OCCUPATIONAL HEALTH SURVEILLANCE MANUAL · Occupational health medical surveillance examinations...

AD-A283 941 DoD 6055o5-M

SDEPARTMENT OF DEFENSE

OCCUPATIONAL HEALTHSURVEILLANCE MANUAL

S ELECTE

AUG 3 01994S!GJULY 1982 __.

27849

ASSISTANT SECRETARY F EFE SE(MANPOWER, RESERVE AFFAIRS, AND LOGISTICS)

.4 8 _29 125

DoD 6055.5-MASSISTANT SECRETARY OF DEFENSE

WASHINGTON. D.C, 20301

MANPOWER.

RESERVE AFFAIRS

AND LOGISTICS July 26, 1982

FOREWORD

This manual is issued under the authority of DoD Instruction S055.5, "Indus-trial Hygiene and Occupational Health," April 30, 1980. Its purpose is to helpoccupational health professionals and others to recognize and evaluate healthrisks associated with workplace agent-specific exposures. Chapter 2 containsmedical surveillance procedures for workers exposed to chemical agents. Medi-cal surveillance procedures for workplace physical and biological agent expo-sures will be addressed in Chapters 3 and 4, which will be issued at a laterdate.

This manual applies to the.Office of the Secretary of Defense, the MilitaryDepartments, the Organization of the Joint Chiefs of Staff, the Unified andSpecified Commands, and the Defense Agencies (hereafter called "DoD Components").Its provisions encompass job-related medical monitoring of military and civilianworkers. The manual does not apply, however, to contractors.

The manual is effective immediately. Heads of DoD Components may issue supple-mentary instructions when necessary to provide for unique requirements withintheir respective Components.

The Navy, as the designated executive agent, shall chair a meeting of DoD Com-

ponent representatives at least annually to

1. Suggest additional agents to be considered for inclusion in the manual.

2. Develop surveillance protocols for each agent.

3. Review and update this manual.

DoD Components may obtain copies of this manual through their own publicationchannels. Other federal agencies and the public may obtain eopies from theDirector, U.S. Naval Publications and Forms Center, 5801 Tabor Avenue, Phila-delphia, Pennsylvania 19120.

Lawrence J. KorbAssistant Secretary of Defense

(M1anpower, Reserve Affairs, and Logistics)

S: •""

DoD 6055.5-M

TABLE OF CONTENTS

Page

CHAPTER 1. GENERAL INFORMATION 1-1

A. Purpose 1-1B. Scope 1-1C. Requirements 1-1

CHAPTER 2. MEDICAL SURVEILLANCE PROCEDURES FORCHEMICAL HAZARDS 2-1

2-Acetylaminofluorene 2-2Acrylamide 2-2Acrylonitrile 2-3Allyl chloride 2-44-Aminodiphenyl 2-4Ammonia 2-5Antimony Accesion FOr 2-5Arsenic (inorganic) 2-6Asbestos NTIS CRA&1 2-7Benzene DTIC TA 2-8Benzidine Unannounced 2-9Benzoyl peroxide Justification 2-9Benzyl chloride 2-10Beryllium 2-10Boron trifluoride By 2-112-Butanone Dist, ibutionfl 2-11Cadmium 2-12Carbaryl (Sevin) Availability Codes 2-12Carbon black Avail and I or 2-13Carbon disulfide Dist Special 2-14Carbon monoxidee 2-14Carbon tetrachloride 2-15Chlorine 2-15Chloroform 2-16bis-Chloromethyl ether 2-16b-Chloroprene 2-17Chromic acid 2-18Chromium (VI) 2-18Cresol 2-19Cyc lohexanone 2-201,2-Dibromo-3-Chloropropane 2-213,3-Dichlorobenzidine (and its salts) 2-214 -Dimethylaminoazobenzene 2-22Dinitro-ortho-cresol 2-23Dioxane 2-24Epichlorohydrin 2-25Ethyl butyl ketone 2-25Ethylene dibromide 2-26Ethylene dichloride 2-27Ethylene glycol dinitrate 2-27Ethyleneimine 2-28

