employee medical monitoring · employee medical monitoring program page 2 of 21 benzene ionizing...

Employee Medical Monitoring

Program

A Subsection to the University Injury and Illness Prevention Program Per California Code of Regulations Title 8 §5097, §5142 - 5223 and §3203

CSU Executive Order #1039 CSU EMMPM, §1.3 and §1.4

CALIFORNIA STATE UNIVERSITY, STANISLAUS Employee Medical Monitoring Program

Table of Contents 1.0 Regulatory Authority ........................................................................................................................ 1

2.0 Administrative Agency ...................................................................................................................... 1

3.0 Background ........................................................................................................................................ 1

4.0 Scope ................................................................................................................................................... 1

5.0 Policy ................................................................................................................................................... 2

6.0 Responsibilities................................................................................................................................... 2

6.1 Safety & Risk Management (S&RM): ..................................................................................... 2

6.2 Directors/Supervisors/Department Chairs: ............................................................................. 2

6.3 Occupational Physician’s: ......................................................................................................... 2

6.4 Human Resources: ..................................................................................................................... 2

6.5 Employee: .................................................................................................................................... 3

7.0 Employee Medical Records and Confidentiality ............................................................................ 3

7.1 Access........................................................................................................................................... 3

7.2 Retention, Recordkeeping and Confidentiality ....................................................................... 3

7.3 Definition of Medical and Exposure Records .......................................................................... 4

8.0 Medical Monitoring Program Operations ...................................................................................... 5

8.1 Objectives .................................................................................................................................... 5

8.2 Administration ............................................................................................................................ 5

8.3 Examination Frequency ............................................................................................................. 5

8.4 Routine Examinations ................................................................................................................ 6

8.5 Special Examinations ................................................................................................................. 7

9.0 Examination Protocols ...................................................................................................................... 7

9.1 Comprehensive Medical Examination ..................................................................................... 7

9.2 Additional Tests as Required .................................................................................................... 8

ANNEX – SPECIFIC STANDARDS AND PROTOCOLS ................................................................ 10

A. Occupational Noise (T8 CCR §5097) ...................................................................................... 10

B. Respiratory Protection (T8 CCR §5144) ................................................................................ 11

C. Lead (T8 CCR §5208 & §5216) ............................................................................................... 12

D. Bloodborne Pathogens (T8 CCR §5193) ................................................................................ 13

E. Asbestos (T8 CCR §5208) ........................................................................................................ 14

F. Pesticides (T8 CCR §6728) ...................................................................................................... 15

G. Formaldehyde (T29 CFR §1910.1048 App C) ....................................................................... 16

H. Lasers (8 CCR §3203 and ANSI Z136.1)................................................................................ 16

I. Respirable Crystalline Silica (8 CCR §5204)............................................................................. 17


J. Radiation (10 CFR 20 and 17 CCR) ........................................................................................... 18

K. Laboratory Employees (8 CCR §5191) .................................................................................. 18

L. Animal Handlers (8 CCR §5097, §5144, §5191, §5209, and §5217) ..................................... 19

M. Aerosol Transmissible Diseases including Tuberculosis (8 CCR §5199 and §5144) .......... 20


Page 1 of 21

1.0 Regulatory Authority

Code of Federal Regulations (CFR) Title 29 §1910, Title 40; California Code of Regulations (CCR) Title 3, Title 8 §5097 Hearing Conservation, 5142 – 5223 Control of Hazardous Substances, and §3203 Injury and Illness Prevention Program; CSU Employee Medical Monitoring Plan Management §1.3 and 1.4; CSU Executive Order 1039 §C

2.0 Administrative Agency

California Division of Occupational Safety and Health (DOSH), Department of Industrial Relations (Cal/OSHA) 3.0 Background

Medical surveillance in the occupational setting is the systematic collection and analysis of the health information on groups of workers potentially exposed to harmful agents, for the purpose of identifying health effects at an early and hopefully reversible stage. Biological monitoring, or the measurement of tissue levels of contaminants or metabolites, is often included as part of a medical monitoring program, even though these tests do not measure adverse health effects.

The California Code of Regulations (CCR) requires that employees with potential exposures to certain harmful agents shall receive medical monitoring examinations. These examinations serve the purpose of detecting adverse health effects which could possibly be related to workplace exposures. Early detection of disease will result in earlier treatment and will allow for cessation of additional exposures that could aggravate a potentially serious medical condition. In addition to monitoring of employee health, biological monitoring may also be necessary. Biological monitoring provides a correlation between external exposures and internal exposure. Biological monitoring provides a reliable indication of health risk to an individual worker.

4.0 Scope Medical physical examinations are required for employees in the following categories:

• Police Officers, pre-employment per California Peace Officer Standards and Training • Employees exposed to specific chemical and physical agents as defined in the CCR and CFR

Employees with occupational exposure to the following conditions and chemicals may be placed in the Employee Medical Monitoring Program (EMMP). Those in the EMMP should have a physical for pre-placement, during probation, whenever an identified hazard is introduced to the job, annually thereafter and for post-employment. Acrylonitrile Confined Space Entry Lead Aerosol Transmissible Diseases Ethylene Oxide Occupational Noise Animal Handlers Formaldehyde Pesticides/Pest Control

