Respiratory Hazard Evaluation (RHE) Part 1

UCI Respiratory Protection Program Appendix A1

Submitter's Name*

Submitter's Job Title*

Submitter's Department*

Supervisor/Manager/Lab Manager/PI Name*

For Labs, indicate PI

PI/Manager Phone*

PI/Manager Email*

Employee(s) Represented by the RHE

List all personnel covered by RHE, including UCI Net ID (ex. Jonas Doe, Jdoe). Attach list if longer than five.

Employee 1 Name*

Employee 1 UCINetID*

Add New

Employee 2 Name

Employee 2 UCINetID

Add New 2

Employee 3 Name

Employee 3 UCINetID

Add New 3

Employee 4 Name

Employee 4 UCINetID

Add New 4

Employee 5 Name

Employee 5 UCINetID

Process Description*

Describe the process that necessitates the use of respiratory protection. Option: If available, attach the written protocol and highlight the process that necessitates respiratory protection

Identity of Contaminant(s)/Hazard, Quantity use per unit time, Duration of Exposure*

Example: Formaldehyde, 2 mls/day, 30 minutes

Controls and/or personal protective equipment used to minimize or eliminate exposure*

Expected physical work effort*

Select

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