 ppm
3
Pyrethrum 5,000 mg/m
Pyridine 1,000 ppm
3
Quinone 100 mg/m
Rhodium (metal fume and insoluble compounds, as 100 mg Rh/m
3
Rh)
3
Rhodium (soluble compounds, as Rh) 2 mg Rh/m
3
Ronnel 300 mg/m
3
Rotenone 2,500 mg/m
3
Selenium compounds (as Se) 1 mg Se/m
Selenium hexafluoride 2 ppm
3
Silica, amorphous 3,000 mg/m
Silica, crystalline (respirable dust)
3
cristobalite/tridymite: 25 mg/m

Department of Occupational Safety & Health, Ministry of Human Resources, Malaysia ™October 2005 58

Guidelines on the Use of PPE Against Chemical Hazards
3
quartz/tripoli: 50 mg/m
3
Silver (metal dust and soluble compounds, as Ag) 10 mg Ag/m
3
Soapstone 3,000 mg/m
3
Sodium fluoroacetate 2.5 mg/m
3
Sodium hydroxide 10 mg/m
Stibine 5 ppm
3
Stoddard solvent 20,000 mg/m
3
Strychnine 3 mg/m
Styrene 700 ppm
Sulfur dioxide 100 ppm
3
Sulfuric acid 15 mg/m
Sulfur monochloride 5 ppm
Sulfur pentafluoride 1 ppm

Sulfuryl fluoride 200 ppm
3
2,4,5-T 250 mg/m
3
Talc 1,000 mg/m
3
Tantalum (metal and oxide dust, as Ta) 2,500 mg Ta/m
3
TEDP 10 mg/m
3
Tellurium compounds (as Te) 25 mg Te/m
Tellurium hexafluoride 1 ppm
3
TEPP 5 mg/m
3
Terphenyl (o, m, p isomers) 500 mg/m
1,1,1,2-Tetrachloro 2,2-difluoroethane 2,000 ppm
1,1,2,2-Tetrachloro 1,2-difluoroethane 2,000 ppm

1,1,2,2-Tetrachloroethane 100 ppm
Tetrachloroethylene 150 ppm
Tetrachloronaphthalene Unknown
3
Tetraethyl lead (as Pb) 40 mg Pb/m
Tetrahydrofuran 2,000 ppm [LEL]
3
Tetramethyl lead (as Pb) 40 mg Pb/m
Tetramethyl succinonitrile 5 ppm

Tetranitromethane 4 ppm
3
Tetryl 750 mg/m
3
Thallium (soluble compounds, as Tl) 15 mg Tl/m
3
Thiram 100 mg/m
3
Tin (inorganic compounds, as Sn) 100 mg Sn/m
3
Tin (organic compounds, as Sn) 25 mg Sn/m
Department of Occupational Safety & Health, Ministry of Human Resources, Malaysia ™October 2005 59

Guidelines on the Use of PPE Against Chemical Hazards
3
Titanium dioxide 5,000 mg/m
Toluene 500 ppm
Toluene 2,4-diisocyanate 2.5 ppm

o-Toluidine 50 ppm
Tributyl phosphate 30 ppm
1,1,2-Trichloroethane 100 ppm

Trichloroethylene 1,000 ppm
Trichloronaphthalene Unknown
1,2,3-Trichloropropane 100 ppm
1,1,2-Trichloro 1,2,2-trifluoroethane 2,000 ppm

Triethylamine 200 ppm
Trifluorobromomethane 40,000 ppm
3
2,4,6-Trinitrotoluene 500 mg/m
3
Triorthocresyl phosphate 40 mg/m
3
Triphenyl phosphate 1,000 mg/m
Turpentine 800 ppm
3
Uranium (insoluble compounds, as U) 10 mg U/m
3
Uranium (soluble compounds, as U) 10 mg U/m
3
Vanadium dust 35 mg V/m
3
Vanadium fume 35 mg V/m
Vinyl toluene 400 ppm
3
Warfarin 100 mg/m
Xylene (o, m, p isomers) 900 ppm
Xylidine 50 ppm
3
Yttrium compounds (as Y) 500 mg Y/m
3
Zinc chloride fume 50 mg/m
3
Zinc oxide 500 mg/m
3
Zirconium compounds (as Zr) 50 mg Zr/m













Department of Occupational Safety & Health, Ministry of Human Resources, Malaysia ™October 2005 60

Guidelines on the Use of PPE Against Chemical Hazards

APPENDIX 2: RESPIRATOR MEDICAL EVALUATION QUESTIONNAIRE


To the employer: Answers to questions in Section 1, and to question 9 in Section 2 of Part
A, do not require a medical examination.

To the employee: Can you read (circle one): Yes / No

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 health care professional who will review it.