Operations Asbestos Hazardous Waste Handling Respirable Crystalline Silica


Page 2 of 21

Benzene Ionizing Radiation Respirator Use Carcinogens Lasers Vinyl Chloride

5.0 Policy

It is the policy of the CSU that medical examinations mandated by federal and state laws and regulations be enforced by each campus. Failure or refusal of an employee to undergo required medical testing, as determined by campus management, shall constitute a failure or refusal to perform the normal and reasonable duties of the position. In such event, the campus has the authority to commence appropriate disciplinary action, up to and including, termination of employment. 6.0 Responsibilities

6.1 Safety & Risk Management (S&RM):

a. Develop and administer the EMMP procedures. b. Manage the medical exam budget, and approve all medical exams by issuing a Medical

Monitoring Order form prior to scheduling the exams. c. Determine which employee job classifications meet the meet the medical monitoring criteria. d. Act as liaison between the examining facility and the employee. e. Coordinate schedules with Departments, employees, and the exam facility. f. Schedule exit exams, as appropriate, for medically monitored employees who are separating

employment with Stanislaus State.

6.2 Directors/Supervisors/Department Chairs: a. Identify newly hired employees that require medical monitoring, based on their job

classification and notify S&RM for their inclusion in the medical monitoring program. b. Ensure that employees follow through, obtain and continue with medical monitoring as

directed by S&RM.

6.3 Occupational Physician’s: a. Report all medical findings to S&RM as soon as possible after the exam. If the physician

feels additional tests are needed, their recommendations should accompany the report of findings.

b. Not decide whether the applicant shall be employed or whether the employee shall continue to be employed. The physician merely determines whether or not the applicant/employee measures up to the medical standard set forth by Stanislaus State specific to their work.

6.4 Human Resources: a. Notify S&RM prior to separation of any employee, so that an exit exam may be scheduled, if

required.


Page 3 of 21

6.5 Employee: a. Read and understand the University EMMP. b. Complete the medical monitoring examinations as directed by S&RM and their department. c. Follow up on any non-work-related guidance provided by the Occupational Physician during

medical monitoring. 7.0 Employee Medical Records and Confidentiality

7.1 Access Employees, their designated representatives, and authorized representatives of Cal/OSHA have full right of access to relevant exposure and medical records. Designated representatives must be given the employees written authorization to exercise the right of access. The legal representative of a deceased or legally incapacitated employee may exercise full right of access to all of an employee’s medical record.

All requests for employee medical or exposure records shall be in writing to the University Medical Record Custodian. A copy or the requested records shall be provided to the employee or designated representative at no cost and no later than fifteen (15) days after the request is made. In the case of an original x-ray, access shall be restricted to on-site examination. Whenever a record has previously been provided without cost to the employee or designated representative, the university may charge for the record search and the cost of additional copies.

In the rare case that a request for records is denied, the employee may appeal the denial to the Division of Occupational Safety and Health (DOSH), State of California. The Chief of DOSH will adjudicate on the appeal and may issue an order to release the information to the employee or their designated representative. Designated representatives must be given the employee’s written authorization to exercise rights of access. A written authorization shall contain the following:

a. The name and signature of the employee authorizing the release of the medical information. b. The date of the written authorization. c. The name of the individual or organization authorized to release the medical information. d. The name of the individual or organization authorized to receive the medical information. e. A general description of the medical information that is authorized to be released. f. A general description of the purpose for release of the medical information, and a date or

condition upon which the written authorization will expire. The employee or representative will be provided a copy of the requested medical records at no charge to the employee.

7.2 Retention, Recordkeeping and Confidentiality

An important part of the Employee Medical Monitoring Program (EMMP) is the confidentiality of the medical and exposure records generated by the program. This program has been carefully designed to ensure that the medical information for individual employees be made available only to medical professionals (including medical records services personnel) and the employee. Specifically, individual medical information is not available to Stanislaus State management


Page 4 of 21

personnel, and in the absence of a subpoena, will not be made available to any person other than the employee or their designated representative of State or Federal regulatory agencies, e.g. Cal/OSHA.

The only information kept on file at the University is a cover-letter describing the employee’s medical qualification to perform regular work, a description of work restrictions (if any) and the names of tests completed by the occupational medicine provider. To ensure that the employee has a complete understanding of these confidentiality procedures and the limited uses that will be made of the employee’s medical data, each employee enrolled in the EMMP is given an Authorization for Use or Disclosure of Health Information form by the occupational medicine provider. Employees are asked to sign the form before beginning an exam. The signed authorization form allows the occupational medicine provider to send the records to the campus. Often, an employee may have undergone a previous medical examination. This information may be of value to the physician performing the exam. If the employee authorizes, copies of these former records may be obtained. The form, Authorization for Use or Disclosure of Health Information, is to be used for this purpose. Medical and exposure records are maintained for 30 years after the termination of employment at Stanislaus State.

7.3 Definition of Medical and Exposure Records

a. Medical records include the following:

1. Medical and employment questionnaires and histories. 2. The results of medical examinations and laboratory tests. 3. Medical opinions and diagnosis, progress rates and recommendations. 4. First aid records. 5. Description of treatment and prescriptions. 6. Employee medical complaints.

b. Medical records do not include medical information in the form of:

1. Physical specimens (e.g. blood or urine samples) which are routinely discarded as part of normal medical practice.

2. Records created solely in preparation for litigation which are protected from discovery under applicable rules of procedure on evidence.

3. Records concerning voluntary employee assistance programs.

c. Exposure records 1. A record containing measurements or monitoring results of the amount of a toxic

substance or harmful physical agent to which the employee is or has been exposed. 2. In the absence of directly relevant records, records of other employees with past or

present job duties or working conditions related to or similar to those of the employee, may be used to indicate the amount and nature of the toxic substances or harmful physical agents to which the employee is or has been subjected.


