Voluntary Respirator Use Notification

If your employer provides respirators for your voluntary use, or if you provide your own respirator, you must submit this form.


Read the information and indicate that you agree to the conditions of voluntary use of a respirator.

Need Help Completing the Form?

head shot of Carol Schmeidler Manager, General Safety & Industrial Hygiene Programs.

Carol Schmeidler, MS, CSP

Manager, General Safety & Industrial Hygiene Programs

Environment, Health & Safety

Phone: 716-829-5833

Email: cbs2@buffalo.edu

Form Facts

Form Type: Formstack document

Requirements: Web browser

Updated: 04/07/2020

Owner: Environment, Health & Safety