Safety Standards for Agriculture


Cholinesterase Monitoring
Chapter 296-307 WAC, Part J-1

WAC

296-307-148 Scope and summary.
296-307-14805 Maintain handling records for covered pesticides
296-307-14810 Implement a medical monitoring program.
296-307-14815 Identify a physician or other licensed health care professional.
296-307-14820 Make cholinesterase testing available.
296-307-14825 Respond to depressed cholinesterase levels.
296-307-14830 Provide medical removal protection benefits.
296-307-14835 Maintain records.
296-307-14840 Provide training.
296-307-14845 Implementation plan.

WAC 296-307-148 Scope and summary.

Your responsibility:

To implement a monitoring program for your employees who, as part of their job duties, handle category I or II organophosphate or N-methyl-carbamate pesticides with the words “DANGER” or “WARNING” on the label.

Definition:

The terms handle and handler refer to employees who are engaged in the job duties listed in the definition of “handler” contained in WAC 296-307-11005, Pesticides (worker protection standard).

Important:

Whenever there is reason to believe than an employee has been poisoned or injured by exposure to pesticides while on the job, you need to provide the medical services required by WAC 296-307-13055.

You must:

Maintain handling records for covered pesticides
WAC 296-307-14805

Implement a medical monitoring program
WAC 296-307-14810

Identify a physician or licensed health care professional
WAC 296-307-14815

Make cholinesterase testing available
WAC 296-307-14820

Respond to depressed cholinesterase levels
WAC 296-307-14825

Provide medical removal protection benefits
WAC 296-307-14830

Maintain records
WAC 296-307-14835

Provide training
WAC 296-307-14840

Implementation plan
WAC 296-307-14845

[Statutory Authority: RCW 49.17.010, .040, .050, and .060. 03-24-105 (Order 02-05), 296-307-148, filed 12/03/03, effective 02/01/04].

WAC 296-307-14805 Maintain handling records for covered pesticides.

You must:

  • Maintain accurate records of all time that each employee spends handling category I or II organophosphate or N-methyl-carbamate pesticides (this includes employees who don't meet the handling hour thresholds in WAC 296-307-14810).
  • Provide a completed CHOLINESTERASE MONITORING HANDLING HOURS REPORT (F413-065-000) to the physician or other licensed health care professional (LHCP) for each employee receiving a periodic cholinesterase blood test and make sure the report is submittted to the laboratory with each periodic cholinesterase test.
  • Provide the employee with a copy of the CHOLINESTERASE MONITORING HANDLING HOURS REPORT upon request.
  • Retain pesticide handling records for 7 years.
  • Make sure that pesticide-handling records are readily accessible to employees, their designated representatives, and treating health care professionals.

[Statutory Authority: RCW 49.17.010, .040, .050, and .060. 06-01-074 (Order 05-32), § 296-307-14805, filed 12/20/2005, effective 02/01/2006. Statutory Authority: RCW 49.17.010, .040, .050, and .060. 03-24-105 (Order 02-05), 296-307-14805, filed 12/03/03, effective 02/01/04].

WAC 296-307-14810 Implement a medical monitoring program.

You must:

  • Implement a medical monitoring program for your employees who handle or will be expected to handle category I or II organophosphate or N-methyl-carbamate pesticides for 30 or more hours in any consecutive 30-day period.

Note:

  • You don't need to count time spent mixing and loading using closed systems (as defined in WAC 296-307-13045(4)(d)) in determining the need for periodic testing. Closed cabs aren't "closed systems." Time using closed systems is still counted for purposes of establishing coverage under this rule and determining the need for obtaining baseline cholinesterase levels.
  • The first 30 consecutive day period begins on the first day of handling organophosphate or N-methyl-carbamate pesticides after obtaining the baseline cholinesterase test.
  • There is nothing in this rule that prohibits employers from providing cholinesterase monitoring to employees who handle organophosphate or N-methyl-carbamate pesticides for fewer than 30 hours in any consecutive 30-day period.