Page 5 of 21

3. Exposure records to the extent necessary to reasonably indicate the amount and nature of the toxic substance or harmful physical agent at workplaces or working conditions to which the employee is being assigned or transferred.

8.0 Medical Monitoring Program Operations

8.1 Objectives

a. Evaluate the health status of potential employees, and determine whether they can perform

the job in a safe and effective manner. b. Detect exposure-related adverse health effects at an early and hopefully reversible stage so

that occupational diseases can be prevented, and proper medical care can be rendered, if necessary.

c. Periodically assess employee suitability for ongoing or new assignments that involve potential contact with hazardous agents.

d. Correlate past occupational or environmental exposures with future workplace activities and exposures, to arrive at an opinion on the risk that the job might represent to the health status of the individual.

e. Provide a medical monitoring program that complies with all the pertinent Federal, State, and local regulations.

f. Identify unrecognized effects of exposure by continually evaluating group employee health data to detect possible adverse health trends.

8.2 Administration

a. Supervisors determine the potential need for employee physicals based on job description

and hazard analysis. b. Once need is determined, supervisors coordinate with S&RM and provide pertinent

employee information. c. S&RM will schedule the exams with the contracted occupational medicine provider and

notify the supervisor and employee of date/time/instructions. d. The Department, for whom the employee works, is financially responsible for the total cost

of exams, screening, tests, etc.

8.3 Examination Frequency a. The Initial Baseline Examination - The purpose of the baseline examination is pre-

placement or probationary screening. All affected employees shall be given a baseline examination before being assigned to work with respirators or in occupations with known potentially hazardous exposures or Cal/OSHA regulated substances.

b. Periodic/Annual Examination - All personnel who have taken the initial pre-placement examination and have reviewed clearance by the examining physician shall be re-examined periodically in accordance with hazard-specific regulations. The date of each periodic examination should fall on or as closely as possible to, the anniversary of the previous examination.


Page 6 of 21

Any employee who has not participated in potentially hazardous work or who is no longer required to use a respirator during the 12-month period following his/her last annual examination, and who is not expected to continue to participate, may discontinue participation in the medical monitoring program as determined by the S&RM Officer and the employee’s appropriate administrator/supervisor.

Record must be kept by S&RM clearly documenting the reasoning and approval for each individual discontinuation of participation.

c. Exit Examination - An exit examination shall be given to any employee whose employment has included contact with OSHA regulated agents and who has been a participant in medical monitoring. If a medical exam has been administered within one year of exit, this requirement may be waived in certain cases. However, the employee must have a termination (of program inclusion) physical examination and not have been exposed to asbestos or Cal/OSHA regulated carcinogens during this period.

d. Special/Emergency Examination (situational medical clearance) - Special testing may be required on certain projects due to the potential for exposure to specific substances. This may be necessary where the potential for heat or cold stress exists, or after an exposure that results in a toxicity reaction. The need for special testing will be assessed on an ongoing basis. Emergency testing may be necessary in the event the of employee exposure.

e. Overdue Exams – If an employee misses a required medical monitoring exam that has been scheduled by S&RM, they will be notified along with their immediate supervisor within a month of the missed exam. Subsequent notifications will be raised to a higher level of management.

f. Physician’s reports - Examining physicians will use the information provided by the employee in the questionnaire, the examination results, and the results of the laboratory tests to determine if any work restrictions or occupational health problems appear to be present. The physician must send a report of the examination directly to the employee as well as the S&RM Officer who will maintain the employees’ records. These records are confidential and can only be viewed by the employee, the employee’s representative, and authorized representatives of the Chief of the Division of Occupational Safety and Health.

Non-work-related health issues may arise during the course of the medical evaluation. The examining physician may recommend that employees see their family doctor or a specialist. Any additional tests required to investigate non-work-related health issues will be the employee’s responsibility.

8.4 Routine Examinations

a. S&RM identifies employees covered by these regulations and coordinates the completion of

baseline, periodic/annual and exit examinations with the employee or his or her supervisor. b. S&RM completes the Employee Medical Monitoring Examination Appointment form, which

includes pre-examination instructions. One copy is given to the employee; another is sent to the employee’s appropriate administrator.

c. S&RM prepares a package for the employee that includes: 1. Medical Monitoring Program Exam Appointment and Pre- Examination Instructions.


Page 7 of 21

2. Authorization to Release Medical Information Form. 3. Authorization to release Previous Medical Information (if applicable). 4. Physical Examination Form. 5. The Health Status Report Form. 6. The Employee Medical Examination Findings Form.

d. The employee completes all applicable forms prior to the examination and observes the pre-exam instructions.

e. The employee attends the appointment. f. The examining Physician completes Health Status Report Form and forwards it to S&RM. g. The examining Physician prepares the Employee Medical Findings Form and forwards it

directly to the employee. h. The examining Physician forwards records to the S&RM Officer. i. S&RM reviews the Health Status Review Form and initiates appropriate action.

8.5 Special Examinations If situations arise in which an employee may have experienced a hazardous exposure or alleges symptoms, S&RM will evaluate the potential workplace problems and arrange for appropriate medical diagnosis and treatment if indicated or required. S&RM will contact the examining physician who will coordinate investigations and treatment to determine if overexposure to a hazardous substance has occurred. A Supervisor Report of Injury detailing the hazardous exposure will be completed by the appropriate administrator and forwarded to S&RM.