ii

Ethylene oxide 2-28Fibrous glass 2-29Fluorides (inorgani 2-29Formaldehyde 2-30Glycidyl ethers 2-31Hexone 2-32Hydrazines 2-32Hydrogen cyanide and cyanide salts 2-33Hydrogen fluoride 2-33Hydrogen sulfide 2-34Hydroquinone 2-34Isopropyl alcohol 2-35Lead (inorganic) 2-36Malathion 2-37Mercury (inorganic) 2-37Methyl alcohol 2-38Methylene chloride 2-38Methyl chloromethyl ether 2-39Methyl (n-amyl) ketone 2-39Methyl parathion 2-404,4-Methylene bis (2-chloroaniline) 2-40a-Naphthylamine 2-41b-Naphthylamine 2-41Nickel carbonyl 2-42Nickel (inorganic) 2-42Nitric acid 2-034-Nitrobiphenyl 2-4;Nitrogen oxides 2-43Nitroglycerin 2-44N-Nitrosodimethylamine 2-44Organic tin compounds 2-45Parathion 2-462-Pentanone 2-46Phenol 2-46Phosgene 2-47Polychlorinated biphenyls 2-47b-Propiolactone 2-48Silica (crystalline) 2-48Sodium hydroxide 2-49Sulfur dioxide 2-49Sulfuric acid 2-491,1,2,2-Tetrachloroethane 2-50Tetrachloroethylene 2-50o-Tolidine 2-51Toluene 2-51Toluene-2,4,-diisocyanate 2-521,1,1-Trichloroethane 2-521,1,1,-Trichloroethylene 2-53Tungsten 2-53Tungsten carbide 2-53Vanadium 2-54Vinyl acetate 2-54Vinyl chloride 2-55Xylene 2-56Zinc oxide 2-57

iii

DoD 6055.5-M

CHAPTER 3. MEDICAL SURVEILLANCE FOR PHYSICAL HAZARDS(IN PREPARATION) 3-1

CHAPTER 4. MEDICAL SURVEILLANCE FOR BIOLOGICALHAZARDS (IN PREPARATION) 4-1

iv

DoD 6055.5-M

REFERENCES

(a) DoD Instruction 6055.5, "Industrial Hygiene and Occupational Health,"April 30, 1980

(b) Title 29, United States Code, Section 651 et seq. (1976), "OccupationalSafety and Health Act of 1970," as amended (29 CFR 1910)

V

DoD 6055.5-M

DEFINITIONS

1. Occupational Health Medical Surveillance Examination. Occupationally re-lated medical history and physical examinations and clinical laboratory tests(preplacement or baseline, special purpose periodic, and termination) that areperformed to assess the health status of individuals as related to their work.Unlike diagnostic internal medical investigations, occupational medical exam-inations are designed to produce specific information upon which decisions maybe based regarding adequacy of protection against potential workplace hazards.This examination may include

a. Occupationally Related Medical History. Information regarding an indi-vidual's medical background including occupational exposures and family andpersonal health.

b. Physical Examination. The process of medically evaluating fitness toperform work while ruling out evidence of acute and chronic injury and disease,using mainly inspection, palpation, percussion, and auscultation.

c. Clinical Laboratory Tests. Clinical tests and measurements used todetect the absorption of toxic agents, or the physiologic or pathologic effectscaused by their absorption.

2. Regulated Area. An area where entry and exit is restricted or controlledbecause of potential exposures to environmental hazards.

3. Worker. Any DoD employee, military or civilian, who may be exposed topotentially hazardous materials in the workplace.

4. Workplace. A physically definable area where work is performed. Workplacesmay be administrative, military operational, or industrial, and may be staffedby civilian or military personnel.

vi

DoD 6055.5-M

CHAPTER I

GENERAL INFORMATION

A. PURPOSE

This manual has been developed to provide occupational health professionalsand others with a useful reference, oriented toward specific chemical, physical,and biological hazards common throughout the Department of Defense, for themedical surveillance of the DoD work force. Since occupational diseases canlargely be prevented or their effects minimized through appropriate environmentaland medical surveillance, use of this manual will strengthen the DoD Components'occupational health programs. Its implementation shall satisfy the basic medicalsurveillance program prescribed in DoD Instruction 6055.5 (reference (a)) byproviding uniform procedures to help identify the health risks associated withworkplace hazards.

B. SCOPE

1. This manual summarizes existing mandatory occupational health medicalsurveillance requirements found in 29 U.S.C. 651 (reference (b)). Additionalguidance is provided to help ensure the utility of this manual as a referencefor DoD health care professionals. While the underlying intent in providingthis guidance is to encourage greater standardization in medical surveillanceprocedures, it should also help indicate both the na*ure of occupational healthmedical surveillance generally and the need for specialized occupational healthconsultation.

2. Because of the multitude of different potentially hazardous materialsfound in DoD workplaces and the variety of conditions in which exposure to themmight occur, the medical surveillance examinations recommended in this manualmay not be all-inclusive or always appropriate. The procedures contained inthis manual may, therefore, be expanded upon or otherwise modified in DoD Compo-nent-specific occupational health programs to tailor, when necessary, medicalsurveillance for specific workplaces or other exposures.

