Effective Date of Rule: February 1, 2006.

     Purpose: Cholinesterase monitoring, chapter 296-307 WAC, this rule making is being adopted based on stakeholder recommendations and to address program changes occurring since original cholinesterase monitoring rule was adopted. These changes are to modify the licensed health care professional's written recommendation to address all employee blood tests, to clarify some requirements, and to make some minor housekeeping changes.

AMENDED SECTIONS:

WAC 296-307-14805 Maintain handling records for covered pesticides.

•	Deleted the reference to the table and added the reference to the applicable WAC section.
•	There is a current requirement in RCW 49.17.285 which requires employers to provide handling hours to the medical provider/laboratory; we are adding this for clarity.

WAC 296-307-14810 Implement a medical monitoring program.

•	Deleted the table and the reference to this table in this section.
•	Added two notes to this section for clarity.

WAC 296-307-14815 Identify a physician or licensed health care professional.

•	Added a requirement for the employer to obtain a written recommendation from the health care provider for all blood testing and to make sure the employee receives a copy of the written recommendation. This will provide employees with ready access to health care provider recommendations.
•	Added a note relating to testing being done by the same laboratory whenever possible.
•	Added a note relating to obtaining employee's written consent to obtain blood test results.
•	Clarified language.

WAC 296-307-14820 Make cholinesterase testing available.

•	Deleted the reference to the table and add the reference to the applicable WAC section.
•	Added a note relating to a "working baseline."
•	Moved two notes to WAC 296-307-14810 for better organization.
•	Added language relating to the employee receiving a copy of the signed declination statement within five business days after receipt from the LHCP.
•	Clarified language.

WAC 296-307-14825 Respond to depressed cholinesterase levels.

•	Changed the table to "Table 1."
•	Added language in the table for clarity.

WAC 296-307-14830 Provide medical removal protection benefits.

•	Added a clarifying note relating to benefits being paid while on medical removal.

     Citation of Existing Rules Affected by this Order: Amending WAC 296-307-14805 Maintain handling records for covered pesticides, 296-307-14810 Implement a medical monitoring program, 296-307-14815 Identify a physician or licensed health care professional, 296-307-14820 Make cholinesterase testing available, 296-307-14825 Respond to depressed cholinesterase levels, and 296-307-14830 Provide medical removal protection benefits.

     Statutory Authority for Adoption: RCW 49.17.010, 49.17.040, 49.17.050, 49.17.060.

      Adopted under notice filed as WSR 05-19-087 on September 20, 2005.

     Changes Other than Editing from Proposed to Adopted Version: There are no costs to assess on the changes from proposed to adopted.

WAC 296-307-14805 Maintain handling records for covered pesticides.

•	Deleted the reference to the table and added the reference to the applicable WAC section.
•	There is a current requirement in RCW 49.17.285 which requires employers to provide handling hours to the medical provider/laboratory; we are adding this for clarity.
•	Added the word "other" in the second bullet.
•	Merged a primary bullet and subbullet for clarity.

WAC 296-307-14810 Implement a medical monitoring program.

•	Delete the table and the reference to this table in this section.
•	Add two notes to this section for clarity.
•	In the note, moved the phrase "Closed cabs are not 'closed systems'" for clarity.

WAC 296-307-14815 Identify a physician or other licensed health care professional.

•	Added a requirement for the employer to obtain a written opinion from the health care provider for all blood testing and to make the opinion available to the employee. This will provide employees with ready access to test results and health care provider recommendations.
•	Added a note relating to testing being done by the same laboratory whenever possible.
•	Added a note relating to obtaining employee's written consent to obtain blood test results.
•	Clarified language.
•	Added the word "other" to the title of this section.
•	Changed the language in the first bullet, first subbullet to read, "Provide baseline and periodic cholinesterase testing through the department of health public health laboratory or a laboratory approved by the department of labor and industries."
•	Added the word "cholinesterase" in the second subbullet for clarity.
•	Added clarifying language after the second subbullet that reads, "Provide you with a written recommendation for each employee's blood test and evaluation."
•	In the second bullet, changed the word "opinion" to "recommendation" for consistency.
•	In the second bullet, clarified the language to read, "Obtain the LHCP's written recommendation for each employee's blood test and evaluation (including baseline tests) and make sure that the employee receives a copy of the LHCP's written recommendation, either through you or directly through the LHCP, within five business days after you receive the recommendation."
•	In the third bullet, clarified the language to read, "Make sure the LHCP's written recommendation for each employee's blood test and evaluation is limited to the following information:

-	The employee's cholinesterase status based on the LHCP's evaluation.