9.0 Examination Protocols

9.1 Comprehensive Medical Examination

a. Identification provided: Name, birthdate, gender, job title, department, etc. b. Personal medical history:

1. Medications 2. Allergies 3. Illness, injuries, hospitalizations, surgeries 4. Smoking, alcohol, drug histories 5. Medical conditions; specifically, lung disease, heart disease, liver disease, skin

conditions, neurological condition c. Family medical history: specifically, cancers and lung, heart, liver, kidneys or neurological

diseases d. General Appearance and Physical Development and Posture: Height and weight are

recorded. 1. Head-Eyes: Titimus vision testing including near, far, color vision and depth, lateral

phoria, esophoric, exphoric and vertical phoria (right and left hemisphere) and peripheral vision. Also noting ptosis, discharge, visual fields, ocular muscle imbalance, presence of corneal scarring, exophthalomos or srabismus uncorrected by corrective lenses. If the applicant wears contact lenses, it will be noted whether they have good tolerance and has


Page 8 of 21

adapted to their use. All vision testing is done without corrective lenses and then with the corrective lenses. This is done in order to determine a baseline vision as well as effectiveness of corrective lenses. Note that certain positions do not allow the use of contact lenses.

2. Ears: Audiometric tests shall be pure tone, air conduction, hearing threshold examinations with test frequencies including as a minimum, 500, 1000, 2000, 3000, 4000 and 6000 Hz. Tests at each frequency shall be taken separately for each ear. Audiometric screening should meet specifications of, and be maintained and used in accordance with ANSI, S 3.6-1969. Audiometry testing room should meet the requirements for maximum allowable octave-band sound pressure levels for audiometric test rooms. In addition, audiometric calibration should be checked acoustically on an annual basis according to Title 8 California Code of Regulations, § 5097 Appendix D. Ear examination also includes noting any evidence of mastoid or middle ear disease, discharge symptoms of aural vertigo or Meniere’s Syndrome.

3. Throat: Examination includes detection of any deformities of the throat, larynx, masses or nodes which may interfere with normal breathing and eating.

4. Heart: Auscultation by stethoscope for heart sounds, presence of murmurs, clicks, rubs, additional heart sounds and dysrhythmias. PMI will be ascertained and full cardiac history is obtained for symptoms such as dyspnea, palpitations, syncope. Blood pressure determinations are also made.

5. Pulmonary: Examination of lungs and thoracic area. Breath sounds are examined specifically noting any signs of chronic obstructive pulmonary disease, congestive heart failure and history of lung disease like asthma or bronchitis.

6. Gastrointestinal System: Complete history, and current signs and symptoms will be noted. Noting will be made specifically for presence of hernia, scars, weakness or injuries, location, size and character of any abdominal masses. Bowel sounds will also be noted. A rectal examination with stool guaiac will be obtained on all male employees over 50 years of age.

7. Genitourinary: Examination for presence of infection or other abnormal findings including urinalysis (noting uncontrolled diabetes, presence of albumin).

8. Neurological: Examination includes pupil reflexes for light and accommodation, sensory, vibratory and positional movements.

9. Extremities: Close examination of all extremities for color, warmth, presence of peripheral pulses and skin tugor. Any deformities, paralysis or varicose veins and leg muscle weakness will be documented.

10. Spine: History of pain, injuries, and physical examination for deformities will be performed.

9.2 Additional Tests as Required

a. Resting 12-lead Electrocardiogram: Electrocardiograms will be read by a Board-Certified

Cardiologist. b. Treadmill EKG: or MASTER STEP TEST c. Pulmonary Function Testing: To include (at the discretion of the examining physician):

a. FVC- Forced Vital Capacity b. FEV 1.0-Forced Expired Volume in one second c. FEV 3.0-Forced Expired Volume in three seconds


Page 9 of 21

d. FEF 25-75 - Forced Expiratory flow e. RV - Residual Volume Results of pulmonary function testing are calibrated in prediction equations. Degree of respiratory impairment is assessed. Some obstructive diseases that may be associated with abnormal findings include: chronic bronchitis, asthma and emphysema. Restrictive diseases like pleural thickening, pulmonary fibrosis and congestive heart failure are associated with other abnormalities found in pulmonary function testing. All pulmonary function testing equipment must be approved by the American Thoracic Society and the operators must be certified by NIOSH (National Institute for Occupational Safety and Health).

d. Complete Blood Count (RBC, Hgb, HCT, WBC, differential) e. Blood Chemistry Panel, Requiring any/all of the following tests:

Glucose Sodium Potassium Chloride Creatinine BUN Phosphate Uric acid Cholesterol Total protein Calcium Globulin Triglycerides Albumin Total Bilirubin Alkaline Phosphatase G-Glutamyl Transpep Transaminase (AST ALT) LDH Sickle Cell Index Lead Mercury Cadmium Cobalt All laboratory testing is performed by a CLIA approved and licensed clinical laboratory.

f. Chest X-Rays: Posterior/anterior view x-rays. Radiologist interpretation should be done by a Board-Certified Radiologist. For employees with potential asbestos exposure, Certified “B” readers will interpret x-rays.

g. Urinalysis (with Microscopy) to test for: a. Specific Gravity b. pH c. Albumin Glucose d. Acetone Protein

h. Biological Monitoring for Lead: a. Blood lead level b. Hemoglobin and hematocrit, red cell indices and peripheral smear morphology c. Zinc protoporphyrin (ZPP) d. Blood Urea nitrogen and creatinine

i. Red blood cell and Plasma Cholinesterase Tests j. Stool Specimen: Submitted for culture and examination for OVA and parasites


Page 10 of 21

ANNEX – SPECIFIC STANDARDS AND PROTOCOLS A. Occupational Noise (T8 CCR §5097)

A.1 Covered employees All employees whose workplace noise exposures equal or exceed the action level.

