Date of Adoption: December 3, 2003.

     Purpose: The Department of Labor and Industries began this rule-making effort at the direction of the Washington state supreme court following a successful lawsuit by farm workers who were exposed to the hazard posed by organophosphate and N-methyl-carbamate cholinesterase-inhibiting pesticides. See Rios v. Dep't of Labor and Indus., 145 Wn.2d 483, 39 P3.d 961 (2002). The rule applies to all agriculture employers and workers covered by chapter 296-307 WAC, which includes the pesticide worker protection standard, WAC 296-307-107.

Chapter 296-307 WAC, Part J-1 - Cholinesterase monitoring.

•     Created this part to include requirements relating to cholinesterase monitoring.

WAC 296-307-14520 What are the department's recommendations for cholinesterase monitoring? (Nonmandatory)

•     Requirements relating to cholinesterase monitoring have been moved to WAC 296-307-148 through 296-307-14845.

•     Repealed this section.

WAC 296-307-148 Scope and summary.

•     Created this section explaining the scope of this part.

•     Added a table of contents/summary page relating to cholinesterase monitoring.

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

•     Created this section requiring the maintenance of records for employees handling category I or II organophosphate or N-methyl-carbamate pesticides and retain those records for seven years.

•     Ensure the records are readily accessible to employees and their designated representatives.

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

•     Created this section relating to implementing a medical monitoring program for employees who handle class I or II organophosphate or N-methyl-carbamate pesticides according to the following schedule.

     -     Effective February 1, 2004, monitoring is required for employees who handle organophosphate or N-methyl-carbamate pesticides for fifty hours or more in any consecutive thirty-day period.

     -     Effective February 1, 2005, monitoring is required for employees who handle organophosphate or N-methyl-carbamate pesticides for thirty hours or more in any consecutive thirty-day period.

•     Added language relating to the department may adjust the threshold for coverage of employees under this chapter on February 1, 2005, based on analysis of medical monitoring data collected during 2004.

•     Added language indicating that nothing in this rule prohibits employers from providing cholinesterase monitoring to employees who handle organophosphate or N-methyl-carbamate pesticides for fewer hours than specified in Table 1.

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

•     Created this section relating to identifying a physician or other licensed health care provider (LHCP) that will:

     -     Provide baseline and periodic cholinesterase testing.

     -     Interpret tests and make recommendations.

•     Added language relating to making sure the physician is familiar with the requirements of this rule.

•     Added language relating to posting the medical provider's information.

•     Added language relating to employers are required to obtain copies of employees test results and written recommendations from the physician or LHCP, and these records must be maintained for seven years.

•     Added language relating to the physician or LHCP to not reveal in writing or in any other communications personally identifiable medical information.

WAC 296-307-14820 Make cholinesterase testing available.

•     Created this section relating to arranging for employees to receive medical monitoring (at no cost to employees and at a reasonable time and place) as follows:

     -     Annual red blood cell (RBC) and plasma cholinesterase baseline tests that are taken at least thirty days after the employee last handled organophosphate or N-methyl-carbamate pesticides.

     -     Within three days after the end of each thirty-day period where the employee meets the handling levels in Table 1; however, testing is not required more often than every thirty days.

          or

     -     At least every thirty days for those employees who may meet the handling levels in Table 1.

•     Included in this section is an exemption that reads, "You do not need to provide baseline or periodic testing for those employees whose work exposure is limited to handling only N-methyl-carbamate pesticides." Also "You do not need to provide periodic testing beyond the baseline for those employees whose handling hours do not exceed the exposure thresholds in Table 1, if you do not count time spent mixing and loading using closed systems, as defined in WAC 296-307-13045 (4)(d)."

•     Added a note that reads, "You do not need to count time spent mixing and loading using closed systems (as defined in WAC 296-307-13045 (4)(d)) in determining the need for periodic testing. Time using closed systems is still counted for purposes of establishing coverage under this rule and determining the need for obtaining baseline cholinesterase levels."

•     Added a note that reads, "The first thirty consecutive day period begins on the first day of handling organophosphate or N-methyl-carbamate pesticides after obtaining the baseline cholinesterase test."

•     Added a note relating to previous baselines may be accepted for new employees if they are obtained according to this rule.

