(a) Employees covered. The employer shall 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
shall 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 shall ensure that all medical
examinations and procedures are performed by or under the
supervision of a licensed physician, and shall 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, shall 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
shall 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) shall 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 shall 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 shall be conducted in
accordance with WAC 296-62-07743, Appendix E.
(3) Periodic examinations.
(a) Periodic medical examinations shall be made available
annually.
(b) The scope of the medical examination shall be in
conformance with the protocol established in subsection (2)(b)
of this section, except that the frequency of chest
roentgenograms shall 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, shall be administered to the employee.
TABLE 2 -- FREQUENCY OF CHEST ROENTGENOGRAMS
Years since first exposure
Age of employee
15 to 35
35+ to 45
45+
0 to 10 . . . . . . . . . . . .
Every 5
years
Every 5
years
Every 5 years.
10+ . . . . . . . . . . . .
Every 5
years
Every 2
years
Every 1 year.
(c) If the examining physician determines that any of the
examinations should be provided more frequently than
specified, the employer shall provide such examinations to
affected employees at the frequencies specified by the
physician.
(4) Termination of employment examinations.
(a) The employer shall 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 shall be in accordance with
the requirements of the periodic examinations stipulated in
subsection (3) of this section, and shall 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
shall provide the following information to the examining
physician:
(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 shall obtain a written opinion from the
examining physician. This written opinion shall contain the
results of the medical examination and shall 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 shall 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 shall provide a copy of the physician's
written opinion to the affected employee within thirty days
from its receipt.