A.2 Examinations

Shall be performed by a licensed or certified audiologist, otolaryngologist, or other physician, or by a technician who is certified by the Council of Accreditation in Occupational Hearing Conservation or who has satisfactorily demonstrated competence in administering audiometric examinations, obtaining valid audiograms, and properly using maintaining and checking calibration and proper functioning of the audiometers being used. The technician must be responsible to an audiologist, otolaryngologist or physician.

A.3 Frequency

Within 6 months of first exposure; at least annually after obtaining the valid baseline audiogram; if using a mobile test van, exams shall be conducted within one year of first exposure

A.4 Protocol

Testing to establish a baseline audiogram shall be preceded by at least 14 hours without exposure to workplace noise. This requirement may be met by wearing hearing protectors of 80 dBA or below. The employer shall inform the employee of the need to avoid high levels of non-occupational noise exposure during the preceding 14 hours.

The audiogram shall be compared to the baseline to determine if a standard threshold shift (STS) has occurred. A retest may be obtained within 30 days if an STS has occurred and consider the results of the retest the annual audiogram. An STS is defined as a change in hearing threshold relative to the baseline audiogram of an average of 10 dB or more at 2000, 3000, 4000 Hz in either ear. Allowance may be made for presbycusis.

A.5 Physician’s Report

If an STS has occurred, the employee shall be notified in writing within 21 days; and shall be referred for a clinical audiological evaluation, an ontological examination, as appropriate, if additional testing is necessary.

A.6 Employers Responsibility

If STS has occurred, the employer shall institute the wearing of hearing protection and / or retraining the employee in the proper use of hearing protection

A.7 Examination Protocols

TEST PRE-EXPOSURE OR

PRE-PLACEMENT ANNUAL PERIODIC EXIT REMARKS

Audiometric Examination

X X X


Page 11 of 21

B. Respiratory Protection (T8 CCR §5144)

B.1 Covered employees Any employee who has the occasion to use any form of respiratory protective equipment

B.2 Examinations

Persons should not be assigned to tasks requiring the use of respirators unless it has been determined that they are physically able to perform the work while using the required respiratory equipment. A licensed physician shall determine what health and physical conditions are pertinent.

B.3 Frequency

The medical status of persons assigned use of respiratory equipment shall be reviewed biannually.

B.4 Protocol

Mandatory tests: a. Comprehensive medical examination with emphasis on respiratory and cardiovascular

condition b. Pulmonary function test c. 2-view and 4-view X-Ray (alternating years) d. Optional test:

1. Electrocardiogram B.5 Physicians Report

Shall indicate if there are any restrictions to be wearing of respiratory protective equipment; shall indicate what levels of respiratory equipment may be worn.

B.6 Examination Protocols

TEST PRE-EXPOSURE OR PRE-PLACEMENT

ANNUAL PERIODIC EXIT REMARKS

Comprehensive medical exam

X X X (1) (1) If not conducted within previous 12 months. (2) Recommended for employees over 40 yrs. (3) At the discretion of the employee, if desired less frequent. (4) At the examining physicians discretion where there is justifiable concern regarding health risk from use of respirator.

Pulmonary function test

X X X (1)

Chest X-ray (2-view or 4-view on alternating years)

X X X (1)

EKG X X (2) X (3) X (1)

Stress Test X (4) X (4) X (4)


Page 12 of 21

C. Lead (T8 CCR §5208 & §5216)

C.1 Employees Covered All work where an employee may be occupationally exposed to lead. All employees occupationally exposed on any day to lead at or above the action level. All employees who are or may be exposed at or above the action level for more than 30 days in any consecutive 12 months.

C.2 Examinations

A comprehensive medical examination and biological monitoring shall be performed by or under the supervision of a licensed physician.

C.3 Frequency

Medical examinations shall be performed prior to initial exposure and annually for each employee: a. Additional Examinations and biological monitoring shall be performed as soon as possible

when either the employee has developed signs or symptoms commonly associated with lead intoxication, desires medical advice concerning reproductive hazards, or the employee has demonstrated difficulty in breathing during a respirator fitting or during use and as medically appropriate for each employee removed from exposure to lead.

b. At least every 2 months for each employee whose last blood lead level was at or above 40ug/100 g until two samples in a row are less than 40ug/100g.

c. Monthly during the period an employee is removed from exposure due to an elevated blood lead level.

C.4 Biological Monitoring Shall Include

a. blood lead level b. hemoglobin and hematocrit, red cell indices and peripheral smear c. morphology d. zinc protoporphyrin (ZPP) e. blood urea nitrogen and creatine f. urinalysis with microscopic examination g. any laboratory or other test which the examining physician deems necessary by sound

medical practice C.5 Medical Removal Protection

The employer shall remove an employee from work having an exposure to lead at or above the action level on each occasion that a periodic and follow-up blood sampling test conducted indicate that the employee’s blood level is at or above 50 ug/100 g.

The employer shall remove an employee from work having an exposure to lead at or above the action level on each occasion that at a final medical examination the employee has a detected medical condition which places the employee at increased risk of material impairment to health from exposure.


