Screening and Surveillance: A Guide to OSHA Standards · Screening and Surveillance: A Guide to OSHA Standards NOTE TO EMPLOYERS: Please remember, more than one standard may apply

Screening andSurveillance:A Guide toOSHA StandardsU.S. Department of LaborOccupational Safety and Health Administration

OSHA 31622000 (Reprinted)

This informational booklet isintended to provide a generic,non-exhaustive overview of aparticular standards-related topic.This publication does not itselfalter or determine complianceresponsibilities, which are setforth in OSHA standards them-selves, and the OccupationalSafety and Health Act. Moreover,because interpretations andenforcement policy may changeover time, for additional guidanceon OSHA compliance require-ments, the reader should consultcurrent administrative interpreta-tions and decisions by theOccupational Safety and HealthReview Commission and thecourts.

Material contained in thispublication is in the publicdomain and may be reproduced,fully or partially, without thepermission of the FederalGovernment. Source credit isrequested but not required.

This information will be madeavailable to sensory impairedindividuals upon request. Voicephone (202) 693-2120.

Screening andSurveillance:A Guide toOSHA StandardsU.S. Department of LaborAlexis M. Herman, Secretary

Occupational Safety and Health AdministrationCharles N. Jeffress, Assistant Secretary

OSHA 31622000 (Reprinted)

The Occupational Safety and Health Admin-istration (OSHA) receives many inquiries aboutthe “medical surveillance” provisions of itsstandards. This guide is a quick reference tohelp you locate and implement the screeningand surveillance requirements of the OSHAstandards in Title 29 of the Code of FederalRegulations (29 CFR).

The guide provides a general overview ofOSHA requirements, but is not a legal authorityfor compliance with them. For full details ofspecific compliance requirements, pleaseconsult the appropriate OSHA standard in theCFR. You can access the medical surveillanceprovisions of the OSHA standards on theInternet at www.osha.gov.

Screening and Surveillance:A Guide to OSHA Standards

NOTE TO EMPLOYERS:Please remember, more than one standard

may apply in your workplace. If so, you mustmeet all the screening and surveillance require-ments for all the standards that apply. Forfurther information, contact your RegionalOSHA office listed at the end of this publicationand on OSHA’s home page on the Internet atwww.osha.gov.

ii

Contents iii

Glossary ........................................................... 1

A Guide to OSHA Standards ............................ 2Acrylonitrile .................................................... 2Arsenic ............................................................. 3Asbestos (General Industry) ............................ 4Asbestos (Construction and Shipyards) ........... 5Benzene ........................................................... 6Bloodborne Pathogens ..................................... 71, 3-Butadiene.................................................. 8Cadmium ......................................................... 9Carcinogens (Suspect) ................................... 10Coke Oven Emissions .................................... 11Compressed Air Environments ...................... 12Cotton Dust .................................................... 131,2-Dibromo-3-chloropropane ....................... 14Ethylene Oxide .............................................. 15Formaldehyde ................................................ 16HAZWOPER ................................................. 17Hazardous Chemicals in Laboratories ........... 18Lead ............................................................... 19Methylenedianiline ........................................ 20Methylene Chloride ....................................... 21Noise .............................................................. 22Respiratory Protection ................................... 23Vinyl Chloride ............................................... 24

Footnotes ....................................................... 25

OSHA Regional Offices .................................. 26

Glossary

BP - blood pressure

BUN - blood urea nitrogen

CBC - complete blood count

FEF - forced expiratory flow

FEV1 - forced expiratory volume one second

FSH - follicle stimulating hormone

FVC - forced vital capacity

HAZWOPER - Hazardous Waste Operationsand Emergency Response

HBV - hepatitis B virus

LH - luteinizing hormone

MDA - methylenedianiline

PPE - personal protective equipment

PHS or USPHS - United States Public HealthService

SGOT - serum glutamic oxalacetictransaminase

SGPT - serum glutamic pyruvictransaminase

ZPP - zinc protoporphyrin

1

Screening and Surveillance:A Guide to OSHA Standards2

Pre-placement Yes1

exam

Periodic exam Yes—annual1

Emergency/exposure Yesexamination and tests

Termination exam Yes—if no exam within6 months of termination

Examination includes Respiratory, gastrointestinal,1special emphasis on thyroid, skin, neurologicalthese body systems (peripheral and central)

