• Establish a medical surveillance plan for all employees who meet any of the following:
– Are or may be exposed to hazardous substances or health hazards for at least thirty days a year, at or above the permissible exposure limits (PELs) or other published exposure levels.
– Wear a respirator for at least thirty days a year.
– Are injured, become ill, or develop signs or symptoms of possible overexposure to hazardous substances or health hazards.
– Are hazardous materials team (HAZMAT) members.
|Reference: ||Employees who use respirators less than thirty days a year are required to have a respirator medical evaluation as outlined by chapter 296-842 WAC, Respirators. Completion of a medical examination required by this section will meet the requirement for a respirator medical evaluation. |
• Make sure medical examinations, consultations, and procedures are:
– Scheduled according to Table 4, Medical Examination Schedule.
– Performed or supervised by a licensed physician.
▪ At a reasonable time and place.
▪ Without loss of pay.
▪ Without cost to employees.
|Note: ||Examples of costs include: Mileage, gas, bus fare, and time spent outside normal work hours. |
Medical Examination Schedule
|If a worker ||Then provide an examination |
|Is assigned to work that is covered by this chapter ||Before work assignment begins |
|Continues to work in hazardous waste operations ||At least once every twelve months, unless the attending physician decides a different interval, up to twenty-four months or less than twelve months, is appropriate |
|Needs to be examined more frequently based on the examining physician's medical judgment ||At an interval less than twelve months |
|Is reassigned to an area where their work is not covered ||As soon as possible, unless he or she was examined within the past six months |
|OR || |
|Employment is terminated || |
|Has an incident that results in injury or illness ||As soon as possible |
|OR || |
|Develops signs or symptoms of possible overexposure to hazardous substances and health hazards || |
|OR || |
|Has been exposed above the permissible exposure limits or published exposure levels || |
|Requires follow-up examinations or consultations because of medical necessity for an exposure incident or injury ||When determined by the examining physician |
• Make sure the medical examination includes the following information for each affected employee:
– A medical and work history, with special emphasis on symptoms related to handling hazardous substances and health hazards.
– Information about fitness for duty including the ability to wear any personal protective equipment (PPE) under conditions that may be expected at the workplace.
– Any additional information that is determined by the examining physician.
|Note: ||The physician should consult the NIOSH Occupational Safety and Health Guidance Manual for Hazardous Waste Site Activities http://www.cdc.gov/niosh/85-115.html. |
• Provide complete information to the examining physician, including:
– A copy of WAC 296-843-210
– Medical evaluation information required by chapter 296-842
– A description of the employee's duties that relate to hazardous substance exposure.
– The actual or anticipated hazardous substance exposure levels for the employee.
– A description of the PPE the employee uses or could use.
– Information available from previous medical examinations.
– Instruction to the physician that the physician's written opinion NOT
include specific findings or diagnoses that are not related to occupational exposures.
|Note: ||You are NOT required to send duplicate information to the physician for each employee. |
• Obtain the physician's written medical opinion that includes the following information:
– Whether medical conditions were found that would increase the employee's risk for impairment during emergency response work or respirator use.
– Limitations of the employee's assigned work, if any.
– Examination and test results, if the employee requests this information.
– A statement that the employee has been confidentially informed of medical examination results (including medical conditions requiring followup required by WAC 296-843-210
• Provide the employee with a copy of the physician evaluation.
[Statutory Authority: RCW 49.17.010, 49.17.040, 49.17.050, and 49.17.060. 04-02-053, § 296-843-21005, filed 1/5/04, effective 5/1/04.]