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1910.1051(k) Medical Screening and Surveillance
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The employer shall institute a medical screening and surveillance program as specified in this paragraph for:
Each employee with exposure to BD at concentrations at or above the action level on 30 or more days or for employees who have or may have exposure to BD at or above the PELs on 10 or more days a year;
Each employee exposed to BD following an emergency situation.
Employers (including successor owners) shall continue to provide medical screening and surveillance for employees, even after transfer to a non-BD exposed job and regardless of when the employee is transferred, whose work histories suggest exposure to BD:
At or above the PELs on 30 or more days a year for 10 or more years;
At or above the action level on 60 or more days a year for 10 or more years; or
Above 10 ppm on 30 or more days in any past year; and
The employer shall ensure that the health questionnaire, physical examination and medical procedures are provided without cost to the employee, without loss of pay, and at a reasonable time and place.
Laboratory tests shall be conducted by an accredited laboratory.
Physical examinations, health questionnaires, and medical procedures shall be performed or administered by a physician or other licensed health care professional.
The employer shall make medical screening available on the following schedule:
For each employee covered under paragraphs (k)(1)(i) and (ii) of this section, a health questionnaire and complete blood count with differential and platelet count (CBC) every year, and a physical examination as specified below:
An initial physical examination that meets the requirements of this rule, if twelve months or more have elapsed since the last physical examination conducted as part of a medical screening program for BD exposure;
Before assumption of duties by the employee in a job with BD exposure;
Every 3 years after the initial physical examination;
At the discretion of the physician or other licensed health care professional reviewing the annual health questionnaire and CBC;
At the time of employee reassignment to an area where exposure to BD is below the action level, if the employee's past exposure history does not meet the criteria of paragraph (j)(1)(ii) of this section for continued coverage in the screening and surveillance program, and if twelve months or more have elapsed since the last physical examination; and
At termination of employment if twelve months or more have elapsed since the last physical examination.
For each employee who must wear a respirator, physical ability to perform the work and use the respirator must be determined as required by 29 CFR 1910.134.
Following an emergency situation, medical screening shall be conducted as quickly as possible, but not later than 48 hours after the exposure.
Medical screening for employees covered by paragraphs (j)(1)(i) and (ii) of this section shall include:
A baseline health questionnaire that includes a comprehensive occupational and health history and is updated annually. Particular emphasis shall be placed on the hematopoietic and reticuloendothelial systems, including exposure to chemicals, in addition to BD, that may have an adverse effect on these systems, the presence of signs and symptoms that might be related to disorders of these systems, and any other information determined by the examining physician or other licensed health care professional to be necessary to evaluate whether the employee is at increased risk of material impairment of health from BD exposure. Health questionnaires shall consist of the sample forms in Appendix C to this section, or be equivalent to those samples;
A complete physical examination, with special emphasis on the liver, spleen, lymph nodes, and skin;
Any other test which the examining physician or other licensed health care professional deems necessary to evaluate whether the employee may be at increased risk from exposure to BD.
Medical screening for employees exposed to BD in an emergency situation shall focus on the acute effects of BD exposure and at a minimum include: A CBC within 48 hours of the exposure and then monthly for three months; and a physical examination if the employee reports irritation of the eyes, nose throat, lungs, or skin, blurred vision, coughing, drowsiness, nausea, or headache. Continued employee participation in the medical screening and surveillance program, beyond these minimum requirements, shall be at the discretion of the physician or other licensed health care professional.
Where the results of medical screening indicate abnormalities of the hematopoietic or reticuloendothelial systems, for which a non-occupational cause is not readily apparent, the examining physician or other licensed health care professional shall refer the employee to an appropriate specialist for further evaluation and shall make available to the specialist the results of the medical screening.
The specialist to whom the employee is referred under this paragraph shall determine the appropriate content for the medical evaluation, e.g., examinations, diagnostic tests and procedures, etc.
Information provided to the physician or other licensed health care professional. The employer shall provide the following information to the examining physician or other licensed health care professional involved in the evaluation:
The employee's actual or representative BD exposure level during employment tenure, including exposure incurred in an emergency situation;
A description of pertinent personal protective equipment used or to be used; and
Information, when available, from previous employment-related medical evaluations of the affected employee which is not otherwise available to the physician or other licensed health care professional or the specialist.
A description of the affected employee's duties as they relate to the employee's BD exposure;
For each medical evaluation required by this section, the employer shall ensure that the physician or other licensed health care professional produces a written opinion and provides a copy to the employer and the employee within 15 business days of the evaluation. The written opinion shall be limited to the following information:
The occupationally pertinent results of the medical evaluation;
A medical opinion concerning whether the employee has any detected medical conditions which would place the employee's health at increased risk of material impairment from exposure to BD;
Any recommended limitations upon the employee's exposure to BD; and
A statement that the employee has been informed of the results of the medical evaluation and any medical conditions resulting from BD exposure that require further explanation or treatment.
The written medical opinion provided to the employer shall not reveal specific records, findings, and diagnoses that have no bearing on the employee's ability to work with BD.
Note: However, this provision does not negate the ethical obligation of the physician or other licensed health care professional to transmit any other adverse findings directly to the employee.
Note: However, this provision does not negate the ethical obligation of the physician or other licensed health care professional to transmit any other adverse findings directly to the employee.
The employer shall ensure that information obtained from the medical screening program activities is aggregated (with all personal identifiers removed) and periodically reviewed, to ascertain whether the health of the employee population of that employer is adversely affected by exposure to BD.
Information learned from medical surveillance activities must be disseminated to covered employees, as defined in paragraph (k)(1) of this section, in a manner that ensures the confidentiality of individual medical information.
Related Code Sections
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1910.1051(k)(4)(i)(A) Toxic and Hazardous Substances,
A baseline health questionnaire that includes a comprehensive occupational and health history and is updated annually. Particular emphasis shall ...
OSHA 1910 General Industry > Z Toxic and Hazardous Substances > 1910.1051 1,3-Butadiene > 1910.1051(k) Medical Screening and Surveillance > 1910.1051(k)(4) Content of Medical Screening > 1910.1051(k)(4)(i) > 1910.1051(k)(4)(i)(A)