[Statutory Authority: RCW 49.17.010, .040, .050, and .060. 06-01-074 (Order 05-32), § 296-307-14810, filed 12/20/2005, effective 02/01/2006. Statutory Authority: RCW 49.17.010, .040, .050, and .060. 03-24-105 (Order 02-05), 296-307-14810, filed 12/03/03, effective 02/01/04].

WAC 296-307-14815 Identify a physician or other licensed health care professional.

You must:

  • Identify a physician or other licensed health care professional (LHCP) who will:
    • - Provide baseline and periodic cholinesterase testing through the department of health public health laboratory or a laboratory approved by the department of Labor & Industries
    • - Interpret cholinesterase tests.
    • - Provide you with a written recommendations for each employee's blood test and evaluation.
  • Obtain the LHCP's written recommendation for each employee's blood test and evaluation (including baseline tests) and make sure that the employee receives a copy of the LHCP's written recommendation, either through you or directly through the LHCP, within 5 business days after you receive the recommendation.
  • Make sure the LHCP's written recommendation for each employee's blood test and evaluation is limited to the following information:

    - The employees cholinesterase status based on the LHCP's evaluation.

    - Identification of changes in cholinesterase levels requiring a work practive evaluation for the employee.

    - Identification of changes in cholinesterase levels requiring the employee to be removed from handling and other exposure to organophosphate and N-methyl-carbamate pesticides.

    - Guidance on medical monitoring.

    - Any other relevant information concerning an employee's workplace exposure to organophosphate and N-methyl-carbamate pesticides.

Note: All testing for an employee should be conducted through the same laboratory. This will allow for accuarate comparison between baseline and periodic tests.

You must:

  • Instruct the LHCP to NOT reveal in writing or in any other communication with you any other personally identifiable medical information.

Note: If the LHCP written recommendation contains specific findings or diagnoses unrelated to occupational exposure, you should send it back and obtain a revised version without the additional information.

You must:

  • Make sure the LHCP is familiar with the requirements of this rule (for example, by providing a copy of the rule or by confirming that the provider has attended training on the rule).
  • Post the name, address, and telephone number of the LHCP you have identified at the locations where employees usually start their work day.
  • Make sure written recommendations from the LHCP are maintained for 7 years.

Note: You may also maintain the employee's actual test results if the employee provides the LHCP with written consent to share these results with you.

[Statutory Authority: RCW 49.17.010, .040, .050, and .060. 06-01-074 (Order 05-32), § 296-307-14815, filed 12/20/2005, effective 02/01/2006. Statutory Authority: RCW 49.17.010, .040, .050, and .060. 03-24-105 (Order 02-05), 296-307-14815, filed 12/03/03, effective 02/01/04].

WAC 296-307-14820 Make cholinesterase testing available.

You must:

  • Make medical monitoring available to employees who will meet the handling hour threshold of 30 or more hours in any consecutive 30-day period (WAC 296-307-14810) at no cost and at a reasonable time and place, as follows:
  • - Provide annual baseline red blood cell (RBC) and serum cholinesterase tests that are taken at least 30 days after the employee last handled organophosphate or N-methyl-carbamate pesticides.

    - Provide periodic RBC and serum cholinesterase testing:

    • Within 3 days after the end of each 30-day period where the employee meets the handling hour threshold in WAC 296-307-14810; however, testing isn't required more often than every 30 days;

      OR

    • At least every 30 days for those employees who may meet the handling hour threshold in WAC 296-307-14810.

    - Follow the recommendations of the LHCP regarding continued employee pesticide handling or removal from handling until a 30-day exposure free baseline can be established.

Exemption: You don't need to provide baseline or periodic testing for those employees whose work exposure is limited to handling only N-Methyl-carbamate pesticides.