C. REQUIREMENTS

1. General

a. Industrial hygiene surveys of workplaces shall be performed toidentify all potential exposures and shall be evaluated to establish completeworkplace exposure profiles. Documentation of these activities is required.See reference (a) for additional guidance on industrial hygiene surveillance.

b. The health of exposed workers also shall be monitored by medicalsurveillance examinations, including medical and occupational histories, clin-ical and biological screening tests, and physical examinations. Examinationresults shall be documented and stored in the worker's medical record.

2. Occupational Health Medical Surveillance. Through this portion of the

DoD occupational safety and health program, the Department of Defense meets legaland regulatory requirements, assesses the effects of the workplace on the workers'

1-1

health, identifies any medical conditions that limit ability to perform assignedduties, and meets its obligation to promote full health in its military andcivilian work force.

a. Medical Surveillance

(1) T

(a) Preplacement or Baseline. These specific examinations aredesigned to assess physical capabilities and limitations in relation to job re-quirements, and to document baseline data for future use in the evaluation ofpotential exposures of DoD workers.

(b) Special Purpose Periodic. These specific examinationsare conducted at intervals to evaluate and document the health effects of occupa-tional exposures. The frequency and extent of these assessments are based on theindustrial hygiene surveillance findings that quantify the exposure or exposuresof concern, and on the findings of previous medical surveillance examinations.These periodic examinations may include interval history, limited physicalexamination, and clinical and biological screening tests. The scope of theseexaminations is determined locally after consideration of all relevant exposurefactors, the information contained in this manual, and any additional professionaland regulatory guidance.

(c) Termination. These specific examinations, performed attermination of employment, are designed to assess pertinent aspects of theworker's health. Documentation of examination results may be beneficial inassessing the relationship of any future medical problems to work or exposurein the workplace. This is particularly applicable to those conditions that arechronic or that may have long latency periods.

(2) Procedures

(a) Based on the results of industrial hygiene surveys of theworkplace and on review of previous occupational health experience and applic-able directives, the DoD Components shall administer occupational health medi-cal surveillance examinations in accordance with in DoD Instruction 6055.5(reference (a)) and this manual.

(b) Regulatory requirements prescribed in 29 U.S.C. 651 etseq. (reference (b)) for medical surveillance examinations will be contained insubsequent chapters of this manual.

(c) DoD Components also shall establish examination require-ments to determine an employee's ability to use respirators, pursuant to refer-ence (b).

(d) When there are no legal standards for medical examina-tions for specific agents, the appropriate recommendations in this manual areuseful. These guidelines were developed from National Institute for Occupational

1-2

Safety and Health publications and occupational health textbooks, and may be usedwhen

1 Workers are protected from exposures exceeding recom-mended exposure limits through the use of respirators.

2 Unprotected workers are exposed to one half or more ofa recommended exposure limit, or significant concern exists because of potentialskin absorption.

3 Workers are known to have been severely exposed aboverecommended exposure limits or are known to have had skin contact with certainchemicals during emergencies or accidents.

(e) If medical surveillance examinations are deemed inappro-priate or of little value in determining the significance of an occupationalexposure, documentation of the rationale used in making this decision shall bemaintained locally.

(3) Recordkeeping

Occupational health medical surveillance examinations shallbe recorded and maintained in accordance with DoD Instruction 6055.5 (reference(a)) and DoD Components' implementing directives.

b. Epidesiology

DoD Components shall accumulate appropriate data to allow trendanalysis and early detection of job-related abnormalities that, if undetectedand uncorrected over a working lifetime, might be associated with high risk ofimpairment, disability, or death.

1-3

DoD 6055.5-M

CHAPTER 2

MEDICAL SURVEILLANCE PROCEDURESFOR CHEMICAL HAZARDS

This chapter contains required and recommended medical surveillance examinationsfor workers occupationally exposed to chemical hazards. Th.se medical surveil-lance procedures that include a citation to 29 CFR 1910 (reference (b)) aremandatory. If there is no regulatory requirement, the guidelines in subpara-graph C.2.a.(2)(d), Chapter 1, shall be used to determine whether medicalsurveillance is needed.

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DoD 6055.5-Ml

CHAPTR 3

MEDICAL SURVEILLAN~CE PROCEDURESFOR PHYSICAL HAZARDS

(IN PREPARATION)

3-1

DoD 6055.5-M

CHAPTER 4

MEDICAL SURVEILLANCE PROCEDURESFOR BIOLOGICAL HAZARDS

(IN PREPARATION)

4-1