Screening and Surveillance

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Screening and

Surveillance:A Guide toOSHA StandardsU.S. Department of LaborOccupational Safety and Health Administration

OSHA 31622000 (Reprinted)


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This informational booklet isintended to provide a generic,non-exhaustive overview of aparticular standards-related topic.This publication does not itselfalter or determine compliance

responsibilities, which are setforth in OSHA standards them-selves, and the OccupationalSafety and Health Act. Moreover,because interpretations andenforcement policy may changeover time, for additional guidance

on OSHA compliance require-ments, the reader should consultcurrent administrative interpreta-tions and decisions by theOccupational Safety and HealthReview Commission and the

courts.

Material contained in thispublication is in the publicdomain and may be reproduced,fully or partially, without thepermission of the Federal

Government. Source credit isrequested but not required.

This information will be madeavailable to sensory impairedindividuals upon request. Voicephone (202) 693-2120.


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Screening and

Surveillance:A Guide toOSHA Standards

U.S. Department of LaborAlexis M. Herman, Secretary

Occupational Safety and Health AdministrationCharles N. Jeffress, Assistant Secretary

OSHA 31622000 (Reprinted)


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The Occupational Safety and Health Admin-istration (OSHA) receives many inquiries aboutthe medical surveillance provisions of itsstandards. This guide is a quick reference to

help you locate and implement the screeningand surveillance requirements of the OSHAstandards in Title 29 of the Code of FederalRegulations (29 CFR).

The guide provides a general overview ofOSHA requirements, but is not a legal authority

for compliance with them. For full details ofspecific compliance requirements, pleaseconsult the appropriate OSHA standard in theCFR. You can access the medical surveillanceprovisions of the OSHA standards on theInternet at www.osha.gov.

Screening and Surveillance:A Guide to OSHA Standards

NOTE TO EMPLOYERS:Please remember, more than one standard

may apply in your workplace. If so, you mustmeet all the screening and surveillance require-

ments for all the standards that apply. Forfurther information, contact your RegionalOSHA office listed at the end of this publicationand on OSHAs home page on the Internet atwww.osha.gov.

ii


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Contents iii

Glossary ........................................................... 1

A Guide to OSHA Standards ............................ 2

Acrylonitrile .................................................... 2

Arsenic ............................................................. 3

Asbestos (General Industry) ............................ 4

Asbestos (Construction and Shipyards) ........... 5

Benzene ........................................................... 6

Bloodborne Pathogens ..................................... 7

1, 3-Butadiene.................................................. 8Cadmium ......................................................... 9

Carcinogens (Suspect) ................................... 10

Coke Oven Emissions .................................... 11

Compressed Air Environments ...................... 12

Cotton Dust .................................................... 131,2-Dibromo-3-chloropropane ....................... 14

Ethylene Oxide .............................................. 15

Formaldehyde ................................................ 16

HAZWOPER ................................................. 17

Hazardous Chemicals in Laboratories ........... 18Lead ............................................................... 19

Methylenedianiline ........................................ 20

Methylene Chloride ....................................... 21

Noise .............................................................. 22

Respiratory Protection ................................... 23Vinyl Chloride ............................................... 24

Footnotes ....................................................... 25

OSHA Regional Offices .................................. 26


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Glossary

BP - blood pressure

BUN - blood urea nitrogen

CBC - complete blood count

FEF - forced expiratory flowFEV

1- forced expiratory volume one second

FSH- follicle stimulating hormone

FVC- forced vital capacity

HAZWOPER - Hazardous Waste Operations

and Emergency Response

HBV - hepatitis B virus

LH - luteinizing hormone

MDA - methylenedianiline

PPE - personal protective equipment

PHS or USPHS - United States Public HealthService

SGOT - serum glutamic oxalacetictransaminase

SGPT - serum glutamic pyruvictransaminase

ZPP - zinc protoporphyrin

1


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2

Pre-placement Yes

1

exam

Periodic exam Yesannual1

Emergency/exposure Yesexamination and tests

Termination exam Yesif no exam within6 months of termination

Examination includes Respiratory, gastrointestinal,1

special emphasis on thyroid, skin, neurologicalthese body systems (peripheral and central)