&lhlsqbul;	Identification of changes in cholinesterase levels requiring a work practice evaluation for the employee.
&lhlsqbul;	Identification of changes in cholinesterase levels requiring the employee to be removed from handling and other exposure to organophosphate and N-methyl-carbamate pesticides."

•	Clarified the note to read, "All testing for an employee should be conducted through the same laboratory. This will allow for accurate comparison between baseline and periodic tests."
•	In the fourth bullet, clarified the language to read, "Instruct the LHCP to not reveal in writing or in any other communication with you any other personally identifiable medical information."
•	Added a note for clarity that reads, "If the LHCP written recommendation contains specific findings or diagnoses unrelated to occupational exposure, you should send it back and obtain a revised version without the additional information."
•	Added the words "You must" after the note.
•	In the fifth bullet, deleted the words "physician or" for consistency.
•	In the sixth bullet, deleted the words "medical provider" for consistency.
•	In the seventh bullet, deleted the words "physician or" for consistency.
•	Clarified the note to read, "You may only obtain the employee's actual test results if the employee provides the LHCP with written consent to share these results with you."

WAC 296-307-14820 Make cholinesterase testing available.

•	Deleted the reference to the table and added the reference to the applicable WAC section.
•	Added a note relating to a "working baseline."
•	Moved two notes to WAC 296-307-14810 for better organization.
•	Added language relating to the employee receiving a copy of the signed declination statement within five business days after receipt from the LHCP.
•	Clarified language.
•	In the first bullet, clarified the language to read, "Make medical monitoring available to employees who will meet the handling hour threshold of thirty or more hours in any consecutive thirty-day period (WAC 296-307-14810) at no cost and at a reasonable time and place as follows:"
•	In the first and second subbullets replaced the word "plasma" with "serum."
•	In the first and second tertiary bullets replaced the words "levels in" with "hour threshold in."
•	Inserted a third subbullet, that was located in another place in this section, that reads, "Follow the recommendations of the LHCP regarding continued employee pesticide handling or removal from handling until a thirty-day exposure free baseline can be established."
•	Deleted the second bullet.
•	In the note, deleted the words "medical provider" for consistency.
•	In the second bullet, deleted the words "physician or" for consistency.
•	In the first subbullet, deleted the words "physician or" for consistency.
•	In the third bullet, clarified the language to read, "Make sure the employee receives a copy of the signed declination statement, either through you or directly through the LHCP, within five business days after you receive the declination statement."

WAC 296-307-14825 Respond to depressed cholinesterase levels.

•	Changed the table to "Table 1."
•	Added language in the table for clarity.
•	In the second subbullet, deleted the words "physician or" for consistency.
•	In table, replaced the "plasma" with "serum" in two places.
•	In the table deleted the words "physician or" for consistency.

WAC 296-307-14830 Provide medical removal protection benefits.

•	Added a clarifying note relating to benefits being paid while on medical removal.
•	Clarified the note to read, "The following are examples of how a worker's pay could be maintained while medically removed from exposure to cholinesterase-inhibiting pesticides:"
•	In the note, replaced the words "the additional two dollars per hour" with "this premium" for clarity.

     Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 6, Repealed 0.

     Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 6, Repealed 0.

     Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0;      Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 6, Repealed 0.

     Date Adopted: December 20, 2005.

Gary Weeks

Director

OTS-8288.5

AMENDATORY SECTION(Amending WSR 03-24-105, filed 12/3/03, effective 2/1/04)

WAC 296-307-14805   Maintain handling records for covered pesticides.  

     You must:

     • Maintain accurate records of all time that each employee spends handling category I or II organophosphate or N-methyl-carbamate pesticides (this includes employees who do not meet the handling hour thresholds in ((Table 1)) WAC 296-307-14810).