Page 13 of 21

C.6 Return to Former Job Status The employee shall be returned to former job status: if removed for a blood lead level at or above 80 ug/100 g when the employee’s blood lead level is at or below 60 mg/100 g of whole blood; if removed for a level at or above 70 ug/100 g when two consecutive tests indicate the blood lead level is at or below 50 mg/100 g; if removed for a level at or above 50 ug/100 g when two consecutive tests indicate the blood lead level is at or below 40 mg/100 g; when removed due to a final medical determination when a subsequent final medical determination states that the employee no longer has a detected medical condition which places the employee at increased risk of material impairment to health.

C.7 Examination Protocols

D. Bloodborne Pathogens (T8 CCR §5193)

D.1 Employees covered All employees who could be “reasonably anticipated” to have occupational exposure to blood or other potentially infectious materials (OPIMs).

D.2 Examinations

All medical evaluations and procedures are to be conducted under the supervision of a licensed physician or another licensed healthcare professional. A “licensed healthcare professional” is defined as a person whose legally permitted scope of practice allows them to independently perform the activities required.

D.3 Program

a. Voluntary hepatitis vaccinations shall be offered to all employees who have occupational exposure to blood or OPIM’s within 10 working days of appointment or assignments

b. An employee declining a Hepatitis B Vaccination must sign a Hepatitis B declination form. c. An employee who initially declines hepatitis B vaccination but at a later date decides to

accept the vaccination, shall receive that hepatitis vaccination at that time. d. If a routine booster dose (titer) of hepatitis B vaccine is recommended by the U.S. Public

Health Service at a future date, such booster dose(s) shall be made available to identified employees.

e. Following an exposure incident, a confidential medical evaluation must be performed to include documentation regarding circumstances of exposure, source testing if feasible, testing exposed employees’ blood (with consent), post-exposure prophylaxis, counseling and evaluation of reported illness.




X X X (1) As required by blood level tests.

Biological monitoring for Lead

X X X (1)

Urinalysis X X X


Page 14 of 21

f. See the University Exposure Control Plan for required forms. E. Asbestos (T8 CCR §5208)

E.1 Employees Covered All employees, who are, or may reasonably be expected to be, exposed to asbestos at or above the action level and/or above the action level and/or excursion limit.

E.2 Examinations

Performed by or under the supervision of a licensed physician. E.3 Frequency

Before an employee is assigned to work involving exposure or within 30 days of the employee’s initial exposure to asbestos, in the event of an emergency, and at least annually thereafter. A termination examination shall be given unless the employee has had an exam within the past year.

E.4 Content of Exam

a. In addition to evaluating for asbestos-related disease, the physician shall evaluate for fitness to wear personal protective equipment including respirators.

b. Comprehensive medical exam plus completion of the required initial medical questionnaire for pre-placement or initial examinations or the periodic medical questionnaire for subsequent found in Appendix D of 8 CCR, § 5208.

c. Chest x-rays shall consist of a 14” X 17” AP and right and left anterior oblique views interpreted by a NIOSH certified B-reader on an ILO rating form. The following frequencies for chest x-rays will be observed.

Years Since First Exposure Age of Employee 0 to 10 10 and above

Less than 40 Every three years Annually*

40 and older Annually* Annually*

* Oblique x-rays need only be performed every three years. d. Spirometry to include forced vital capacity (FVC) and force expiratory volume at 1 second

(FEV 1) performed by a technician certified by NIOSH in pulmonary function testing. e. Additional tests deemed appropriate or necessary by the examining physician.

E.5 Information provided to the Physician

A copy of title 8 CCR §5208 and Appendices D, E, and I; a description of the employee’s duties; their representative or anticipated exposure levels; description of any personal protective equipment to be used; information from previous medical examinations.

E.6 Physician report

The report shall contain the results of the examination without diagnosis disclosure unrelated to occupational exposure to asbestos. It shall also contain any recommended limitations on the employee or upon the use of personal protection equipment; the physician’s opinion as to whether the employee has any detected medical conditions that would place the employee at an


Page 15 of 21

increased risk of material impairment from exposure to asbestos; and a statement that the employee has been informed by the physician of the results of the medical examination and of any medical conditions resulting from asbestos exposure that require further explanation or treatment.

E.7 Examination Protocols




X X X (1) (1) If last exam not within past 12 months.

Asbestos medical questionnaire

X X

Chest X-ray X X “B-Reader” every other year

X

Spirometry X X F. Pesticides (T8 CCR §6728)

F.1 Covered employees Employees who mix, load, apply, store, transport or otherwise handle pesticides in toxicity category one or two that contain an organophosphate or carbamate.

F.2 Examinations

Baseline red cell and plasma cholinesterase tests shall be performed by a clinical laboratory currently approved by the State Department of Health to perform these tests.

F.3 Frequency

Baseline red cell and plasma cholinesterase tests shall be verified every two years. F.4 Monitoring Shall Include

a. Pulmonary Function Test- Complete screening. b. Blood Chemistry- Full panel of 20 analyses, including enzymes indicative of liver function

status. c. Hematology- Complete blood count. d. Urinalysis- Complete analysis, including microscopic examination. e. Electrocardiography- 12-lead resting electrocardiogram. f. Special Procedures- Red blood cell cholinesterase determination (RBC ChE)


Page 16 of 21

F.5 Examination Protocols




X X X (1) (1) If not conducted within previous 12 months.

* See Respiratory Protection for additional protocols.

