Respirators are an effective method of protection against designated hazards when properly selected and worn but respirators are only effective against the specified hazards presented (i.e. organic vapor, particulate dust, acid gas, etc.). Respirators provide no assistance when used in conditions that are oxygen deficient or in conditions that are Immediately Dangerous to Life and Health (IDLH). If a respirator is used improperly or not kept clean, the respirator itself can become a hazard to the worker.
Additionally the user understands that added burden is placed on the respiratory system due to the fact that the user is pulling the air through filter media which collects the contaminants of concern while purifying the air. Users with reduced or weakened respiratory capacity should seek medical approval prior to commencing respirator use.
Sometimes, workers seek a greater degree of protection than is required by the U.S. Occupational Safety and Health Administration (OSHA). In these cases respirator use is encouraged, even when exposures are below regulatory thresholds, to provide an additional level of comfort and protection for workers.
While the employer does not discourage the Voluntary Use of respiratory protection, the employer does not supply such Personal Protective Equipment and assumes no liability related to its use or misuse. The employee needs to understand certain precautions need to be taken to ensure sure that the respirator itself does not present a hazard.
At a minimum the employee should do the following:

• Only wear approved respirators.
• Read all instructions provided by the manufacturer on use, maintenance, cleaning and care, and warnings regarding the respirators limitations.
• Do not wear your respirator into areas containing contaminants for which your respirator is not designed to protect against. For example, a respirator designed to filter dust particles will not protect you against gases, vapors, or very small solid particles of fumes or smoke.
• Keep track of your respirator so that you do not mistakenly use someone else's respirator

Respiratory Voluntary Use Agreement Form
Employee Name: ________________________ _______________________
(last) (first)
Department: ___________________________
Employee T#: __________________________
 
I have read and understood the information provided above regarding voluntary respirator use.
____________________________________ ___________________
Employee Signature Date