     • Provide a completed CHOLINESTERASE MONITORING HANDLING HOURS REPORT (F413-065-000) to the physician or other licensed health care professional (LHCP) for each employee receiving a periodic cholinesterase blood test and make sure the report is submitted to the laboratory with each periodic cholinesterase test.

     • Provide the employee with a copy of the CHOLINESTERASE MONITORING HANDLING HOURS REPORT upon request.

     • Retain pesticide handling records for seven years.

     • Make sure that pesticide-handling records are readily accessible to employees, their designated representatives, and treating health care professionals.

[Statutory Authority: RCW 49.17.010, 49.17.040, 49.17.050, and 49.17.060. 03-24-105, § 296-307-14805, filed 12/3/03, effective 2/1/04.]

     You must:

     • Implement a medical monitoring program for your employees who handle or will be expected to handle category I or II organophosphate or N-methyl-carbamate pesticides ((according to the schedule in Table 1)) for thirty or more hours in any consecutive thirty-day period.

((Table 1
Implementation Schedule

[Statutory Authority: RCW 49.17.010, 49.17.040, 49.17.050, and 49.17.060. 03-24-105, § 296-307-14810, filed 12/3/03, effective 2/1/04.]

     You must:

     • Identify a physician or other licensed health care professional (LHCP) who will:

     – Provide baseline and periodic cholinesterase testing through the department of health public health laboratory((,)) or ((beginning in 2006, through any)) a laboratory approved by the department of labor and industries.

     – Interpret cholinesterase tests.

     – Provide you with a written recommendation((s and opinions that:

     &sqbul; Identify employees with periodic test results requiring a work practice evaluation.

     &sqbul; Identify employees with periodic test results indicating they must be removed from handling and other exposure to organophosphate and N-methyl-carbamate pesticides)) for each employee's blood test and evaluation.

     • Obtain the LHCP's written recommendation for each employee's blood test and evaluation (including baseline tests) and make sure that the employee receives a copy of the LHCP's written recommendation, either through you or directly through the LHCP, within five business days after you receive the recommendation.

     • Make sure the LHCP's written recommendation for each employee's blood test and evaluation is limited to the following information:

     – The employee's cholinesterase status based on the LHCP's evaluation.

     – Identification of changes in cholinesterase levels requiring a work practice evaluation for the employee.

     – Identification of changes in cholinesterase levels requiring the employee to be removed from handling and other exposure to organophosphate and N-methyl-carbamate pesticides.

     ((&sqbul; Provide)) – Guidance on medical monitoring.

     ((&sqbul; Include)) – Any other relevant information concerning an employee's workplace exposure to organophosphate and N-methyl-carbamate pesticides.

Note:

All testing for an employee should be conducted through the same laboratory. This will allow for accurate comparison between baseline and periodic tests.

     You must:

     • Instruct the ((physician or other licensed health care professional ())LHCP(())) to NOT reveal in writing or in any other communication with you((,)) any other personally identifiable medical information((, other than laboratory test results, for any employee)).

    

Note:

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

     You must:

     • Make sure the ((physician or)) LHCP is familiar with the requirements of this rule (for example, by providing a copy of the rule or by confirming that the provider has attended training on the rule).

     • Post the name, address, and telephone number of the ((medical provider)) LHCP you have identified at the locations where employees usually start their work day.

     • Make sure ((copies of employee test results and)) written recommendations from the ((physician or)) LHCP are maintained for seven years.

Note:

You may only obtain the employee's actual test results if the employee provides the LHCP with written consent to share these results with you.

[Statutory Authority: RCW 49.17.010, 49.17.040, 49.17.050, and 49.17.060. 03-24-105, § 296-307-14815, filed 12/3/03, effective 2/1/04.]

     You must:

     • Make medical monitoring available to employees who will meet the ((exposure)) handling hour threshold((s in Table 1,)) of thirty or more hours in any consecutive thirty-day period (WAC 296-307-14810) at no cost and at a reasonable time and place, as follows:

     – Provide annual baseline red blood cell (RBC) and ((plasma)) serum cholinesterase tests that are taken at least thirty days after the employee last handled organophosphate or N-methyl-carbamate pesticides.