Work and medical Required for all exams2

history

Chest x-ray Yes

Pulmonary function Notest (PFT)

Other required tests Fecal occult blood1

Evaluation of Yesability to weara respirator

Additional tests Yesif deemed necessary

Written medical Yes—physician to employer;opinion employer to employee

Employee counseling Yes—by physicianre: exam results,conditions of increasedrisk

Medical removal plan No

Standard Requirements

Acrylonitrile1910.1045(n)/1926.1145/1915.1045*

3

Pre-placement Yes1

exam

Periodic exam Yes1



Examination includes Skin, nasalspecial emphasis onthese body systems

Work and medical Required for all exams2 withhistory focus on respiratory symptoms;

includes smoking history

Chest x-ray Yes


Other required tests No






Arsenic (Inorganic)1910.1018(n)/1926.1118/1915.1018*




Pre-placement Yes1, 3

exam


Emergency/exposure Noexamination and tests

Termination exam Yes—within ± 30 days oftermination

Examination includes Respiratory, cardiovascular,special emphasis on gastrointestinalthese body systems

Work and medical Required for all exams2;history standardized form required;

see standard, Appendix D

Chest x-ray Yes1—B reader, board eligible/certified radiologist or physicianwith expertise in pneumoconiosesrequired; see standard, Appendix Efor x-ray interpretation andclassification requirements

Pulmonary function FVC, FEV1test (PFT)





Employee counseling Yes—by physician; includesre: exam results, informing employee of increasedconditions of increased risk of lung cancer from combinedrisk effect of smoking and asbestos

exposure



Asbestos (General Industry)1910.1001(l)

5

Asbestos (Construction and Shipyards)1926.1101(m)/1915.1001



exam

Periodic exam Yes — annual1 or more frequentlyif determined by physician


Termination exam No

Examination includes Pulmonary and gastrointestinalspecial emphasis onthese body systems

Work and medical Required for all exams2; specialhistory emphasis on pulmonary,

cardiovascular, gastrointestinal;standardized form required; seestandard, Appendix D

Chest x-ray Yes1 — B reader, board eligible/certified radiologist or physicianwith expertise in pneumoconiosesrequired; see standard, Appendix Efor x-ray interpretation andclassification requirements






Employee counseling Yes—by physician; includesre: exam results, informing employee of increasedconditions of increased risk of lung cancer from combinedrisk effect of smoking and asbestos

exposure




Pre-placement Yes1,3, 4

exam

Periodic exam Yes—annual1, 4

Emergency/exposure Yes1, 4—includes urinary phenolexamination and tests test

Termination exam No

Examination includes Hemopoietic; addspecial emphasis on cardiopulmonary if respiratorythese body systems protection used at least 30 days/

year, (initially, then every 3 years)

Work and medical Required for initial and periodichistory exams (pre-placement exam

requires special history)2

Chest x-ray No

Pulmonary function Initially and every 3 years iftest (PFT) respiratory protection used 30

days/year; specific testerrequirements

Other required tests CBC, differential, other specificblood tests; repeated as required;see standard

Evaluation of Yes—if respirators are usedability to weara respirator




Medical removal plan Yes


Benzene1910.1028(i)/1926.1128/1915.1028*

7

Pre-placement No—must offer Hepatitis B (HBV)exam vaccine unless already immune or

vaccine contraindicated

Periodic exam No

Emergency/exposure Specific post-exposure monitoringexamination and tests for employee and source;

