WAC 296-307-70420   Medical surveillance.  Provide medical surveillance to employees.

     You must:

     (1) Provide medical surveillance for employees to comply with Tables 7 and 8, and the following:

     • Make medical surveillance available at:

     – Reasonable times and places.

     – 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

     – Wages for additional time spent outside of employees' normal work hours.

     • Make sure a licensed physician performs or supervises exams and procedures.

     • Give complete information to the examining physician including:

     – A copy of this section.

     – A description of the employee's duties that relate to hazardous substance exposure.

     – The hazardous substance exposure levels anticipated for the employee.

     – A description of the personal protective equipment (PPE) the employee could use.

     – Information available from previous medical examinations.

     – The medical evaluation information required by chapter 296-307 WAC, Part Y-5, Respirators.

     • Medical exams must include, at a minimum:

     – A medical history.

     – A work history (or updated history if on file).

     – A special emphasis on:

     ▪ Assessment of symptoms related to handling hazardous substances.

     ▪ Health hazards.

     ▪ 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).

     – Other content as determined by the examining physician.

Note:

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 web site: http://www.osha.gov).

     You must:

     (2) Obtain the physician's written opinion and give a copy to the employee that includes:

     • 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.

     • Limitations recommended to the employee's assigned work, if any.

     • Exam and test results if the employee requests this information.

     • 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 section 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), OR • 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.

*Note:

A medical evaluation for respirator use is required by chapter 296-307 WAC, Part Y-5, Respiratory protection, 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, 49.17.060. 05-01-166, § 296-307-70420, filed 12/21/04, effective 4/2/05.]