IMPORTANT:

Medical evaluations meeting all requirements of this section will fulfill the medical evaluation requirement found in another chapter, Respirators, chapter 296-842 WAC.

Employees who wear respirators need to be medically evaluated to make sure the respirator will not harm them, before they are assigned work in areas requiring respirators.

(1) You must make medical evaluations available to current employees:

(a) Who have been, are, or may be exposed above the action level (AL) for at least thirty days in any twelve-month period.

(b) Exposed to EtO during an emergency situation.

(d) Whenever the employee develops signs and symptoms commonly associated with ethylene oxide.

(e) At no cost including travel costs and wages associated with any time spent obtaining the medical evaluation.

(f) At reasonable times and places.

(2) You must complete Steps one through four of the medical evaluation process at the following times:

(a) Initially, when employees are assigned to work in an area where exposure monitoring results are, or will likely be, above the action level (AL) for at least thirty days in a twelve-month period.

(b) Every twelve months for employees exposed above the AL for at least thirty days in the preceding year unless the examining physician determines that they should be provided more frequently.

(c) When employment with exposure ends, if the employee has not had an evaluation within the six-month period before exposure ends.

Note:	1. Employees who decline to receive medical examination and testing to monitor for health effects caused by EtO are not excluded from receiving a separate medical evaluation for respirator use.
	2. If employers discourage participation in medical monitoring for health effects caused by EtO, 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 complaint, instituting proceedings, or testifying prohibited—Procedure—Remedy.

Medical evaluation process

Step one:	Select an appropriate licensed health care professional (LHCP) who will conduct or supervise examinations and procedures.
	• If the LHCP is not a licensed physician, make sure individuals who conduct pulmonary function tests have completed a training course in spirometry sponsored by an appropriate governmental, academic, or professional institution.
Step two:	Make sure the LHCP receives all of the following information before the medical evaluation is performed:
	• A copy of:
	– This chapter.
	– The following information found in the General occupational health standards, chapter 296-62 WAC:
	■ The Substance safety data sheet, WAC 296-62-07383(1) Appendix A.
	■ The Substance technical guidelines, WAC 296-62-07385(2) Appendix B.
	■ Medical surveillance guidelines, WAC 296-62-07387(3) Appendix C.
	• A description of the duties of the employee being evaluated and how these duties relate to EtO exposure.
	• The anticipated or representative exposure monitoring results for the employee being evaluated.
	• A description of the personal protective equipment (PPE) and respirators each employee being evaluated uses or will use.
	• Information from previous employment-related examinations when this information is not available to the examining LHCP.
	• Instructions that the written opinions the LHCP provides you be limited to the following information:
	– Whether or not medical conditions were found that would increase the employee's risk for impairment from exposure to EtO.
	– Any recommended limitations for EtO exposure and use of respirators or other PPE.
	– A statement that the employee has been informed of medical results and medical conditions caused by EtO exposure requiring further examination or treatment.
Step three:	Make medical evaluations available to the employee. Make sure they include the content listed in Table 3, Content of Medical Evaluations.
Step four:	Obtain the LHCP's written opinion for the employee's medical evaluation and make sure the employee receives a copy within five business days after you receive the written opinion.
	• Make sure the written opinion is limited to the information specified for written opinions in Step two.

Note:

• If the written opinion contains specific findings or diagnoses unrelated to occupational exposure, send it back and obtain a revised version without the additional information.

Table 3

Content of Medical Evaluations

When conducting:	Include:
An initial and annual evaluation	• A work history and medical history that includes emphasis on:
	– Pulmonary, hematological, neurological, reproductive systems;
	and
	– The eyes and skin.
	• A physical examination that includes emphasis on:
	– Pulmonary, hematological, neurological, and reproductive systems;
	and
	– The skin and eyes.
	• A complete blood count including a:
	– White cell count with differential
	– Red cell count
	– Hematocrit
	– Hemoglobin.
	• Additional examinations the licensed health care professional (LHCP) believes appropriate based on the employee's exposure to ethylene oxide (EtO) or respirator use.
	• Additional testing:
	– Pregnancy test, and laboratory evaluation for fertility if requested by employee and approved by evaluating LHCP.
Evaluations due to termination of employment	• The same content as specified for initial and annual evaluations.
Evaluations due to reassignment to an area where EtO exposure is below the AL	• The same content as specified for initial and annual evaluations.
	• As determined by the LHCP.
Evaluations due to exposure during an emergency	• The same content as specified for initial and annual evaluations.
Evaluations triggered by employee signs and symptoms commonly associated with overexposure to EtO or a request for reproductive advice	• The content of medical examinations and consultations will be determined by the examining LHCP.
	– Pregnancy test, and laboratory evaluation for fertility if requested by employee and approved by evaluating LHCP.
Evaluations determined necessary by LHCP for exposed employees	• The content of medical examinations and consultations will be determined by the examining LHCP.

PDFWAC 296-855-30030

Medical evaluations.