HBV vaccine; see standard

Termination exam No

Examination includes Nospecial emphasis onthese body systems

Work and medical Nohistory

Chest x-ray No


Other required tests Yes—post-exposure incident;follow US Public Health Service(USPHS) post-exposure protocols

Evaluation of Noability to weara respirator

Additional tests Yes—for post-exposure incident;if deemed necessary follow USPHS post-exposure

protocols

Written medical Yes—licensed health careopinion professional to employer;

employer to employee

Employee counseling Yes—by licensed health carere: exam results, professional; counseling re: HBVconditions of increased vaccine and post-exposurerisk followup; see standard



Bloodborne Pathogens1910.1030(f)



Pre-placement Yes1, 3, 4

exam

Periodic exam Yes1, 4

Emergency/exposure Yes1,4—within 48 hours ofexamination and tests exposure

Termination exam Yes4—if 12 months haveelapsed since last exam

Examination includes Liver, spleen, lymph nodes,special emphasis on and skinthese body systems

Work and medical Required annually and for allhistory examinations2; standardized

form or equivalent; includescomprehensive occupationaland health history; seestandard, Appendices F and C

Chest x-ray No


Other required tests CBC with differential andplatelet count, annually; alsowithin 48 hrs after exposure inan emergency situation andrepeated monthly for 3 moremonths

Evaluation of Yes—if respirators are usedability to weara respirator


Written medical Yes—physician or otheropinion licensed health care

professional to employer andemployee

Employee counseling Yes—by physician or otherre: exam results, licensed health careconditions of increased professionalrisk


1, 3-Butadiene1910.1051(k)/1926.1151*


9


exam

Periodic exam Yes1,4

Emergency/exposure Yes1,4

examination and tests

Termination exam Yes3—see standard for timeframe and other specifics

Examination includes Respiratory, cardiovascular (BP),special emphasis on urinary, and for males over 40—these body systems prostate palpation1

Work and medical Required for preplacement andhistory periodic exams2; standardized form

required

Chest x-ray Yes


Other required tests Annually,1 cadmium in urine,beta-2 microglobulin in urine,cadmium in blood, CBC, BUN,serum creatinine, urinalysis; seestandard


Additional tests if Yesdeemed neccessary


Employee counseling Yes—by physician; includesre: exam results, explanation of results, treatment,conditions of increased and diet, and discussion ofrisk decisions re: medical removal;

see standard for details



Cadmium1910.1027(l)/1926.1127/1915.1027/1928.1027*



Pre-placement Yesexam

Periodic exam Yes—annual

Emergency/exposure Yes1—special medicalexamination and tests surveillance begins within

24 hours

Termination exam No

Examination includes Exam includes determinationspecial emphasis on for increased risk (e.g.,these body systems treatment with steroids or

cytotoxic agents, reducedimmunological competence,pregnancy or cigarettesmoking)

Work and medical Required for all examinations;history includes family and

occupational history, geneticand environmental factors

Chest x-ray No



Evaluation of Yes—as specified in theability to wear respiratory protection standard

1910.134(e), if respiratorsare used


Written medical Yes—physician to employeropinion

Employee counseling Nore: exam results,conditions of increasedrisk



Carcinogens (Suspect)1910.1003-1016(g)/1926.1103/1915.1003-1016*

11

Pre-placementexam Yes1

Periodic exam Yes1


Termination exam Yes—if no exam within 6 monthsof termination

Examination includes Skinspecial emphasis onthese body systems

Work and medical Required for all exams2; includeshistory smoking history and presence and

degree of respiratory symptoms

Chest x-ray Yes


Other required tests Weight, urine cytology, urinalysisfor sugar, albumin, hematuria


Additional tests if Yes—see standard, Appendix Bdeemed neccessary


Employee counseling Yes—by physician; also, employerre: exam results, must inform employee of possibleconditions of increased health consequences if employeerisk refuses any required medical exam