•     Added language relating to obtaining a "working baseline" for employees as soon as possible for employees who initially declined cholinesterase testing.

•     Created this section relating to obtaining a signed declination form from the medical provider or LHCP if an employee declines cholinesterase testing.

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

•     Created this section relating to responding to an employee's depressed cholinesterase levels by taking described actions and following the medical provider's occupational health recommendations.

•     Added language relating to employees being restricted from handling or other work exposures to organophosphate or N-methyl-carbamate pesticides during the medical removal period.

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

•     Created this section relating to medical removal benefits being provided for a maximum of three months on each occasion an employee is temporarily removed from work or assigned to other duties due to depressed cholinesterase levels.

WAC 296-307-14835 Maintain records.

•     Created this section relating to maintaining accurate medical records for all covered employees.

•     Added language relating to maintaining medical monitoring records for seven years.

•     Added language relating to ensuring that employee medical records being readily accessible.

WAC 296-307-14840 Provide training.

•     Created this section relating to training about possible hazards of organophosphate and N-methyl-carbamate pesticide exposure.

•     Added language relating to providing training before employees receive medical monitoring.

•     Added language relating to training required by this rule may be combined with other pesticide handler training.

WAC 296-307-14845 Implementation plan.

•     The department will implement this rule by doing the following:

     -     Organize a scientific team to oversee collection and analysis of data collected during 2004 and 2005.

     -     Establish a cholinesterase stakeholder advisory committee to evaluate issues related to rule implementation and provide recommendations to the department.

     -     Evaluate the data collected during 2004 and make modifications to the rule as appropriate.

     -     Make efforts to defray the costs of medical testing during 2004.

     -     Prepare and distribute provider guidelines.

     -     Develop and make available a model employee training program.

     -     Publish a list of providers and certified laboratories on the Internet.

     -     Coordinate record-keeping requirements with the Department of Agriculture.

     Citation of Existing Rules Affected by this Order: Repealing WAC 296-307-14520 What are the department's recommendations for cholinesterase monitoring? (Nonmandatory).

     Statutory Authority for Adoption: RCW 49.17.010, 49.17.040, 49.17.050, and 49.17.060.

      Adopted under notice filed as WSR 03-15-032 on July 9, 2003.

     Changes Other than Editing from Proposed to Adopted Version:

WAC 296-307-148 Scope and summary.

•     Deleted the link. Links are not codified in WISHA rules.

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

•     Deleted the helpful tool. Helpful tools are not codified in WISHA rules.

•     Added language in the last bullet in this section. It now reads, "Make sure that pesticide-handling records are readily accessible to employees, their designated representative, and treating health care professional."

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

•     Changed the effective dates to February 1, 2004, and February 1, 2005.

•     Changed the date in the note from "January 15, 2005" to "February 1, 2005."

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

•     In the first bullet replaced the word "provider" with "professional."

•     In the first secondary bullet clarified the language. It now reads, "Provide baseline and periodic cholinesterase testing through the department of health public health laboratory, or beginning in 2006, through any laboratory approved by the department of labor and industries."

•     In the second secondary bullet, clarified the language, it now reads,

     -     Interpret tests

     -     Provide you with written recommendations and opinions that:

&sqbul;     Identify employees with periodic tests results requiring a work practice evaluation.

&sqbul;     Identify employees with periodic test results indicating they must be removed from handling and other exposure to organophosphate and N-methyl-carbamate pesticides.

&sqbul;     Provide guidance on medical monitoring.

&sqbul;     Include any other relevant information concerning an employee's workplace exposure to organophosphate and N-methyl-carbamate pesticides.

•     In the second bullet, clarified the language, it now reads, "Instruct the physician or other licensed health care professional (LHCP) to NOT reveal in writing or in any other communication with you, personally identifiable medical information, other than laboratory tests results, for any employee."

•     Deleted the link. Links are not codified in WISHA rules.

•     In the last bullet, clarified the language, it now reads, "Make sure copies of employee test results and written recommendations from the physician or LHCP are maintained for seven years."

WAC 296-307-14820 Make cholinesterase testing available.

•     In the first and second secondary bullets, added the word "provide" at the beginning.

•     In the second secondary bullet clarified the language. It now reads,

     -     Provide periodic RBC and plasma cholinesterase testing.

