Voluntary Use of Dust Masks (OSHA Appendix D)

This template outlines OSHA Appendix D guidance for the voluntary use of filtering facepiece respirators (dust masks). It explains when voluntary use applies, highlights the importance of proper selection and NIOSH certification, and cautions against using dust masks in atmospheres for which they are not designed. It covers correct use, limitations, cleaning and maintenance, and keeping track of assigned respirators. The form includes sections for supervisor review and signatures to document employee acknowledgment. Intended as a starting point for workplace safety programs; users should verify suitability for their specific jurisdiction and operations.