(1) Provide medical surveillance for employees to comply
with Tables 7 and 8, and the
following:
Make medical surveillance available at:
- Reasonable times and places.
- No cost to employees, including travel
associated costs such as mileage, gas or
bus fare if the employee is required to travel off
site. and
- Wages for additional time spent outside
of employees' normal work hours.
Make sure a licensed physician performs or
supervises exams and procedures.
Give complete information to the examining
physician including:
- A copy of this chapter.
- A description of the employee's duties
that relate to hazardous substance
exposure.
- The hazardous substance exposure levels
anticipated for the employee.
- A description of the personal protective
equipment (PPE) the employee could use.
- Information available from previous medical
examinations.
- The medical evaluation information required
by chapter 296-842
WAC, Respirators.
Medical exams must include, at a minimum:
- A medical history
- A work history (or updated history if
on file)
- A special emphasis on:
Assessment of symptoms related to handling
hazardous substances
Health hazards
Evaluation of fitness for duty (including
the ability to wear any PPE or other conditions that may
be expected at the workplace)
- Other content as determined by the examining
physician.
Note:
The physician should consult the Occupational
Safety and Health Guidance Manual for Hazardous Waste Site
Activities and the Medical Management Guidelines for Acute
Chemical Exposure (search OSHA website: http://www.osha.gov).
(2) Obtain the physician's written opinion and give a
copy to the employee that includes:
A statement of whether or not medical conditions
were found which would increase the employee's risk for impairment
during emergency response work or respirator use.
- Don't include specific findings or diagnoses
unrelated to occupational exposures.
Limitations recommended to the employee's
assigned work, if any.
Exam and test results if the employee requests
this information.
A statement that affirms the employee has
been confidentially informed of medical exam results (including
medical conditions requiring follow-up).
Table 7
Medical Surveillance for Employee Categories
If the employee is covered by this chapter
and is...
Then you must...
Exposed at least for 30 days a year
to health hazards or hazardous substances at or above
the permissible exposure limit or published exposure levels
(even when respirators are used), OR
Required to wear a respirator for at
least 30 days a year*
Offer standard medical surveillance
as specified in Table 8*
A hazardous materials (HAZMAT) team
member.
A hazardous materials specialist
Provide standard medical surveillance
as specified in Table 8
An emergency responder who shows immediate or delayed
signs or symptoms possibly resulting from exposure to
hazardous substances during an incident
Provide incident-specific medical surveillance
as specified in Table 8
Not an emergency responder and:
- May be injured
- Show immediate or delayed signs
or symptoms possibly resulting from exposure to hazardous
substances
- May have been exposed to hazardous
substances at concentrations above the permissible
exposure limits (PELs) or the published exposure levels
without appropriate PPE
Offer incident-specific medical surveillance
as specified in Table 8
Note:
A medical evaluation for respirator use
is required by chapter 296-842
WAC, Respirators, for those employees who have not been
cleared for respirator use during medical surveillance activities.
Table 8
Frequency of Exams and Consultations
If the employee is covered by...
Then medical surveillance must include...
Standard medical surveillance
Exams and consultations:
- Before assignment
Note:
If the employee is a hazardous materials (HAZMAT)
team member or a hazardous materials specialist, the
employee must receive a baseline physical examination
- At least once every 12 months
after their initial assignment unless the physician
believes a shorter, or longer interval (but no more
than 24 months) is appropriate
- Whenever employees are reassigned
to an area where they will no longer be covered by
medical surveillance and they haven't been examined
within the past 6 months
- As soon as possible after an employee
reports:
Signs or symptoms of possible
overexposure to hazardous substances or health
hazards
Injury
Exposure above the permissible
exposure limits or published exposure levels
- At the termination of their employment
unless they were examined within the past 6 months
Incident-specific medical surveillance
Medical consultations and exams:
- As soon as possible following the
incident or development of signs or symptoms
- At additional times, if the physician
determines follow-up is medically necessary
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