Coke Oven Emissions1910.1029(j)




Periodic exam Yes1


Termination exam No

Examination includes Not specifiedspecial emphasis onthese body systems

Work and medical Nohistory

Chest x-ray No




Additional tests Noif deemed necessary

Written medical Noopinion



Compressed Air Environments1926.803(b)


13

Pre-placement Physical exam not specified;exam other tests required

Periodic exam Physical exam not specified;other tests required1,4


Termination exam No


Work and medical Medical history; standardizedhistory questionnaire required; see

standard, Appendix B-11,2, 4

Chest x-ray No

Pulmonary function FVC, FEV1, FEV1/FVCtest (PFT) Employees with specific

abnormalities are referred tospecialists1,4, 5



Additional tests Noif deemed necessary


Employee counseling Yes—by physician re: resultsre: exam results, of exam and any medicalconditions of increased conditions requiring furtherrisk examination or treatment

Medical removal plan Yes—for inability to wear arespirator (6 months)


Cotton Dust1910.1043(h)




Periodic exam Yes1

Emergency/exposure Yes—male reproductive;examination and tests repeat in 3 months

Termination exam No

Examination includes Reproductive, genitourinary; seespecial emphasis on standard for detailsthese body systems

Work and medical Required for all exams2; includeshistory reproductive history; see standard,

Appendix C

Chest x-ray No


Other required tests Sperm count, FSH, LH, Totalestrogen (females); see standard,Appendix C for guidelines

Evaluation ofability to wear Yesa respirator





1,2-Dibromo-3-chloropropane1910.1044(m)/1926.1144/1915.1044*


15

Pre-placement Yes1

exam


Emergency/exposure Yes1


Termination exam Yes1

Examination includes Pulmonary, skin, neurologic,special emphasis on hematologic, reproductive, eyesthese body systems

Work and medical Required for all exams; includeshistory reproductive history and special

emphasis on some body systems;see standard

Chest x-ray No


Other required tests CBC, white cell count withdifferential, hematocrit, hemoglobin,red cell count; if requested byemployee, pregnancy testing andfertility testing (female/male)will be added to the exam asdeemed appropriate by physician






Ethylene Oxide1910.1047(i)/1926.1147*





exam

Periodic exam Yes1,4



Termination exam No

Examination includes Evidence of irritation orspecial emphasis on sensitization of skin, respiratorysystems these body system, eyes; shortness of breath

Work and medical Required for all exams2;history questionnaire required;

see standard, Appendix D

Chest x-ray No

Pulmonary function FVC, FEV1, FEF should betest (PFT) evaluated if respiratory protection

is used





Employee counseling Yes—by physician; includesre: exam results, information on whether medicalconditions of increased conditions were caused by pastrisk exposures or emergency

exposures



Formaldehyde1910.1048(l)/1926.1148/1915.1048*

17

Pre-placement Yes1

exam

Periodic exam Yes—annually or at physician’sdiscretion1



Termination exam Yes—if no exam within 6 monthsof termination/reassignment

Examination includes Determined by physician; seespecial emphasis on standard, Appendix D, referencethese body systems 10 for guidelines

Work and medical Yes—with emphasis onhistory symptoms related to handling

hazardous substances and healthhazards, fitness for duty andability to wear PPE2

Chest x-ray No—unless determined byphysician

Pulmonary function No—unless determined bytest (PFT) physician

Other required tests No—unless determined byphysician







HAZWOPER1910.120(f)/1926.65*



Pre-placement When required by other standardsexam

Periodic exam When required by other standards



Termination exam No


Work and medical When required by other standardshistory

Chest x-ray When required by other standards

Pulmonary function When required by other standardstest (PFT)

Other required tests When required by other standards

Evaluation of Yes—when required by otherability to wear standardsa respirator

Additional tests When required by other standardsif deemed necessary

Written medical Yes—physician to employeropinion



Hazardous Chemicals in Laboratories1910.1450(g)