G. Formaldehyde (T29 CFR §1910.1048 App C)

G.1 Covered employees Medical monitoring is provided for employees exposed to formaldehyde vapor greater than the AL or STEL, employees experiencing signs and symptoms related to exposure, employees concerned about their exposure, or employees in emergency situations.

G.2 Examinations

A medical questionnaire is completed by the employee (see Appendix D of 29 CFR 1910.1048). The physician then determines whether an examination is also necessary. Examinations are performed by a licensed physician. The physician must submit a written opinion to the employer, for each employee examined.

G.3 Frequency

If respirators are worn by employees, then examinations and pulmonary function tests must be performed annually.

G.4 Examination Protocols






H. Lasers (8 CCR §3203 and ANSI Z136.1) H.1 Covered Employees

1. Individuals operating Class 1, Class 2 and Class 3a lasers are exempt from medical surveillance.

2. Class 3b and Class 4 laser operators are required to have a baseline eye examination prior to using the laser that covers: ocular history, visual acuity, amsler grid test, & color vision.

3. Incident personnel (individuals working in areas where there is potential for exposure to laser radiation from a Class 3b or Class 4 laser, but do not operate the laser) shall have a baseline eye examination for visual acuity.

4. An eye examination is recommended when an individual terminates his or her work in a laser laboratory.


Page 17 of 21

I. Respirable Crystalline Silica (8 CCR §5204) I.1 Covered Employees

Any employee who will be occupationally exposed to respirable crystalline silica at or above the action level for 30 or more days per year.

I.2 Examinations

A medical and work history, with emphasis on: Past, present, and anticipated exposure to respirable crystalline silica, dust, and other agents affecting the respiratory system; any history of respiratory system dysfunction, including signs and symptoms of respiratory disease (e.g., shortness of breath, cough, wheezing); history of tuberculosis; and smoking status and history.

I.3 Frequency The employer shall make available an initial (baseline) medical examination within 30 days after initial assignment, unless the employee has received a medical examination that meets the requirements of this section within the last three years. Periodic examinations shall be performed at least every 3 years.

I.4 Content of Exam a. A physical examination with special emphasis on the respiratory system; b. A chest X-ray (a single posteroanterior radiographic projection or radiograph of the chest at

full inspiration recorded on either film (no less than 14 x 17 inches and no more than 16 x 17 inches) or digital radiography systems), interpreted and classified according to the International Labour Office (ILO) International Classification of Radiographs of Pneumoconioses by a NIOSH-certified B Reader;

c. A pulmonary function test to include forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) and FEV1/FVC ratio, administered by a spirometry technician with a current certificate from a NIOSH-approved spirometry course;

d. Testing for latent tuberculosis infection; e. Any other tests deemed appropriate by the physician.

I.5 Physician's Report

The physician shall provide each employee with a written medical report within 30 days of each medical examination performed. The written report shall contain: A statement indicating the results of the medical examination, including any medical condition(s) that would place the employee at increased risk of material impairment to health from exposure to respirable crystalline silica and any medical conditions that require further evaluation or treatment; Any recommended limitations on the employee's use of respirators; Any recommended limitations on the employee's exposure to respirable crystalline silica; and a statement that the employee should be examined by a specialist if the chest X-ray provided in accordance with this section is classified as 1/0 or higher by the B Reader, or if referral to a specialist is otherwise deemed appropriate by the physician.


Page 18 of 21

I.6 Examination Protocols





Chest X-Ray X X

Pulmonary Function Test

X X

TB X X

* See Respiratory Protection for additional protocols. J. Radiation (10 CFR 20 and 17 CCR)

J.1 Covered Employees

All persons who receive, possess, use or transfer material licensed by the Nuclear Regulatory Commission, or who use radioactive material and who may have had exposure to a total occupational dose in excess of the standard. Assessment of individual intakes of radioactive materials should be in accordance with U.S. Nuclear Regulatory guides 8.9. External radiation monitoring is done with Thermoluminescent dosimeters (TLD's).

J.2 Frequency Baseline tests will be performed on any individuals who may use lodine-125 or Tritium under conditions which might require bioassay. Routine bioassays are performed depending on the circumstances. Bioassays are also performed after exposure has been discontinued. When respiratory protection equipment is used to limit inhalation exposure, examination by a physician prior to initial use of respirators and at least every 12 months thereafter is required.

J.3 Examinations The Nuclear Regulatory Commission incorporates appropriate surveillance (bioassay) provisions in each license. Determination of ability to wear a respirator is per 8 CCR §5144.

J.4 Examination Protocols






K. Laboratory Employees (8 CCR §5191) K.1 Employees covered

Those engaged in the laboratory use of hazardous chemicals as defined in the regulation.


Page 19 of 21

K.2 Examinations The employer shall provide all employees who work with hazardous chemicals an opportunity to receive medical attention, including any follow-up examinations which the examining physician determines to be necessary, under the following circumstances: a. whenever an employee develops signs or symptoms associated with a hazardous chemical; b. where exposure monitoring reveals an exposure to a regulated substance where medical

surveillance requirements have already been established; c. other exposure has occurred, whenever an incident such as a spill, leak, explosion or a

medical consultation shall be provided in determining the need for a medical examination.

Regular medical surveillance should be established to the extent required by regulations. Anyone whose work involves consistent and frequent handling of toxicologically significant quantities of a chemical should consult a qualified physician to determine on an individual basis whether a regular schedule of medical surveillance is desirable.

