Mandatory Respiratory Protection Program in Long Term Care: Requirements and Support

Mandatory Respiratory Protection Program in Long Term Care: Requirements and Support

PLEASE NOTE!  If you have NOT had your staff fit tested for N95 masks, you need to have this done ASAP.  DOSH is giving citations for fit testing not being completed! This requirement applies to skilled nursing, assisted living, adult day programs (especially if you have any aerosol generating procedures being done in your building, such as nebulizers, CPAP/BiPAP, suctioning, use of incentive spirometers, ventilators)

Workers who could be exposed to respiratory hazards such as the COVID-19 or the influenza virus need to use respiratory protection. Organizations using N95 respirators must comply with the Respirator Rule (WAC 296-842). If your employees are not yet fit tested to an N95 or you have questions, please visit the Washington State Department of Health Fit Test Project website or email

To comply with the Respirator Rule, your organization must take all the following steps.

  1. Formally document the respiratory protection program at each worksite. Here is a respiratory protection program templatecreated by the Department of Labor and Industries to get you started.
  2. Provide medical evaluations to employees using N95s. Evaluations must be done by licensed health care providers familiar with the Respiratory Rule. Your organization can meet this requirement by one the three options:
    • Using the medical evaluation vendor under contract with the Department of Health. This is available to you at no cost throughout 2021. Email HAI-FitTest@doh.wa.govwith your facility name and address, contact name, and email address to get signed up.  NOTE: If you have signed up to use a Department of Health medical evaluation vendor but have not yet logged in to enter in employee names, please email to request a new link and instructions on next steps.
    • Having your in-house licensed health care provider provide medical evaluations for your organization. Email HAI-FitTest@doh.wa.govfor more information.
    • Hiring a licensed health care provider or Occupational Health Clinic to provide medical evaluations for your organization.
  3. Provide respirator use training to employees using N95s. Training must occur beforeemployees are fit tested. There is specific information that needs to be covered to meet the Respirator Rule. Visit the Department of Health Fit Test Project site or the Department of Labor and Industries site for training material.
  4. Provide fit testing for each employee. Fit tests ensure that specific N95 used will protect your employee. The Department of Health has engaged vendors to perform fit testing at facilities that request it. Visit the Department of Health Fit Test Project site or email HAI-FitTest@doh.wa.govfor more information. 

NOTE: Fit test vendors will not schedule an appointment until you complete the medical evaluations. If you have questions about how the Department of Health can support your Respiratory Protection Program, please email

The funding for both the medical evaluation service and the mobile fit test vendor will expire at the end of 2021. In addition, the July 7, 2021, DOSH Directive 11.80 has reinstated the annual fit testing rule.





Laura Hofmann, MSN, RN – Director of Clinical and Nursing Facility Regulatory Services
c: 425-231-4804