&sqbul;     Within three days after the end of each thirty-day period where the employee meets the handling levels in Table 1; however, testing is not required more often than every thirty days.

     or

&sqbul;     At least every thirty days for those employees who may meet the handling levels in Table 1.

•     In the first bullet in the note, clarified the language. It now reads, "You do not need to count time spent mixing and loading using closed systems (as defined in WAC 296-307-13045 (4)(d)) in determining the need for periodic testing. Time using closed systems is still counted for purposes of establishing coverage under this rule and determining the need for obtaining baseline cholinesterase levels."

•     In the third bullet replaced the word "written" with "signed."

•     In the third bullet deleted the words "Appendix A."

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

•     In the table replaced the word "investigate" with "evaluate" in two places.

•     In the table, second column, first row, add the words "to identify and correct potential sources of pesticide exposure."

•     In the table, second column, second row, add the words "to identify and correct potential sources of pesticide exposure."

•     In the table, second column, middle row, replaced the word "previously" with "recently."

•     In the table, third column, last row, clarified the language. It now reads, "Continue periodic cholinesterase monitoring."

WAC 296-307-14835 Maintain medical monitoring records.

•     Changed the title of this section to "Maintain records."

•     In the first bullet, deleted the words "medical monitoring." It now reads, "Make sure that the following records are maintained:".

•     Deleted the proposed secondary bullet and the subbullets. Added a secondary bullet that reads, "Written recommendations and opinions received from the physician or LHCP."

•     In the third bullet, deleted the words "retain medical monitoring" and replaced with "maintain."

•     In the fourth bullet, deleted the words "medical monitoring" and replaced with "all."

WAC 296-307-14840 Provide training.

•     Deleted the helpful tool. Helpful tools are not codified in WISHA rules.

WAC 296-307-14845 Implementation plan.

•     Deleted Appendix A. This will be in the helpful tool section of this rule.

     Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted at Request of a Nongovernmental Entity: New 10, Amended 0, Repealed 1.

     Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 1.

     Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 10, Amended 0, Repealed 1.

     Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0;      Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 10, Amended 0, Repealed 1.
     Effective Date of Rule: February 1, 2004.

December 3, 2003

Paul Trause

Director

OTS-6447.5

Part J-1

CHOLINESTERASE MONITORING
NEW SECTION
WAC 296-307-148   Scope and summary.  

     Your responsibility:

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

     Definition:

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

     IMPORTANT:

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

     You must:

     Maintain handling records for covered pesticides

     WAC 296-307-14805.

     Implement a medical monitoring program

     WAC 296-307-14810.

     Identify a physician or licensed health care professional

     WAC 296-307-14815.

     Make cholinesterase testing available

     WAC 296-307-14820.

     Respond to depressed cholinesterase levels

     WAC 296-307-14825.

     Provide medical removal protection benefits

     WAC 296-307-14830.

     Maintain records

     WAC 296-307-14835.

     Provide training

     WAC 296-307-14840.

     Implementation plan

     WAC 296-307-14845.

[]

     You must:

     • Maintain accurate records of all time that each employee spends handling category I or II organophosphate or N-methyl-carbamate pesticides (this includes employees who do not meet the handling hour thresholds in Table 1).

     • Retain pesticide handling records for seven years.

     • Make sure that pesticide-handling records are readily accessible to employees, their designated representatives, and treating health care professionals.

[]

     You must:

     • Implement a medical monitoring program for your employees who handle or will be expected to handle category I or II organophosphate or N-methyl-carbamate pesticides according to the schedule in Table 1.

Table 1

Implementation Schedule

[]

     You must:

     • Identify a physician or other licensed health care professional (LHCP) who will:

     – Provide baseline and periodic cholinesterase testing through the department of health public health laboratory, or beginning in 2006, through any laboratory approved by the department of labor and industries.

     – Interpret tests.

     – Provide you with written recommendations and opinions that:

     &sqbul; Identify employees with periodic test results requiring a work practice evaluation.

     &sqbul; Identify employees with periodic test results indicating they must be removed from handling and other exposure to organophosphate and N-methyl-carbamate pesticides.

     &sqbul; Provide guidance on medical monitoring.

     &sqbul; Include any other relevant information concerning an employee's workplace exposure to organophosphate and N-methyl-carbamate pesticides.