Part A. Section 1. (Mandatory) The following information must be provided by every
employee who has been selected to use any type of respirator (please print).

1. Today’s date: ______________________

2. Your name: _______________________

3. Your age (to nearest year): ___________

4. Sex (circle one): Male/Female

5. Your height: ____m.

6. Your weight: ____ kg.

7. Your job title:_____________________

8. A phone number where you can be reached by the health care professional who reviews
this questionnaire (include the Area Code): ___________________________

9. The best time to phone you at this number: ____________

10. Has your employer told you how to contact the health care professional who will review
this questionnaire (circle one): Yes / No

11. Check the type of respirator you will use (you can check more than one category):
a. ____ N, R, or P disposable respirator (filter-mask, non-cartridge type only).
b. ____ Other type (for example, half- or full face-piece type, powered-air purifying,
supplied-air, self-contained breathing apparatus).

12. Have you worn a respirator (circle one): Yes / No

If ‘‘yes,’’ what type(s): __________________________


Department of Occupational Safety & Health, Ministry of Human Resources, Malaysia ™October 2005 61

Guidelines on the Use of PPE Against Chemical Hazards


Part A. Section 2. (Mandatory) Questions 1 through 9 below must be answered by every
employee who has been selected to use any type of respirator (please circle ‘‘yes’’ or ‘‘no’’).

1. Do you currently smoke tobacco, or have you smoked tobacco in the last month: Yes / No

2. Have you ever had any of the following conditions?
a. Seizures (fits): Yes / No
b. Diabetes (sugar disease): Yes / No
c. Allergic reactions that interfere with your breathing: Yes / No
d. Claustrophobia (fear of closed-in places): Yes / No
e. Trouble smelling odours: Yes / No

3. Have you ever had any of the following pulmonary or lung problems?
a. Asbestosis: Yes / No
b. Asthma: Yes / No
c. Chronic bronchitis: Yes / No
d. Emphysema: Yes / No
e. Pneumonia: Yes / No
f. Tuberculosis: Yes / No
g. Silicosis: Yes / No
h. Pneumothorax (collapsed lung): Yes / No
i. Lung cancer: Yes / No
j. Broken ribs: Yes / No
k. Any chest injuries or surgeries: Yes / No
l. Any other lung problem that you’ve been told about: Yes / No

4. Do you currently have any of the following symptoms of pulmonary or lung illness?
a. Shortness of breath: Yes / No
b. Shortness of breath when walking fast on level ground or walking up a slight hill or
incline: Yes / No
c. Shortness of breath when walking with other people at an ordinary pace on level
ground: Yes / No
d. Have to stop for breath when walking at your own pace on level ground: Yes / No
e. Shortness of breath when washing or dressing yourself: Yes / No
f. Shortness of breath that interferes with your job: Yes / No
g. Coughing that produces phlegm (thick sputum): Yes / No
h. Coughing that wakes you early in the morning: Yes / No
i. Coughing that occurs mostly when you are lying down: Yes / No
j. Coughing up blood in the last month: Yes / No
k. Wheezing: Yes / No
l. Wheezing that interferes with your job: Yes / No
m. Chest pain when you breathe deeply: Yes / No
n. Any other symptoms that you think may be related to lung problems: Yes / No





Department of Occupational Safety & Health, Ministry of Human Resources, Malaysia ™October 2005 62

Guidelines on the Use of PPE Against Chemical Hazards


5. Have you ever had any of the following cardiovascular or heart problems?
a. Heart attack: Yes / No
b. Stroke: Yes / No
c. Angina: Yes / No
d. Heart failure: Yes / No
e. Swelling in your legs or feet (not caused by walking): Yes / No
f. Heart arrhythmia (heart beating irregularly): Yes / No
g. High blood pressure: Yes / No
h. Any other heart problem that you’ve been told about: Yes / No

6. Have you ever had any of the following cardiovascular or heart symptoms?
a. Frequent pain or tightness in your chest: Yes / No
b. Pain or tightness in your chest during physical activity: Yes / No
c. Pain or tightness in your chest that interferes with your job: Yes / No
d. In the past two years, have you noticed your heart skipping or missing a beat: Yes /
No
e. Heartburn or indigestion that is not related to eating: Yes / No
f. Any other symptoms that you think may be related to heart or circulation problems:
Yes / No

7. Do you currently take medication for any of the following problems?
a. Breathing or lung problems: Yes / No
b. Heart trouble: Yes / No
c. Blood pressure: Yes / No
d. Seizures (fits): Yes / No

8. If you’ve used a respirator, have you ever had any of the following problems? (If you’ve
never used a respirator, check the following space and go to question 9)
a. Eye irritation: Yes / No
b. Skin allergies or rashes: Yes / No
c. Anxiety: Yes / No
d. General weakness or fatigue: Yes / No
e. Any other problem that interferes with your use of a respirator: Yes / No

9. Would you like to talk to the health care professional who will review this questionnaire
about your answers to this questionnaire: Yes / No












Department of Occupational Safety & Health, Ministry of Human Resources, Malaysia ™October 2005 63

Guidelines on the Use of PPE Against Chemical Hazards

Questions 10 to 15 below must be answered by every employee who has been selected to
use either a full face-piece respirator or a self-contained breathing apparatus (SCBA).
For employees who have been selected to use other types of respirators, answering these
questions is voluntary.

