MASON TI?NDIiRS1 TRAINING F1IN0
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MEDICAL EXAMINATION FOR RESPIRATORY PROTECTION
APPLICANTS
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TELEP1-LONE NO.:
DATE OF BIRTH:
SOCIAL SECURIT
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RASED UPON THE MEDICAL WHICH INCLUDES:
I. PULMONARY FUNCTION TESTS (SPIROMETRY) OF FORCED VITAL CAPACITY (PVC), FORCED Vfl
CAPACITY (FVC), FORCED EXPIRATORY VOLUME AT ONE SECOND (FEV 1) AND INTERPRETATIO'
2. A CHEST ROENTGENOGRAM, TWO (2) VIEWS AND RADIOLOGICAL SERVICES ".OVIDED BY A
QUALIFIED INTERPRETER.
3. MEDICAL IIISI'ORY
4, A PHYSICAL EXAMINATION DIRECTED TO THE PULMONARY AND (lASTROINTF.STINAI .
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WEAR A RESPIRATOR IN THE PERFORMANCE OF HIS JO
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