     • Instruct the physician or other licensed health care professional (LHCP) to NOT reveal in writing or in any other communication with you, personally identifiable medical information, other than laboratory test results, for any employee.

     • Make sure the physician or LHCP is familiar with the requirements of this rule (for example, by providing a copy of the rule or by confirming that the provider has attended training on the rule).

     • Post the name, address, and telephone number of the medical provider you have identified at the locations where employees usually start their work day.

     • Make sure copies of employee test results and written recommendations from the physician or LHCP are maintained for seven years.

[]

     You must:

     • Make medical monitoring available to employees who will meet the exposure thresholds in Table 1, at no cost and at a reasonable time and place, as follows:

     – Provide annual baseline red blood cell (RBC) and plasma cholinesterase tests that are taken at least thirty days after the employee last handled organophosphate or N-methyl-carbamate pesticides.

     – Provide periodic RBC and plasma cholinesterase testing:

     &sqbul; Within three days after the end of each thirty-day period where the employee meets the handling levels in Table 1; however, testing is not required more often than every thirty days;

     OR

     &sqbul; At least every thirty days for those employees who may meet the handling levels in Table 1.

     • Arrange to obtain a "working baseline" as soon as possible for employees who initially decline cholinesterase testing and later choose to participate in testing.

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

Exemption:

You do not need to provide baseline or periodic testing for those employees whose work exposure is limited to handling only N-methyl-carbamate pesticides.

Note:	• You do not need to count time spent mixing and loading using closed systems (as defined in WAC 296-307-13045 (4)(d)) in determining the need for periodic testing. Time using closed systems is still counted for purposes of establishing coverage under this rule and determining the need for obtaining baseline cholinesterase levels.
	• For new employees, the medical provider may accept previous baselines, if they are obtained according to this rule.
	• The first thirty consecutive day period begins on the first day of handling organophosphate or N-methyl-carbamate pesticides after obtaining the baseline cholinesterase test.

     You must:

     • Obtain a signed declination statement from the physician or LHCP for employees who decline cholinesterase testing.

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

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

     • Make sure the employee receives a copy of the signed declination statement.

Note:

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

[]

     You must:

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

     – Taking the actions required in Table 2;

     AND

     – Following any additional occupational health recommendations from the physician or LHCP.

Table 2

Required Responses to an Employee's Depressed Cholinesterase Levels

[]

     You must:

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

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

     OR

     – Assigned to other duties due to depressed cholinesterase levels.

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

[]

     You must:

     • Make sure that the following records are maintained:

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

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

     – Findings of all work practice investigations.

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

     – Signed declination statements.

     • Maintain records for seven years.

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

[]

     You must:

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

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

     – The purpose and requirements for medical monitoring.

Note:

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

[]

     • Organize a scientific team to oversee collection and analysis of data collected during 2004 and 2005. L&I will select representatives of the University of Washington, Washington State University, as well as other interested members of the academic and scientific communities, to participate on the team. The team will provide an initial analysis of testing data and any appropriate recommendations directly to L&I and to the cholinesterase monitoring advisory committee by November 1, 2004, and a further analysis and any appropriate recommendations by November 1, 2005. A final report and recommendations will be completed by September 30, 2006.

     • Establish a cholinesterase stakeholder advisory committee to evaluate issues related to rule implementation and provide recommendations to the department regarding implementation of the rule and any possible modifications to it. L&I will invite representatives of growers, labor and other affected state agencies to participate on the advisory committee. The committee will have an opportunity to comment on the analysis completed by the scientific team and to make any appropriate recommendations before December 1, 2004, and again before December 1, 2005. In addition, the committee will review the scientific committee's final report and recommendations and provide advice to L&I prior to December 1, 2006.

     • Review reports from the scientific team and stakeholder advisory committee, and other relevant information and make modifications to the rule as appropriate.

     • Make efforts to defray the costs of medical testing during 2004.

     • Prepare and distribute provider guidelines.

     • Develop and make available a model employee training program.

     • Publish a list of trained providers and certified laboratories on the internet.

     • Coordinate recordkeeping requirements with the department of agriculture.

[]

OTS-6448.1

REPEALER

     The following section of the Washington Administrative Code is repealed:

WAC 296-307-14520

What are the department's recommendations for cholinesterase monitoring? (Nonmandatory)

© Washington State Code Reviser's Office