General information
Medical surveillance refers to the periodic testing of employees
exposed to potentially hazardous materials or other risks in the
workplace in an attempt to uncover early signs of work-related illness.
Occupational Safety Health Administration (OSHA) often requires
surveillance to detect illness caused by materials such as asbestos,
lead, formaldehyde, benzene, and hazardous waste. The critical component
of the medical surveillance is appropriate follow-up of abnormalities
discovered during the examination.
Employers must obtain material safety data sheets (MSDS) from manufacturers
for all hazardous chemicals used in the workplace. An MSDS is the
first step in determining the need for medical surveillance.
If the workplace has carcinogens or chemical substances subject
to OSHA regulations, you must review the standard(s) for detailed
information about whether medical surveillance is required.
The level of exposure at which surveillance becomes advisable is
referred to as the "action level." Usually, it is 50 percent
of the permissible exposure limit (PEL). A major exception is the
OSHA lead standard for which the action level is 60 percent of the
maximum permissible concentration, which is an eight-hour time-weighted
average (TWA).
If you need to develop a medical surveillance program, you'll need
to determine the components, select a healthcare provider, and inform
your employees about the program. Health First Occupational Medicine
can help you set up a program, as well as perform all the necessary
medical surveillance exams and evaluations.
Components of a medical surveillance
program
- Questionnaire — which depends on the nature of the health
risk from exposure to a substance.
- The physical exam — which is similar to any other medical
exam. Attention is given to all body systems, especially those
that may be affected by occupational exposure to the agent under
study.
Determining the frequency and type of laboratory testing can be
problematic. Some are relatively straightforward, such as the need
to perform certain blood tests (blood levels for lead and zinc protoporphyrins)
for occupational exposures to lead. In other cases, such as those
covered by the OSHA hazardous waste standard, the examining physician
must carefully consider the type as well as frequency of testing
for exposed workers based on their chemical exposure.
The most common laboratory tests used in medical surveillance include
pulmonary function testing, audiometric evaluations, and the blood
and urine studies that are components of biological monitoring.
Biological monitoring refers to the lab testing of blood or urine
to measure the concentration of a substance, a metabolic product
of a substance, or a physiological effect caused by exposure to
a substance. Biological monitoring is valuable because it can show
the direct "dose" a person has received from workplace
exposure.
Surveillance for exposure to chemical substance includes the following
frequency of medical exams and biological testing:
- Pre-placement
- Baseline
- At transfer, retirement, or termination
- Annually
- More often than annual (if the physician deems appropriate,
when the employee develops signs or symptoms associated with chemical
exposure, or according to OSHA standards)
Information required to start medical surveillance
Management must provide the occupational health professional or
examining physician the following information for each employee
undergoing a medical surveillance exam:
- Employee's job title, job description, and whether personal
protective equipment (including respirators) is used at work.
- Chemical exposure on the job, including actual exposure levels
of each substance.
- An MSDS for any substance to which the employee is exposed.
- Physical or ergonomic exposure on the job.
- Also, OSHA requires that the physician receive an actual copy
of some standards, such as lead (1910.1025).
The examining physician may use a standard medical form to convey
chemical exposure information and the employee's ability to perform
the required elements of the assigned position.
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Common OSHA regulations, and the exams
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General information
Components of a medical surveillance program
Information required to start medical surveillance
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