Provide medical surveillance to employees.

You must:

(1) Provide medical surveillance for employees to comply with Tables 7 and 8, and the following:

• Make medical surveillance available at:

– Reasonable times and places.

– No cost to employees, including travel associated costs such as mileage, gas or bus fare if the employee is required to travel off site

and

– Wages for additional time spent outside of employees' normal work hours.

• Make sure a licensed physician performs or supervises exams and procedures.

• Give complete information to the examining physician including:

– A copy of this section.

– A description of the employee's duties that relate to hazardous substance exposure.

– The hazardous substance exposure levels anticipated for the employee.

– A description of the personal protective equipment (PPE) the employee could use.

– Information available from previous medical examinations.

– The medical evaluation information required by chapter 296-307 WAC, Part Y-5, Respirators.

• Medical exams must include, at a minimum:

– A medical history.

– A work history (or updated history if on file).

– A special emphasis on:

■ Assessment of symptoms related to handling hazardous substances.

■ Health hazards.

■ Evaluation of fitness for duty (including the ability to wear any personal protective equipment (PPE) or other conditions that may be expected at the workplace).

– Other content as determined by the examining physician.

Note:

The physician should consult the Occupational Safety and Health Guidance Manual for Hazardous Waste Site Activities and the Medical Management Guidelines for Acute Chemical Exposure (search OSHA web site: http://www.osha.gov).

You must:

(2) Obtain the physician's written opinion and give a copy to the employee that includes:

• A statement of whether or not medical conditions were found which would increase the employee's risk for impairment during emergency response work or respirator use.

– Do not include specific findings or diagnoses unrelated to occupational exposures.

• Limitations recommended to the employee's assigned work, if any.

• Exam and test results if the employee requests this information.

• A statement that affirms the employee has been confidentially informed of medical exam results (including medical conditions requiring follow-up).

Table 7 Medical Surveillance for Employee Categories
If the employee is covered by this section and is:	Then you must:
• Exposed for at least 30 days a year to health hazards or hazardous substances at or above the permissible exposure limit or published exposure levels (even when respirators are used), or • Required to wear a respirator for at least 30 days a year.*	• Offer standard medical surveillance as specified in Table 8.*
• A hazardous materials (HAZMAT) team member. • A hazardous materials specialist.	• Provide standard medical surveillance as specified in Table 8.
• An emergency responder who shows immediate or delayed signs or symptoms possibly resulting from exposure to hazardous substances during an incident.	• Provide incident-specific medical surveillance as specified in Table 8.
• Not an emergency responder and: – May be injured. – Shows immediate or delayed signs or symptoms possibly resulting from exposure to hazardous substances. – May have been exposed to hazardous substances at concentrations above the permissible exposure limits (PELs) or the published exposure levels without appropriate PPE.	• Offer incident-specific medical surveillance as specified in Table 8.

*Note:

A medical evaluation for respirator use is required by chapter 296-307 WAC, Part Y-5, Respiratory protection, for those employees who have not been cleared for respirator use during medical surveillance activities.

Table 8 Frequency of Exams and Consultations
If the employee is covered by:	Then medical surveillance must include:
• Standard medical surveillance	Exams and consultations: • Before assignment. Note: If the employee is a hazardous materials (HAZMAT) team member or a hazardous materials specialist, the employee must receive a baseline physical examination. • At least once every 12 months after their initial assignment unless the physician believes a shorter, or longer interval (but no more than 24 months) is appropriate. • Whenever employees are reassigned to an area where they will no longer be covered by medical surveillance and they have not been examined within the past 6 months. • As soon as possible after an employee reports: – Signs or symptoms of possible overexposure to hazardous substances or health hazards. – Injury. – Exposure above the permissible exposure limits or published exposure levels. • At the termination of their employment unless they were examined within the past 6 months.
• Incident-specific medical surveillance	Medical consultations and exams: • As soon as possible following the incident or development of signs or symptoms. • At additional times, if the physician determines follow-up is medically necessary.

PDFWAC 296-307-70420

Medical surveillance.