10. Have you ever lost vision in either eye (temporarily or permanently): Yes / No

11. Do you currently have any of the following vision problems?
a. Wear contact lenses: Yes / No
b. Wear glasses: Yes / No
c. Colour blind: Yes / No
e. Any other eye or vision problem: Yes / No

12. Have you ever had an injury to your ears, including a broken ear drum: Yes / No

13. Do you currently have any of the following hearing problems?
a. Difficulty hearing: Yes / No
b. Wear a hearing aid: Yes / No
c. Any other hearing or ear problem: Yes / No

14. Have you ever had a back injury: Yes / No

15. Do you currently have any of the following musculoskeletal problems?
a. Weakness in any of your arms, hands, legs, or feet: Yes / No
b. Back pain: Yes / No
c. Difficulty fully moving your arms and legs: Yes / No
d. Pain or stiffness when you lean forward or backward at the waist: Yes / No
e. Difficulty fully moving your head up or down: Yes / No
f. Difficulty fully moving your head side to side: Yes / No
g. Difficulty bending at your knees: Yes / No
h. Difficulty squatting to the ground: Yes / No
i. Climbing a flight of stairs or a ladder carrying more than 25 lbs or 11 kg: Yes / No
j. Any other muscle or skeletal problem that interferes with using a respirator: Yes /
No















Department of Occupational Safety & Health, Ministry of Human Resources, Malaysia ™October 2005 64

Guidelines on the Use of PPE Against Chemical Hazards

Part B Any of the following questions, and other questions not listed, may be added to the
questionnaire at the discretion of the health care professional who will review the
questionnaire.

1. In your present job, are you working at high altitudes (over 5,000 feet or 1,500 metres) or
in a place that has lower than normal amounts of oxygen: Yes / No

If ‘‘yes,’’ do you have feelings of dizziness, shortness of breath, pounding in your chest, or
other symptoms when you’re working under these conditions: Yes / No

2. At work or at home, have you ever been exposed to hazardous solvents, hazardous airborne
chemicals (e.g., gases, fumes, or dust), or have you come into skin contact with hazardous
chemicals: Yes / No

If ‘‘yes,’’ name the chemicals if you know them:
__________________________________________________________________________


3. Have you ever worked with any of the materials, or under any of the conditions, listed
below?
a. Asbestos: Yes / No
b. Silica (e.g., in sandblasting): Yes / No
c. Tungsten/cobalt (e.g., grinding or welding this material): Yes / No
d. Beryllium: Yes / No
e. Aluminium: Yes / No
f. Coal (for example, mining): Yes / No
g. Iron: Yes / No
h. Tin: Yes / No
i. Dusty environments: Yes / No
j. Any other hazardous exposures: Yes / No

If ‘‘yes,’’ describe these exposures:
_______________________________________________________________________

4. List any second jobs or side businesses you have: _____________________________

5. List your previous occupations: ____________________________________________

6. List your current and previous hobbies: ______________________________________

7. Have you been in the military services? Yes / No

If ‘‘yes,’’ were you exposed to biological or chemical agents (either in training or combat):
Yes / No

8. Have you ever worked on a HAZMAT team? Yes / No



Department of Occupational Safety & Health, Ministry of Human Resources, Malaysia ™October 2005 65

Guidelines on the Use of PPE Against Chemical Hazards
9. Other than medications for breathing and lung problems, heart trouble, blood pressure, and
seizures mentioned earlier in this questionnaire, are you taking any other medications for any
reason (including over-the-counter medications): Yes / No

If ‘‘yes,’’ name the medications if you know them:______________________________

10. Will you be using any of the following items with your respirator(s)?
a. HEPA Filters: Yes / No
b. Canisters (for example, gas masks): Yes / No
c. Cartridges: Yes / No

11. How often are you expected to use the respirator(s) (circle ‘‘yes’’ or ‘‘no’’ for all answers
that apply to you)?
a. Escape only (no rescue): Yes / No
b. Emergency rescue only: Yes / No
c. Less than 5 hours per week: Yes / No
d. Less than 2 hours per day: Yes / No
e. About 2 to 4 hours per day: Yes / No
f. Over 4 hours per day: Yes / No

