(1) General.

(a) The employer must make medical surveillance available at no cost to the employee, and at a reasonable time and place, for all employees:

(i) Who are or may be occupationally exposed to chromium (VI) at or above the action level for thirty or more days a year;

(ii) Experiencing signs or symptoms of the adverse health effects associated with chromium (VI) exposure; or

(iii) Exposed in an emergency.

(b) The employer must ensure that all medical examinations and procedures required by this section are performed by or under the supervision of a PLHCP.

(2) Frequency. The employer shall provide a medical examination:

(a) Within thirty days after initial assignment, unless the employee has received a chromium (VI) related medical examination that meets the requirements of this paragraph within the last twelve months;

(b) Annually;

(c) Within thirty days after a PLHCP's written medical opinion recommends an additional examination;

(d) Whenever an employee shows signs or symptoms of the adverse health effects associated with chromium (VI) exposure;

(e) Within thirty days after exposure during an emergency which results in an uncontrolled release of chromium (VI); or

(f) At the termination of employment, unless the last examination that satisfied the requirements of WAC 296-62-08023, Medical surveillance was less than six months prior to the date of termination.

(3) Contents of examination. A medical examination consists of:

(a) A medical and work history, with emphasis on: Past, present, and anticipated future exposure to chromium (VI); any history of respiratory system dysfunction; any history of asthma, dermatitis, skin ulceration, or nasal septum perforation; and smoking status and history;

(b) A physical examination of the skin and respiratory tract; and

(c) Any additional tests deemed appropriate by the examining PLHCP.

(4) Information provided to the PLHCP. The employer must ensure that the examining PLHCP has a copy of this standard, and must provide the following information:

(a) A description of the affected employee's former, current, and anticipated duties as they relate to the employee's occupational exposure to chromium (VI);

(b) The employee's former, current, and anticipated levels of occupational exposure to chromium (VI);

(c) A description of any personal protective equipment used or to be used by the employee, including when and for how long the employee has used that equipment; and

(d) Information from records of employment-related medical examinations previously provided to the affected employee, currently within the control of the employer.

(5) PLHCP's written medical opinion.

(a) The employer must obtain a written medical opinion from the PLHCP, within thirty days for each medical examination performed on each employee, which contains:

(i) The PLHCP's opinion as to whether the employee has any detected medical condition(s) that would place the employee at increased risk of material impairment to health from further exposure to chromium (VI);

(ii) Any recommended limitations upon the employee's exposure to chromium (VI) or upon the use of personal protective equipment such as respirators;

(iii) A statement that the PLHCP has explained to the employee the results of the medical examination, including any medical conditions related to chromium (VI) exposure that require further evaluation or treatment, and any special provisions for use of protective clothing or equipment.

(b) The PLHCP must not reveal to the employer specific findings or diagnoses unrelated to occupational exposure to chromium (VI).

(c) The employer must provide a copy of the PLHCP's written medical opinion to the examined employee within two weeks after receiving it.