Note:

  • For employees who have had exposure to organophosphate or N-methyl-carbamate pesticides in the 30 days prior to the test obtain a working baseline. For example, a worker who initially declines cholinesterase testing and later chooses to participate in testing would obtain a "working baseline."
  • For new employees, the LHCP may accept pervious baselines, if they are obtained according to this rule.

You must:

  • Obtain a signed declination statement from the LHCP for each employee who declines cholinesterase testing.

    - Employees may decline cholinesterase testing only after they receive training about cholinesterase inhibiting pesticides and discuss the risks and benefits of participation with the LHCP.

    - An employee may change his or her mind and elect to participate or decline to continue participation in the testing program at any time.

  • Make sure the employee receives a copy of the signed declination statement either through you or directly through the LHCP, within 5 business days after you receive the declination statement.

Note: If employers discourage participation in cholinesterase monitoring, or in any way interfere with an employee's decision to continue with this program, this interference may represent unlawful discrimination under RCW 49.17.160, Discrimination against employee filing, instituting proceedings, or testifying prohibited--Procedure--Remedy.

[Statutory Authority: RCW 49.17.010, .040, .050, and .060. 06-01-074 (Order 05-32), § 296-307-14820, filed 12/20/2005, effective 02/01/2006. Statutory Authority: RCW 49.17.010, .040, .050, and .060. 03-24-105 (Order 02-05), 296-307-14820, filed 12/03/03, effective 02/01/04].

WAC 296-307-14825 Respond to depressed cholinesterase levels.

You must:

  • Respond to an employee's depressed cholinesterase levels by:

    -Taking the actions required in Table 1;

    AND

    - Following any additional occupational health recommendations from the or LHCP.

  • Table 1 - Required Responses to an Employee's Depressed Cholinesterase Levels

      When:

      Action to be taken:

      Methods:

      An employee's RBC or serum cholinesterase levels fall more than 20 percent below the baseline

      Evaluate the employee's workplace and work practices to identify and correct potential sources of pesticide exposure

      Review:

      • Personal protective equipment (PPE) and its condition
      • Employees' PPE usage
      • General sanitation and decontamination practices and availability of decontamination facilities required by WAC 296-307-13050
      • Pesticide handling practices
      • Pesticide label requirements

      An employee's RBC cholinesterase level falls 30 percent or more from the baseline

      OR

      An employee's serum cholinesterase level falls 40 percent or more from the baseline

      Remove the employee from handling and other work exposures to organophosphate and N-methyl-carbamate pesticides such as thinning and harvesting in recently treated areas

      AND

      Evaluate the employee's work practices to identify and correct potential sources of pesticide exposure

      • When available; provide the employee with other duties that don't include handling and other work exposures to organophosphate and N-methyl-carbamate pesticides
      • Provide medical monitoring and cholinesterase testing as recommended by the LHCP
      • Provide salary and benefits as if employee was continuing pesticide application activities

      A removed employee's cholinesterase levels return to 20 percent or less below baseline

      The employee may return to handling class I and II organophosphate and N-methyl-carbamate pesticides

      Continue periodic cholinesterase monitoring

[Statutory Authority: RCW 49.17.010, .040, .050, and .060. 06-01-074 (Order 05-32), § 296-307-14825, filed 12/20/2005, effective 02/01/2006. Statutory Authority: RCW 49.17.010, .040, .050, and .060. 03-24-105 (Order 02-05), 296-307-14825, filed 12/03/03, effective 02/01/04].

WAC 296-307-14830 Provide medical removal protection benefits.

You must:

  • Provide medical removal protection benefits for a maximum of three months on each occasion:

    - An employee is temporarily removed from work due to depressed cholinesterase levels;

  • OR

    - Assigned to other duties due to depressed cholinesterase levels.

  • Provide medical removal protection benefits that include maintenance of the same pay, seniority and other employment rights and benefits of an employee as though the employee has not been removed from normal exposure to organophosphate or N-methyl-carbamate pesticides or otherwise limited.