     – Provide periodic RBC and ((plasma)) serum cholinesterase testing:

     &sqbul; Within three days after the end of each thirty-day period where the employee meets the handling ((levels in Table 1)) hour threshold in WAC 296-307-14810; however, testing is not required more often than every thirty days;

     OR

     &sqbul; At least every thirty days for those employees who may meet the handling ((levels)) hour threshold in ((Table 1)) WAC 296-307-14810.

     ((• Arrange to obtain a "working baseline" as soon as possible for employees who initially decline cholinesterase testing and later choose to participate in testing.))

     – Follow the recommendations of the ((physician or)) LHCP regarding continued employee pesticide handling or removal from handling until a thirty-day exposure free baseline can be established.

Exemption:

You do not need to provide baseline or periodic testing for those employees whose work exposure is limited to handling only N-methyl-carbamate pesticides.

Note:	((• You do not need to count time spent mixing and loading using closed systems (as defined in WAC 296-307-13045 (4)(d)) in determining the need for periodic testing. Time using closed systems is still counted for purposes of establishing coverage under this rule and determining the need for obtaining baseline cholinesterase levels.)) • For employees who have had exposure to organophosphate or N-methyl-carbamate pesticides in the thirty days prior to the test obtain a working baseline. For example, a worker who initially declines cholinesterase testing and later chooses to participate in testing would obtain a "working baseline."
	• For new employees, the ((medical provider)) LHCP may accept previous baselines, if they are obtained according to this rule.
	((• The first thirty consecutive day period begins on the first day of handling organophosphate or N-methyl-carbamate pesticides after obtaining the baseline cholinesterase test.))

     You must:

     • Obtain a signed declination statement from the ((physician or)) LHCP for each employee((s)) who declines cholinesterase testing.

     – Employees may decline cholinesterase testing only after they receive training about cholinesterase inhibiting pesticides and discuss the risks and benefits of participation with the ((physician or)) LHCP.

     – An employee may change his or her mind and elect to participate or decline to continue participation in the testing program at any time.

     • Make sure the employee receives a copy of the signed declination statement, either through you or directly through the LHCP, within five business days after you receive the declination statement.

Note:

If employers discourage participation in cholinesterase monitoring, 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, instituting proceedings, or testifying prohibited -- Procedure -- Remedy.

[Statutory Authority: RCW 49.17.010, 49.17.040, 49.17.050, and 49.17.060. 03-24-105, § 296-307-14820, filed 12/3/03, effective 2/1/04.]

     You must:

     • Respond to an employee's depressed cholinesterase levels by:

     – Taking the actions required in Table ((2)) 1;

     AND

     – Following any additional occupational health recommendations from the ((physician or)) LHCP.

Table ((2)) 1
Required Responses to an Employee's Depressed Cholinesterase Levels

[Statutory Authority: RCW 49.17.010, 49.17.040, 49.17.050, and 49.17.060. 03-24-105, § 296-307-14825, filed 12/3/03, effective 2/1/04.]

     You must:

     • Provide medical removal protection benefits for a maximum of three months on each occasion:

     – An employee is temporarily removed from work due to depressed cholinesterase levels;

     OR

     – Assigned to other duties due to depressed cholinesterase levels.

     • Provide medical removal protection benefits that include maintenance of the same pay, seniority and other employment rights and benefits of an employee as though the employee had not been removed from normal exposure to organophosphate or N-methyl-carbamate pesticides or otherwise limited.

Note:	The following are examples of how a worker's pay could be maintained while medically removed from exposure to cholinesterase-inhibiting pesticides:
	• A removed worker is assigned to work eight hours a day but the employer's pesticide handlers are working ten hours a day. The removed worker would be paid for ten hours at the handler's pay rate.
	• The farmer pays workers two dollars more per hour when they are handling organophosphate or N-methyl-carbamate pesticides. The removed worker will be paid this premium when the pesticides are being handled on the farm; however, the worker will be paid at their usual pay rate when the pesticides are not being handled on the farm.

[Statutory Authority: RCW 49.17.010, 49.17.040, 49.17.050, and 49.17.060. 03-24-105, § 296-307-14830, filed 12/3/03, effective 2/1/04.]