Work and medical Required for all exams2

history

Chest x-ray Yes

Pulmonary function Notest (PFT)

Other required tests Fecal occult blood1

Evaluation of Yesability to weara respirator

Additional tests Yes

if deemed necessaryWritten medical Yesphysician to employer;opinion employer to employee

Employee counseling Yesby physicianre: exam results,conditions of increased

risk

Medical removal plan No

Standard Requirements

Acrylonitrile1910.1045(n)/1926.1145/1915.1045*


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3

Pre-placement Yes1

exam

Periodic exam Yes1


Terminationexam Yesif no exam within6 months of termination

Examination includes Skin, nasalspecial emphasis onthese body systems

Work and medical Required for all exams2 withhistory focus on respiratory symptoms;

includes smoking history

Chest x-ray Yes


Other required tests No




Employee counseling Yesby physicianre: exam results,conditions of increased

risk


Arsenic (Inorganic)1910.1018(n)/1926.1118/1915.1018*




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4

Pre-placement Yes1, 3

exam

Periodic exam Yesannual1

Emergency/exposure Noexamination and tests

Termination exam Yeswithin 30 days oftermination

Examination includes Respiratory, cardiovascular,special emphasis on gastrointestinalthese body systems

Work and medical Required for all exams2;history standardized form required;

see standard, Appendix D

Chest x-ray Yes1B reader, board eligible/certified radiologist or physicianwith expertise in pneumoconioses

required; see standard, Appendix Efor x-ray interpretation andclassification requirements

Pulmonary function FVC, FEV1

test (PFT)



Additional tests Yesif deemed necessary

Written medical Yesphysician to employer;opinion employer to employee

Employee counseling Yesby physician; includesre: exam results, informing employee of increasedconditions of increased risk of lung cancer from combinedrisk effect of smoking and asbestos

exposure



Asbestos (General Industry)1910.1001(l)


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Asbestos (Construction and Shipyards)1926.1101(m)/1915.1001



exam

Periodic exam Yes annual1 or more frequentlyif determined by physician


Termination exam No

Examination includes Pulmonary and gastrointestinalspecial emphasis onthese body systems

Work and medical Required for all exams2

; specialhistory emphasis on pulmonary,

cardiovascular, gastrointestinal;standardized form required; seestandard, Appendix D

Chest x-ray Yes1 B reader, board eligible/certified radiologist or physician

with expertise in pneumoconiosesrequired; see standard, Appendix Efor x-ray interpretation andclassification requirements

Pulmonary function FVC, FEV1

test (PFT)





Employee counseling Yesby physician; includesre: exam results, informing employee of increasedconditions of increased risk of lung cancer from combinedrisk effect of smoking and asbestos

exposure




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6

Pre-placement Yes1,3, 4

exam

Periodic exam Yesannual1, 4

Emergency/exposure Yes1, 4includes urinary phenolexamination and tests test

Terminationexam No

Examination includes Hemopoietic; addspecial emphasis on cardiopulmonary if respiratorythese body systems protection used at least 30 days/

year, (initially, then every 3 years)

Work and medical Required for initial and periodichistory exams (pre-placement exam

requires special history)2

Chest x-ray No

Pulmonary function Initially and every 3 years iftest (PFT) respiratory protection used 30

days/year; specific testerrequirements

Other required tests CBC, differential, other specificblood tests; repeated as required;

see standard

Evaluation of Yesif respirators are usedability to weara respirator


if deemed necessary


Employee counseling Yesby physicianre: exam results,conditions of increasedrisk

Medical removal plan Yes


Benzene1910.1028(i)/1926.1128/1915.1028*


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7

Pre-placement Nomust offer Hepatitis B (HBV)

exam vaccine unless already immune orvaccine contraindicated

Periodic exam No

Emergency/exposure Specific post-exposure monitoringexamination and tests for employee and source;

