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PDFWAC 296-824-40005

Provide medical surveillance to employees.

(1) You must provide medical surveillance for employees to comply with Tables 7 and 8, and the following:
(a) Make medical surveillance available at:
(i) Reasonable times and places;
(ii) No cost to employees, including travel associated costs such as mileage, gas or bus fare if the employee is required to travel off-site; and
(iii) Wages for additional time spent outside of employees normal work hours.
(b) Make sure a licensed physician performs or supervises exams and procedures;
(c) Give complete information to the examining physician including:
(i) A copy of this chapter.
(ii) A description of the employee's duties that relate to hazardous substance exposure.
(iii) The hazardous substance exposure levels anticipated for the employee.
(iv) A description of the personal protective equipment (PPE) the employee could use.
(v) Information available from previous medical examinations.
(vi) The medical evaluation information required by chapter 296-842 WAC, Respirators.
(d) Medical exams must include, at a minimum:
(i) A medical history;
(ii) A work history (or updated history if on file);
(iii) A special emphasis on:
(A) Assessment of symptoms related to handling hazardous substances;
(B) Health hazards;
(C) Evaluation of fitness for duty (including the ability to wear any personal protective equipment (PPE) or other conditions that may be expected at the workplace).
(iv) Other content as determined by the examining physician.
The physician should consult the Occupational Safety and Health Guidance Manual for Hazardous Waste Site Activities and the Medical Management Guidelines for Acute Chemical Exposure (search OSHA website:
(2) You must obtain the physician's written opinion and give a copy to the employee that includes:
(a) A statement of whether or not medical conditions were found which would increase the employee's risk for impairment during emergency response work or respirator use.
Do not include specific findings or diagnoses unrelated to occupational exposures.
(b) Limitations recommended to the employee's assigned work, if any.
(c) Exam and test results if the employee requests this information.
(d) A statement that affirms the employee has been confidentially informed of medical exam results (including medical conditions requiring follow-up).
Table 7
Medical Surveillance for Employee Categories
If the employee is covered by this chapter and is:
Then you must:
• Exposed for at least 30 days a year to health hazards or hazardous substances at or above the permissible exposure limit or published exposure levels (even when respirators are used),
• Required to wear a respirator for at least 30 days a year.*
• Offer standard medical surveillance as specified in Table 8.*
• A hazardous materials (HAZMAT) team member
• A hazardous materials specialist
• Provide standard medical surveillance as specified in Table 8.
• An emergency responder who shows immediate or delayed signs or symptoms possibly resulting from exposure to hazardous substances during an incident.
• Provide incident-specific medical surveillance as specified in Table 8.
• Not an emergency responder and:
- May be injured
- Shows immediate or delayed signs or symptoms possibly resulting from exposure to hazardous substances
- May have been exposed to hazardous substances at concentrations above the permissible exposure limits (PELs) or the published exposure levels without appropriate PPE.
• Offer incident-specific medical surveillance as specified in Table 8.
A medical evaluation for respirator use is required by chapter 296-842 WAC, Respirators, for those employees who have not been cleared for respirator use during medical surveillance activities.
Table 8
Frequency of Exams and Consultations
If the employee is covered by:
Then medical surveillance must include:
• Standard medical surveillance
• Exams and consultations:
- Before assignment.
Note: If the employee is a hazardous materials (HAZMAT) team member or a hazardous materials specialist, the employee must receive a baseline physical examination.
- At least once every 12 months after their initial assignment unless the physician believes a shorter, or longer interval (but no more than 24 months) is appropriate.
- Whenever employees are reassigned to an area where they will no longer be covered by medical surveillance and they have not been examined within the past 6 months.
- As soon as possible after an employee reports:
♦ Signs or symptoms of possible overexposure to hazardous substances or health hazards
♦ Injury
♦ Exposure above the permissible exposure limits or published exposure levels
- At the termination of their employment unless they were examined within the past 6 months.
• Incident-specific medical surveillance
• Medical consultations and exams:
- As soon as possible following the incident or development of signs or symptoms.
- At additional times, if the physician determines follow-up is medically necessary.
[Statutory Authority: RCW 49.17.010, 49.17.040, 49.17.050, and 49.17.060. WSR 17-18-075, § 296-824-40005, filed 9/5/17, effective 10/6/17; WSR 05-03-093, § 296-824-40005, filed 1/18/05, effective 3/1/05; WSR 02-20-034, § 296-824-40005, filed 9/24/02, effective 10/1/02.]
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