19

Pre-placement Yes1,4 except in constructionexam industries; construction requires

initial blood tests only


Emergency/exposure Yes1, 4


Termination exam No

Examination includes Teeth, gums, hematologic, gastro-special emphasis on intestinal, renal, cardiovascularthese body systems (BP), neurological; pulmonary

status if respiratory protection used

Work and medical Required for all exams2; includeshistory reproductive history, past lead

exposure, both work/non-work,and history of specific bodysystems; see standard

Chest x-ray No

Pulmonary function No—unless deemed necessarytest (PFT) by physician

Other required tests Hemoglobin, hematocrit, ZPP,BUN, serum creatinine, urinalysiswith micro, blood-lead levels,peripheral smear morphology,red cell indices1, 5; if requested byemployee, pregnancy testing andfertility testing (female/male)




Employee counseling Yes—by physician; includesre: exam results, advising the employee of anyconditions of increased medical condition, occupationalrisk or non-occupational, requiring

further medical examination ortreatment


Lead1910.1025(j)/1926.62*





exam

Periodic exam Yes—annual1, 4

Emergency/exposure Yes1, 4


Termination exam No

Examination includes Skin, hepaticspecial emphasis onthese body systems

Work and medical Required for all examinations2;history includes past work with MDA and

other specific items; see standard

Chest x-ray No


Other required tests Liver function tests, urinalysis






Methylenedianiline1910.1050(m)


21

Pre-placement Yes1,4

exam


Emergency/exposure Yes4—see standard for specificsexamination and tests


Examination includes Lungs, cardiovascular (includingspecial emphasis on BP and pulse), liver, nervous, skin;these body systems extent of exam determined by

examiner based on employee’shealth status, work, andmedical history

Work and medical Required for all exams; examplehistory of work and medical history form

provided in standard, Appendix B

Chest x-ray No

Pulmonary function No—unless deemed necessaryby physician or other licensedhealth care professional

Other required tests Laboratory surveillance mayinclude tests as determined byexaminer including “before andafter shift tests”; see standard,Appendix B

Evaluation of Yes—as specified under theability to wear respiratory protection standarda respirator 1910.134(e)


Written medical Yes—physician or other licensedopinion health care professional to

employer and employee

Employee counseling Yes—by physician or otherre: exam results, licensed health care professionalconditions of increasedrisk



Methylene Chloride1910.1052(j)/1926.1152*



Pre-placement No physical exam but audiometricexam testing required

Periodic exam No physical exam but audiometrictesting required


Termination exam No physical exam but audiometrictesting required

Examination includes Nospecial emphasis onthese body systems

Work and medicalhistory No

Chest x-ray No


Other required tests Initial and annual audiometrictesting1, 4, 5; see standard re:specific qualifications for the testadministrator



Written medical Noopinion

Employee counseling Yes—if standard threshold shiftre: exam results, or suspected ear pathologyconditions of increasedrisk


Noise1910.95(g)/1926.52†


23

Pre-placement Evaluation questionnaire or exam;exam followup exam when required5

Periodic exam Yes—in specific situations5


Termination exam No

Examination includes Yes5—see standard, Appendix Cspecial emphasis onthese body systems

Work and medical Yes2—see standard, Appendix Chistory

Chest x-ray As determined by physician orother licensed health careprofessional

Pulmonary function As determined by physician ortest (PFT) other licensed health care

professional

Other required tests As determined by physician orother licensed health careprofessional



Written medical Yes—physician or other licensedopinion health care professional to

employer and employee

Employee counseling Yes—by physician or otherre: exam results, licensed health care professionalconditions of increasedrisk