HBV vaccine; see standard

Termination exam No

Examination includes Nospecial emphasis on

these body systemsWork and medical Nohistory

Chest x-ray No


Other required tests Yespost-exposure incident;follow US Public Health Service(USPHS) post-exposure protocols

Evaluation of Noability to weara respirator

Additional tests Yesfor post-exposure incident;if deemed necessary follow USPHS post-exposure

protocols

Written medical Yeslicensed health careopinion professional to employer;

employer to employee

Employee counseling Yesby licensed health carere: exam results, professional; counseling re: HBV

conditions of increased vaccine and post-exposurerisk followup; see standard



Bloodborne Pathogens1910.1030(f)



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Pre-placement Yes1, 3, 4

examPeriodic exam Yes1, 4

Emergency/exposure Yes1,4within 48 hours ofexamination and tests exposure

Termination exam Yes4if 12 months have

elapsed since last exam

Examination includes Liver, spleen, lymph nodes,special emphasis on and skinthese body systems

Work and medical Required annually and for all

history examinations2

; standardizedform or equivalent; includescomprehensive occupationaland health history; seestandard, Appendices F and C

Chest x-ray No


Other required tests CBC with differential andplatelet count, annually; alsowithin 48 hrs after exposure inan emergency situation and

repeated monthly for 3 moremonths

Evaluation of Yesif respirators are usedability toweara respirator


Written medical Yesphysician or otheropinion licensed health care

professional to employer andemployee

Employee counseling Yesby physician or otherre: exam results, licensed health care

conditions of increased professionalrisk


1, 3-Butadiene1910.1051(k)/1926.1151*



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exam

Periodic exam Yes1,4

Emergency/exposure Yes1,4

examination and tests

Termination exam Yes3

see standard for timeframe and other specifics

Examination includes Respiratory, cardiovascular (BP),special emphasis on urinary, and for males over 40these body systems prostate palpation1

Work and medical Required for preplacement andhistory periodic exams2; standardized formrequired

Chest x-ray Yes

Pulmonary function FVC, FEV1test (PFT)

Other required tests Annually,1 cadmium in urine,beta-2 microglobulin in urine,cadmium in blood, CBC, BUN,serum creatinine, urinalysis; seestandard


Additional tests if Yesdeemed neccessary


Employee counseling Yesby physician; includesre: exam results, explanation of results, treatment,conditions of increased and diet, and discussion ofrisk decisions re: medical removal;

see standard for details



Cadmium1910.1027(l)/1926.1127/1915.1027/1928.1027*



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Pre-placement Yes

exam

Periodic exam Yesannual

Emergency/exposure Yes1special medicalexamination and tests surveillance begins within

24 hours

Termination exam No

Examination includes Exam includes determinationspecial emphasis on for increased risk (e.g.,these body systems treatment with steroids or

cytotoxic agents, reducedimmunological competence,

pregnancy or cigarettesmoking)

Work andmedical Required for all examinations;history includes family and

occupational history, geneticand environmental factors

Chest x-ray No



Evaluation of Yesas specified in theability to wear respiratory protection standard

1910.134(e), if respiratorsare used


Written medical Yesphysician to employeropinion

Employee counseling Nore: exam results,conditions of increased

risk



Carcinogens (Suspect)1910.1003-1016(g)/1926.1103/1915.1003-1016*


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Pre-placement

exam Yes1

Periodic exam Yes1


Termination exam Yesif no exam within 6 monthsof termination

Examination includes Skinspecial emphasis onthese body systems

Work and medical Required for all exams2; includeshistory smoking history and presence and

degree of respiratory symptoms

Chest x-ray Yes

Pulmonary function FVC, FEV1test (PFT)

Other required tests Weight, urine cytology, urinalysisfor sugar, albumin, hematuria


Additional tests if Yessee standard, Appendix Bdeemed neccessary


Employee counseling Yesby physician; also, employerre: exam results, must inform employee of possibleconditions of increased health consequences if employeerisk refuses any required medical exam