K.3 Frequency

Immediately upon any of the above and as determined by the examining or consulting physician.

K.4 Mandatory Tests

As determined by the examining physician appropriate for that exposure.

K.5 Information provided to Physician The identity of the hazardous chemical; a description to the physician of conditions under which the exposure occurred including quantitative data; a description of the signs and symptoms of exposure that the employee is experiencing.

K.6 Physician's Report

Recommendations for further medical follow-up; the results of the medical examination and any associated tests, if requested by the employee; any medical condition which may be revealed in the course of the examination which may place the employee at increased risk as a result of exposure to a hazardous chemical found in the workplace; and a statement that the employee has been informed by the physician of the results of the consultation or medical examination and any medical condition that may require further examination or treatment. The written opinion shall not reveal specific findings of diagnoses unrelated to occupational exposure.

L. Animal Handlers (8 CCR §5097, §5144, §5191, §5209, and §5217)

L.1 Covered Employees

Employees who handle or work near animals or their excreta, including but not necessarily limited to animal caretakers, animal technicians, veterinarians, investigators, researchers, laboratory support personnel, cage wash operators and others requiring various type of contact with animals, their tissues, excreta and other biological materials or the contaminated environment, shall be identified and enrolled in the Employee Medical Monitoring Program.


Page 20 of 21

L.2 Health Surveillance Participation Employee participation in the Health Surveillance portion of Animal Care and Use Occupational Health Program depends on animal contact duration and species type the employee will encounter on the job. Individuals in Risk Category 3 or above shall complete a pre-employment physical examination. Individuals are assigned a risk category by their supervisor or the Director of Animal Care. These risk categories are defined in Section 6.1 in Stanislaus States’ Animal Care and Use Occupational Health & Safety Program.

a. Health Questionnaire

A pre-assignment health questionnaire must be completed by individuals in Risk Category 3 or higher prior to starting work. This questionnaire elicits the employee's medical history, employment history and family history in relation to sensitivities or conditions that may be aggravated by animal handling. This questionnaire must be forward to the medical provider for review. The medical provider will then determine if further medical evaluations are necessary.

b. Pre-employment Physical Employees in Risk Category 8 or above shall have pre-employment physical exams completed. Employees in lower risk categories may be required to complete a physical exam, if based on review of the health questionnaire, the medical provider deems one is necessary. The pre-employment physical consists of a physical and laboratory testing. Blood work includes a complete blood count with differential, liver, function tests, VDRL and a baseline serum sample to be frozen for possible later use. Serial serum sample should only be obtained as needed on the basis of the infectious agents being handled. Urinalysis and stool for ova and parasites shall be performed. Screening for tuberculosis and immunizations necessary for the specific job shall be performed as will other specialized immunizations.

c. Periodic Physical Periodic physicals occur every three years and consist of the same protocol as the pre-employment physical, unless work conditions change or as directed by the physician.

M. Aerosol Transmissible Diseases including Tuberculosis (8 CCR §5199 and §5144)

M.1 Covered Employees

The scope of this exposure control program at Stanislaus State focuses on risk group employees and students (i.e., Student Health Center, University Police, athletic trainers, International Education, and animal care personnel).

M.2 Examinations

Shall be performed by or under the supervision of a licensed physician and that all laboratory tests are conducted by an accredited laboratory. This shall be without cost to the employee and at a reasonable time and place. The results of the laboratory tests shall be reviewed by the examining physician.

M.3 Frequency

TB screening tests for risk group individuals shall be conducted prior to assignment and annually thereafter if negative. Individuals with positive test results must submit to a chest X-


Page 21 of 21

ray to determine the disease’s state of activity. If the chest X-ray reveals an active TB condition, the individual will be referred to Stanislaus County Public Health for treatment.

M.4 Mandatory Tests

Employees placed in at risk groups will undergo Tuberculin testing annually via Purified Protein Derivative (PPD) method. Booster testing will be completed for new at-risk employees 1 - 3 weeks following initial negative PPD test. If PPD tests results are positive, the individual will complete a chest X-ray examination.

a. Emergency Examinations

Exposed individuals shall undergo Tuberculin skin testing immediately. If test results are negative, the individual shall undergo follow-up testing in 12 weeks to allow sufficient time for antibody generation.

b. Additional Examinations and Referrals If subsequent X-ray examinations yield positive results, the individual will be reported to the Stanislaus County Public Health Department and will not be allowed to return to work until cleared by the Stanislaus County Public Health Department or their physician.

M.5 Information Provided to the Physician

a. A copy of 8 CCR § 5199 and its appendices; b. A description provided of the affected employee's duties as they relate to the employee's

exposure; c. A description of any personal protective equipment used or to be used; d. Information from previous employment-related medical examinations of the affected

employee which is not otherwise available to the examining physician. M.6 Physician's Report

Shall contain the occupationally pertinent results of the medical examination and tests; the physician's opinion concerning whether the employee has any detected medical conditions which would place the employee's health at greater than normal risk of material impairment from exposure to tuberculosis; the physician's recommended limitations upon the exposure to tuberculosis or upon the employee's use of protective clothing or equipment and respirators; and a statement that the employee has been informed by the physician of the results of the medical examination and any medical conditions resulting from tuberculosis exposure which require further explanation or treatment. The written opinion obtained by the employer shall not reveal specific records, findings and diagnoses that have no bearing on the employee's ability to work in a tuberculosis-exposed workplace.

employee medical monitoring · employee medical monitoring program page 2 of 21 benzene ionizing...

Documents