Note: The following are examples of how a worker's pay could be maintained while medically removed from exposure to cholinesterase-inhibiting pesticides:

  • A removed worker is assigned to work 8 hours a day but the employer's pesticide handlers are working 10 hours a day. The removed worker would be paid for 10 hours at the handler's pay rate.
  • The farmer pays workers 2 dollars more per hour when they are handling organophosphate or N-methyl-carbamate pesticides. The removed worker will be paid this premium when the pesticides are being handled on the farm; however, the worker will be paid at their usual pay rate when the pesticides aren't being handled on the farm.

[Statutory Authority: RCW 49.17.010, .040, .050, and .060. 06-01-074 (Order 05-32), § 296-307-14830, filed 12/20/2005, effective 02/01/2006. Statutory Authority: RCW 49.17.010, .040, .050, and .060. 03-24-105 (Order 02-05), 296-307-14830, filed 12/03/03, effective 02/01/04 ].

WAC 296-307-14835 Maintain records.

You must:

  • Make sure that the following records are maintained:

    - The name, address, and telephone number of the physician or LHCP.

    - Written recommendations and opinions received from the physician or LHCP.

    - Findings of all work practice investigations.

    - Dates when employees were medically removed from their duties and dates when employees are returned to duties that include handling organophosphate orN-methyl-carbamate pesticides.

    - Signed declination statement.

  • Maintain records for 7 years.
  • Make sure that all records are readily accessible to the employee and his or her designated representative.

[Statutory Authority: RCW 49.17.010, .040, .050, and .060. 03-24-105 (Order 02-05), 296-307-14835, filed 12/03/03, effective 02/01/04].

WAC 296-307-14840 Provide training.

You must:

  • Make sure employees have received training before initial medical monitoring. The training must include at least the following:

    -

  • The human health hazards and physical symptoms of overexposure to organophosphate and N-methyl-carbamate cholinesterase-inhibiting pesticides.

    - The purpose and requirements for medical monitoring.

Note:

Training required by this rule may be combined with other pesticide handler training as required byWAC 296-307-13025, Pesticide safety training--Standards for pesticide handlers.

[Statutory Authority: RCW 49.17.010, .040, .050, and .060. 03-24-105 (Order 02-05), 296-307-14840, filed 12/03/03, effective 02/01/04].

WAC 296-307-14845 Implementation Plan.

The department will implement and complete an evaluation of this rule by doing the following:

  • Organize a scientific team to oversee collection and analysis of data collected during 2004 and 2005. L&I will select representatives of the University of Washington, Washington State University, as well as other interested members of the academic and scientific communities, to participate on the team. The team will provide an initial analysis of testing data and any appropriate recommendations directly to L&I and to the cholinesterase monitoring advisory committee by November 1, 2004, and a further analysis and any appropriate recommendations by November 1, 2005. A final report and recommendations will be completed by September 30, 2006.
  • Establish a cholinesterase stakeholder advisory committee to evaluate issues related to rule implementation and provide recommendations to the department regarding implementation of the rule and any possible modifications to it. L&I will invite representatives of growers, labor and affected state agencies to participate on the advisory committee. The committee will have an opportunity to comment on the analysis completed by the scientific team and to make any appropriate recommendations before December 1, 2004, and again before December 1, 2005. In addition, the committee will review the scientific committee's final report and recommendations and provide advice to L&I prior to December 1, 2006.
  • Review reports from the scientific team and stakeholder advisory committee, and other relevant information and make modifications to the rule as appropriate.
  • Make efforts to defray the costs of medical testing during 2004.
  • Prepare and distribute provider guidelines.
  • Develop and make available a model employee training program.
  • Publish a list of trained providers and certified laboratories on the internet.
  • Coordinate recordkeeping requirements with the department of agriculture.

[Statutory Authority: RCW 49.17.010, .040, .050, and .060. 03-24-105 (Order 02-05), 296-307-14845, filed 12/03/03, effective 02/01/04].

Cholinesterase Monitoring Helpful Tools

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