Coke Oven Emissions1910.1029(j)



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Pre-placement Yes

exam

Periodic exam Yes1


Termination exam No

Examination includes Not specifiedspecial emphasis onthese body systems

Work andmedical Nohistory

Chest x-ray No




Additional tests Noif deemed necessary

Written medical Noopinion

Employee counseling Nore: exam results,conditions of increasedrisk


Compressed AirEnvironments1926.803(b)



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Pre-placement Physical exam not specified;exam other tests required

Periodic exam Physical exam not specified;other tests required1,4


Termination exam No

Examination includes Not specifiedspecial emphasis on

these body systems

Work andmedical Medical history; standardizedhistory questionnaire required; see

standard, Appendix B-11,2, 4

Chest x-ray No

Pulmonary function FVC, FEV1, FEV

1/FVC

test (PFT) Employees with specificabnormalities are referred tospecialists1,4, 5



Additional tests Noif deemed necessary


Employee counseling Yesby physician re: resultsre: exam results, of exam and any medicalconditions of increased conditions requiring furtherrisk examination or treatment

Medical removal plan Yesfor inability to wear a

respirator (6 months)


Cotton Dust1910.1043(h)



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Pre-placement Yes

exam

Periodic exam Yes1

Emergency/exposure Yesmale reproductive;examination and tests repeat in 3 months

Termination exam No

Examination includes Reproductive, genitourinary; seespecial emphasis on standard for detailsthese body systems

Work andmedical Required for all exams2

; includeshistory reproductive history; see standard,

Appendix C

Chest x-ray No


Other required tests Sperm count, FSH, LH, Totalestrogen (females); see standard,

Appendix C for guidelines

Evaluation ofability to wear Yesa respirator



Employee counseling Yesby physicianre: exam results,

conditions of increasedrisk


1,2-Dibromo-3-chloropropane1910.1044(m)/1926.1144/1915.1044*



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Pre-placement Yes1

examPeriodic exam Yesannual1

Emergency/exposure Yes1


Termination exam Yes1

Examination includes Pulmonary, skin, neurologic,special emphasis on hematologic, reproductive, eyesthese body systems

Work andmedical Required for all exams; includeshistory reproductive history and special

emphasis on some body systems;see standard

Chest x-ray No


Other required tests CBC, white cell count withdifferential, hematocrit, hemoglobin,red cell count; if requested byemployee, pregnancy testing andfertility testing (female/male)

will be added to the exam asdeemed appropriate by physician







Ethylene Oxide1910.1047(i)/1926.1147*




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exam

Periodic exam Yes1,4



Termination exam No

Examination includes Evidence of irritation orspecial emphasis on sensitization of skin, respiratorysystems these body system, eyes; shortness of breath

Work andmedical Required for all exams2;history questionnaire required;

see standard, Appendix D

Chest x-ray No

Pulmonary function FVC, FEV1, FEF should be

test (PFT) evaluated if respiratory protectionis used





Employee counseling Yesby physician; includesre: exam results, information on whether medicalconditions of increased conditions were caused by past

risk exposures or emergencyexposures



Formaldehyde1910.1048(l)/1926.1148/1915.1048*


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Pre-placement Yes1

exam

Periodic exam Yesannually or at physiciansdiscretion1



Termination exam Yesif no exam within 6 monthsof termination/reassignment

Examination includes Determined by physician; seespecial emphasis on standard, Appendix D, reference

these body systems 10 for guidelines

Work andmedical Yeswith emphasis onhistory symptoms related to handling

hazardous substances and healthhazards, fitness for duty andability to wear PPE2

Chest x-ray Nounless determined byphysician

Pulmonary function Nounless determined bytest (PFT) physician

Other required tests Nounless determined byphysician








HAZWOPER1910.120(f)/1926.65*



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Pre-placement When required by other standards

exam

Periodic exam When required by other standards



Termination exam No

Examination includes Not specifiedspecial emphasis onthese body systems

Work andmedical When required by other standardshistory

Chest x-ray When required by other standards

Pulmonary function When required by other standardstest (PFT)

