Skip to main content
Report an Issue

Respiratory Medical Clearance Forms

If you need a medical clearance questionnaire, see below.

If you have already turned in a medical clearance questionnaire and have questions about whether or not you have been cleared, call Employee Occupational Health and Wellness (EOHW) at 919-684-3136.

Large Groups (25 or more employees): 
If your work area is listed below, fill out the appropriate form and email it to Employee Occupational Health and Wellness at

Other Groups:

Please call 919-684-5996 to get the appropriate questionnaire. It can be emailed or hand-delivered to you. DO NOT use any of the above questionnaires, because they do not have the correct respirator and hazard information for your work area.

All employees:

If you have questions about the medical portion of the form, or to find out your medical clearance status, please call EOHW at 919-684-3136. If you have questions about filling out the first two pages of the form, please call OESO at 919-684-5996.