12. During the period you are using the respirator(s), is your work effort:

a. Light (less than 200 kcal per hour): Yes / No

If ‘‘yes,’’ how long does this period last during the average shift: ____ hrs. ___ mins.
Examples of a light work effort are sitting while writing, typing, drafting, or
performing light assembly work; or standing while operating a drill press (1–3 lbs. or
2-7 kg) or controlling machines.

b. Moderate (200 to 350 kcal per hour): Yes / No

If ‘‘yes,’’ how long does this period last during the average shift: ____ hrs. ___ mins.
Examples of moderate work effort are sitting while nailing or filing; driving a truck or
bus in urban traffic; standing while drilling, nailing, performing assembly work, or
transferring a moderate load (about 35 lbs.or15 kg) at trunk level; walking on a level
surface about 2 mph (3 km/h) or down a 5-degree grade about 3 mph (5 km/h); or
pushing a wheelbarrow with a heavy load (about 100 lbs. or 45 kg) on a level surface.

c. Heavy (above 350 kcal per hour): Yes / No

If ‘‘yes,’’ how long does this period last during the average shift: ____ hrs. ___ mins.
Examples of heavy work are lifting a heavy load (about 50 lbs. or 23 kg.) from the
floor to your waist or shoulder; working on a loading dock; shovelling; standing while
bricklaying or chipping castings; walking up an 8-degree grade about 2 mph (3 km/h);
climbing stairs with a heavy load (about 50 lbs. or 23 kg.).





Department of Occupational Safety & Health, Ministry of Human Resources, Malaysia ™October 2005 66

Guidelines on the Use of PPE Against Chemical Hazards
13. Will you be wearing protective clothing and/or equipment (other than the respirator)
when you’re using your respirator: Yes / No

If ‘‘yes,’’ describe this protective clothing and/or equipment:
______________________________

14. Will you be working under hot conditions (temperature exceeding 77° F or 25° C): Yes /
No

15. Will you be working under humid conditions: Yes / No

16. Describe the work you’ll be doing while you’re using your respirator(s):
__________________

17. Describe any special or hazardous conditions you might encounter when you’re using
your respirator(s) (for example, confined spaces, life-threatening gases):
________________________

18. Provide the following information, if you know it, for each toxic substance that you’ll be
exposed to when you’re using your respirator(s):
Name of the first toxic substance: ____________________________
Estimated maximum exposure level per shift:
___________________________________
Duration of exposure per shift ___________________
Name of the second toxic substance: _____________________________
Estimated maximum exposure level per shift: ___________________
Duration of exposure per shift: ____
Name of the third toxic substance:
___________________________________________
Estimated maximum exposure level per shift: ______________________
Duration of exposure per shift: ______
The name of any other toxic substances that you’ll be exposed to while using your
respirator:
_______________________________________________________________

19. Describe any special responsibilities you’ll have while using your respirator(s) that may
affect the safety and well-being of others (for example, rescue, security):
_____________________













Department of Occupational Safety & Health, Ministry of Human Resources, Malaysia ™October 2005 67

Hazards
Guidelines on the Use of PPE Against Chemical
Department: _______________________
NRIC No: _______________________ Position: __________________________
Date join department: _______________
APPENDIX 3: EMPLOYEES PPE ISSUANCE RECORD FORMAT
*Date Receiver *Date *Date *Date initials inspection/ inspection/ inspection/ inspection/ reissue reissue reissue reissue 68







*Date inspection/ reissue Department of Occupational Safety & Health, Ministry of Human Resources, Malaysia ™October 2005
Name: ________________________
Staff No: ______________________

Date issued









helmet goggles spectacles shields respirator gas mask apparatus gloves suit boot shoes/ *Strikethrough wherever applicable


PPE type 1.Safety 2.Safety 3.Safety 4.Face 5.Toxic 6.Dust 7.Breathing 8.Chemical 9.Coverall 10.Chemical 11.Safety

Hazards 68
Guidelines on the Use of PPE Against Chemical



Receiver initials










*Date inspection/ reissue









*Date inspection/ reissue

NRIC No: _______________________ Position: __________________________
Department: _______________________
Date join department: _______________




*Date inspection/ reissue

APPENDIX 3: EMPLOYEES PPE ISSUANCE RECORD FORMAT





*Date inspection/ reissue








*Date inspection/ reissue Department of Occupational Safety & Health, Ministry of Human Resources, Malaysia ™October 2005
Name: ________________________
Staff No: ______________________


Date issued








helmet goggles spectacles shields respirator gas mask apparatus gloves suit boot shoes/ *Strikethrough wherever applicable


PPE type 1.Safety 2.Safety 3.Safety 4.Face 5.Toxic 6.Dust 7.Breathing 8.Chemical 9.Coverall 10.Chemical 11.Safety