Other required tests When required by other standards

Evaluation of Yeswhen required by otherability to wear standardsa respirator

Additional tests When required by other standardsif deemed necessary

Written medical Yesphysician to employeropinion



Hazardous Chemicals in Laboratories1910.1450(g)



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Pre-placement Yes1,4 except in constructionexam industries; construction requires

initial blood tests only

Periodic exam Yes1, 4

Emergency/exposure Yes1, 4


Termination exam No

Examination includes Teeth, gums, hematologic, gastro-special emphasis on intestinal, renal, cardiovascularthese body systems (BP), neurological; pulmonary

status if respiratory protection used

Work andmedical Required for all exams2; includes

history reproductive history, past leadexposure, both work/non-work,and history of specific bodysystems; see standard

Chest x-ray No

Pulmonary function Nounless deemed necessarytest (PFT) by physician

Other required tests Hemoglobin, hematocrit, ZPP,BUN, serum creatinine, urinalysiswith micro, blood-lead levels,peripheral smear morphology,red cell indices1, 5; if requested by

employee, pregnancy testing andfertility testing (female/male)




Employee counseling Yesby physician; includesre: exam results, advising the employee of anyconditions of increased medical condition, occupational

risk or non-occupational, requiringfurther medical examination ortreatment


Lead1910.1025(j)/1926.62*




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exam

Periodic exam Yesannual1, 4

Emergency/exposure Yes1, 4


Termination exam No

Examination includes Skin, hepaticspecial emphasis onthese body systems

Work andmedical Required for all examinations2;

history includes past work with MDA andother specific items; see standard

Chest x-ray No

Pulmonary function No

test (PFT)

Other required tests Liver function tests, urinalysis






Methylenedianiline1910.1050(m)



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Pre-placement Yes1,4

exam

Periodic exam Yes1, 4

Emergency/exposure Yes4see standard for specificsexamination and tests

Termination exam Yesif no exam within6 months of termination

Examination includes Lungs, cardiovascular (includingspecial emphasis on BP and pulse), liver, nervous, skin;these body systems extent of exam determined by

examiner based on employees

health status, work, andmedical history

Work andmedical Required for all exams; examplehistory of work and medical history form

provided in standard, Appendix B

Chest x-ray No

Pulmonary function Nounless deemed necessaryby physician or other licensedhealth care professional

Other required tests Laboratory surveillance mayinclude tests as determined byexaminer including before and

after shift tests; see standard,Appendix B

Evaluation of Yesas specified under theability to wear respiratory protection standarda respirator 1910.134(e)


if deemed necessary

Written medical Yesphysician or other licensedopinion health care professional to

employer and employee

Employee counseling Yesby physician or otherre: exam results, licensed health care professional




Methylene Chloride1910.1052(j)/1926.1152*



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Pre-placement No physical exam but audiometric

exam testing required

Periodic exam No physical exam but audiometrictesting required


Termination exam No physical exam but audiometrictesting required

Examination includes Nospecial emphasis onthese body systems

Work andmedicalhistory No

Chest x-ray No


Other required tests Initial and annual audiometrictesting1, 4, 5; see standard re:specific qualifications for the test

administrator



if deemed necessaryWritten medical Noopinion

Employee counseling Yesif standard threshold shiftre: exam results, or suspected ear pathologyconditions of increased

risk


Noise1910.95(g)/1926.52



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23

Pre-placement Evaluation questionnaire or exam;

exam followup exam when required5

Periodic exam Yesin specific situations5


Termination exam No

Examination includes Yes5see standard, Appendix Cspecial emphasis onthese body systems

Work andmedical Yes2see standard, Appendix Chistory

Chest x-ray As determined by physician orother licensed health careprofessional

Pulmonary function As determined by physician ortest (PFT) other licensed health care

professional

Other required tests As determined by physician orother licensed health careprofessional



