(1) General.

(a) Employees covered. The employer must institute a medical surveillance program for all employees who are or will be exposed to airborne concentrations of fibers of asbestos at or above the permissible exposure limits. Exception.

Employers in the construction or shipyard industries must institute a medical surveillance program for all employees who for a combined total of thirty or more days per year are engaged in Class I, II, and III work, or are exposed at or above the permissible exposure limit for combined thirty days or more per year; or who are required by the standard to wear negative pressure respirators. For the purpose of this subsection, any day in which an employee engaged in Class II or III work or a combination thereof for one hour or less (taking into account the entire time spent on the removal operation, including cleanup), and, while doing so adheres to the work practices specified in this standard, shall not be counted.

(b) Examination by a physician.

(i) The employer must ensure that all medical examinations and procedures are performed by or under the supervision of a licensed physician, and must be provided without cost to the employee and at a reasonable time and place.

(ii) Persons other than licensed physicians, who administer the pulmonary function testing required by this section, must complete a training course in spirometry sponsored by an appropriate academic or professional institution.

(2) Preplacement examinations.

(a) Except as provided by WAC 296-62-07725 (1)(a), before an employee is assigned to an occupation exposed to airborne concentrations of asbestos, a preplacement medical examination must be provided or made available by the employer. Examinations administered using the thirty or more days per year criteria of WAC 296-62-07725 (1)(a) must be given within ten working days following the thirtieth day of exposure. Examinations must be given prior to assignment of employees to areas where negative-pressure respirators are worn.

(b) All examinations must include, as a minimum, a medical and work history: A complete physical examination of all systems with special emphasis on the pulmonary, cardiovascular, and gastrointestinal systems; completion of the respiratory disease standardized questionnaire in WAC 296-62-07741, Appendix D, Part 1; a chest roentgenogram (posterior-anterior 14x17 inches); pulmonary function tests to include forced vital capacity (FVC) and forced expiratory volume at 1 second (FEV1.0); and any additional tests deemed appropriate by the examining physician. Interpretation and classification of chest roentgenograms must be conducted in accordance with WAC 296-62-07743, Appendix E.

(3) Periodic examinations.

(a) Periodic medical examinations must be made available annually.

(b) The scope of the medical examination must be in conformance with the protocol established in subsection (2)(b) of this section, except that the frequency of chest roentgenograms must be conducted in accordance with Table 2 of this section, and the abbreviated standardized questionnaire contained in WAC 296-62-07741, Appendix D, Part 2, must be administered to the employee.

(c) If the examining physician determines that any of the examinations should be provided more frequently than specified, the employer must provide such examinations to affected employees at the frequencies specified by the physician.

(4) Termination of employment examinations.

(a) The employer must provide, or make available, a termination of employment medical examination for any employee who has been exposed to airborne concentrations of fibers of asbestos at or above the permissible exposure limits.

(b) The medical examination must be in accordance with the requirements of the periodic examinations stipulated in subsection (3) of this section, and must be given within thirty calendar days before or after the date of termination of employment.

(5) Recent examinations. No medical examination is required of any employee, if adequate records show that the employee has been examined in accordance with subsection (2), (3), or (4) of this section within the past one-year period.

(6) Information provided to the physician. The employer must provide the following information to the examining physician:

(a) A copy of this standard and Appendices D, E, and H of WAC 296-62-07741, 296-62-07743, and 296-62-07749 respectively.

(b) A description of the affected employee's duties as they relate to the employee's exposure.

(c) The employee's representative exposure level or anticipated exposure level.

(d) A description of any personal protective and respiratory equipment used or to be used.

(e) Information from previous medical examinations of the affected employee that is not otherwise available to the examining physician.

(7) Physician's written opinion.

(a) The employer must obtain a written opinion from the examining physician. This written opinion must contain the results of the medical examination and must include:

(i) The physician's opinion as to whether the employee has any detected medical conditions that would place the employee at an increased risk of material health impairment from exposure to asbestos;

(ii) Any recommended limitations on the employee or upon the use of personal protective equipment such as clothing or respirators;

(iii) A statement that the employee has been informed by the physician of the results of the medical examination and of any medical conditions resulting from asbestos exposure that require further explanation or treatment; and

(iv) A statement that the employee has been informed by the physician of the increased risk of lung cancer attributable to the combined effect of smoking and asbestos exposure.

(b) The employer must instruct the physician not to reveal in the written opinion given to the employer specific findings or diagnoses unrelated to occupational exposure to asbestos.

(c) The employer must provide a copy of the physician's written opinion to the affected employee within thirty days from its receipt.