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Disclaimer

The intent of this questionnaire is to determine probable medical capability to use a respirator. It is not intended to diagnose, discover, warn or treat any medical condition(s) that may be present. It does not replace medical care, diagnosis and treatment that are solely the responsibility of the employee and their own healthcare provider. In the course of respirator questionnaire review, the employee will not be informed by New Beginnings Medical Surveillance, Inc.  of potential health problems.

New Beginnings Medical Surveillance, Inc. relies on accurate submission of information from the employee to make the determination of probable medical capability to use a respirator. New Beginnings Medical Surveillance, Inc. is not responsible for determinations made from erroneous, inaccurate, incomplete or false information. New Beginnings Medical Surveillance, Inc. does not assume any responsibility or liability for adverse effects experienced by the employee that are related to respirator use, type of respirators selected by the employer and/or working conditions or environments.

All reasonable efforts will be made to maintain the confidentiality and security of submitted data. However New Beginnings Medical Surveillance, Inc. and it's affiliates,  do not assume responsibility for breach of confidentially by the employee, the employer, or by any other healthcare provider other than those employed by New Beginnings Medical Surveillance, Inc.   The questionnaire record will only be released to the employee upon their written request. Releases to any other parties will only be upon subpoena or court order.