Respiratory Protection1910.134(e)/1926.103*



Pre-placement Yes1

exam

Periodic exam Yes1


Termination exam No

Examination includes Special attention to detectingspecial emphasis on enlargement of the liver, spleen orthese body systems kidneys, or dysfunction of these

organs and abnormalities in skin,connective tissue, and pulmonarysystem; see standard, Appendix A

Work and medical Required for initial and periodichistory exams2; includes alcohol intake,

history of hepatitis, exposure tohepatotoxic agents, bloodtransfusions, hospitalizations, andwork history

Chest x-ray No


Other required tests Blood test for total bilirubin,alkaline phosphatase, SGOT, SGPTand gamma glustamyltranspeptidase






Vinyl Chloride1910.1017(k)/1926.1117*


25

1 Pre-placement and periodic examinations aredependent upon specific factors cited in thestandard such as airborne concentrations of thesubstance and/or years of exposure, biologicalindices, age of employee, amount of timeexposed per year. In addition, some standardsrequire periodic exams to be conducted atvarying time intervals. Refer to standard forcomplete details.

2 Standard requires medical and work historyfocused on special body systems, symptoms,personal habits, and/or specific family, environ-mental or occupational history. Refer to standardfor complete details.

3 No examination required if previous examina-tion done within specified time frame (e.g., 6months or 12 months) and provisions of standardmet. Refer to standard for details.

4 Additional physician review: Some standardshave provisions for referring employees withabnormalities to a specialist as deemed neces-sary by examiner. Other standards have provi-sions for multiple physician review. See specificstandard for details.

5 Standard requires specific protocol.See standard for details.

*These Maritime and Construction standards areidentical to 29 CFR 1910, General Industrystandards.

†1926.52 requires an effective and continuedhearing conservation program. OSHA hasinterpreted this to include audiograms whenfeasible. See letter of interpretation datedAugust 4, 1992.

Footnotes

26

Region I(CT,* MA, ME, NH, RI, VT*)JFK Federal BuildingRoom E-340Boston, MA 02203Telephone: (617) 565-9860

Region II(NJ, NY,* PR,* VI*)201 Varick StreetRoom 670New York, NY 10014Telephone: (212) 337-2378

Region III(DC, DE, MD,* PA, VA,* WV)The Curtis Center-Suite 740 West170 S. Independence Mall WestPhiladelphia, PA 19106-3309Telephone: (215) 861-4900

Region IV(AL, FL, GA, KY,* MS, NC,* SC,* TN*)Atlanta Federal Center61 Forsyth Street, SW, Room 6T50Atlanta, GA 30303Telephone: (404) 562-2300

Region V(IL, IN,* MI,* MN,* OH, WI)230 South Dearborn StreetRoom 3244Chicago, IL 60604Telephone: (312) 353-2220

OSHA Regional Offices

Region VI(AR, LA, NM,* OK, TX)525 Griffin StreetRoom 602Dallas, TX 75202Telephone: (214) 767-4731

Region VII(IA,* KS, MO, NE)City Center Square1100 Main Street, Suite 800Kansas City, MO 64105Telephone: (816) 426-5861

Region VIII(CO, MT, ND, SD, UT,* WY*)1999 Broadway, Suite 1690Denver, CO 80202-5716Telephone: (303) 844-1600

Region IX(American Samoa, AZ,* CA,* Guam,HI,* NV,* Trust Territories of the Pacific)71 Stevenson Street4th FloorSan Francisco, CA 94105Telephone: (415) 975-4310

Region X(AK,* ID, OR,* WA*)1111 Third AvenueSuite 715Seattle, WA 98101-3212Telephone: (206) 553-5930

*These states and territories operate their own OSHA-approved job safety and health programs (Connecticut andNew York plans cover public employees only). States withapproved programs must have a standard that is identical to,or at least as effective as, the federal standard.

27

Documents

Screening and Surveillance: A Guide to OSHA Standards · Screening and Surveillance: A Guide to OSHA Standards NOTE TO EMPLOYERS: Please remember, more than one standard may apply