Written medical Yesphysician or other licensedopinion health care professional to

employer and employee

Employee counseling Yesby physician or otherre: exam results, licensed health care professionalconditions of increased

risk



Respiratory Protection1910.134(e)/1926.103*



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Pre-placement Yes1

exam

Periodic exam Yes1


Termination exam No

Examination includes Special attention to detectingspecial emphasis on enlargement of the liver, spleen orthese body systems kidneys, or dysfunction of these

organs and abnormalities in skin,

connective tissue, and pulmonarysystem; see standard, Appendix A

Work andmedical Required for initial and periodichistory exams2; includes alcohol intake,

history of hepatitis, exposure tohepatotoxic agents, bloodtransfusions, hospitalizations, and

work history

Chest x-ray No


Other required tests Blood test for total bilirubin,alkaline phosphatase, SGOT, SGPTand gamma glustamyltranspeptidase




Employee counseling Nore: exam results,conditions of increasedrisk


Vinyl Chloride1910.1017(k)/1926.1117*



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1 Pre-placement and periodic examinations aredependent upon specific factors cited in thestandard such as airborne concentrations of thesubstance and/or years of exposure, biologicalindices, age of employee, amount of timeexposed per year. In addition, some standardsrequire periodic exams to be conducted atvarying time intervals. Refer to standard forcomplete details.

2 Standard requires medical and work historyfocused on special body systems, symptoms,personal habits, and/or specific family, environ-mental or occupational history. Refer to standardfor complete details.

3 No examination required if previous examina-tion done within specified time frame (e.g., 6months or 12 months) and provisions of standardmet. Refer to standard for details.

4 Additional physician review: Some standardshave provisions for referring employees withabnormalities to a specialist as deemed neces-sary by examiner. Other standards have provi-sions for multiple physician review. See specificstandard for details.

5 Standard requires specific protocol.See standard for details.

*These Maritime and Construction standards areidentical to 29 CFR 1910, General Industrystandards.

1926.52 requires an effective and continuedhearing conservation program. OSHA hasinterpreted this to include audiograms whenfeasible. See letter of interpretation datedAugust 4, 1992.

Footnotes


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Region I(CT,* MA, ME, NH, RI, VT*)JFK Federal BuildingRoom E-340Boston, MA 02203Telephone: (617) 565-9860

Region II(NJ, NY,* PR,* VI*)201 Varick StreetRoom 670New York, NY 10014Telephone: (212) 337-2378

Region III(DC, DE, MD,* PA, VA,* WV)The Curtis Center-Suite 740 West170 S. Independence Mall WestPhiladelphia, PA 19106-3309Telephone: (215) 861-4900

Region IV(AL, FL, GA, KY,* MS, NC,* SC,* TN*)Atlanta Federal Center61 Forsyth Street, SW, Room 6T50Atlanta, GA 30303Telephone: (404) 562-2300

Region V(IL, IN,* MI,* MN,* OH, WI)230 South Dearborn StreetRoom 3244Chicago, IL 60604Telephone: (312) 353-2220

OSHA Regional Offices


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Region VI(AR, LA, NM,* OK, TX)525 Griffin StreetRoom 602Dallas, TX 75202Telephone: (214) 767-4731

Region VII(IA,* KS, MO, NE)City Center Square1100 Main Street, Suite 800Kansas City, MO 64105Telephone: (816) 426-5861

Region VIII(CO, MT, ND, SD, UT,* WY*)1999 Broadway, Suite 1690Denver, CO 80202-5716Telephone: (303) 844-1600

Region IX(American Samoa, AZ,* CA,* Guam,HI,* NV,* Trust Territories of the Pacific)71 Stevenson Street4th FloorSan Francisco, CA 94105Telephone: (415) 975-4310

Region X(AK,* ID, OR,* WA*)1111 Third AvenueSuite 715Seattle, WA 98101-3212Telephone: (206) 553-5930

*These states and territories operate their own OSHA-approved job safety and health programs (Connecticut andNew York plans cover public employees only). States withapproved programs must have a standard that is identical to,or at least as effective as, the federal standard.

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