OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

Subject: CSHO Medical Examinations

A. Purpose. This instruction establishes the annual CSHO Medical Examination Program for OSHA bargaining unit employees and other positions as identified in section G. by implementing the OSHA medical requirements standards for these people and requiring annual medical examinations. This instruction incorporates the applicable terms of the agreement on the implementation of this program reached between the U.S. Department of Labor and the National Council of Field Labor Locals, (NCFLL), AFGE, AFL-CIO.

B. Scope. This instruction applies OSHA-wide.

C. References.

1. Draft OSHA Instruction, April 6, 1987, Subject: OSHA Medical Requirements Standard.

2. Coronary Risk Handbook - Estimating Risk of Coronary Heart Disease in Daily Practice, American Heart Association.

3. Memorandum to Regional Administrators, April 14, 1987, Subject: Public Health Service Contract for CSHO Physicals, from Leo Carey and Edward Baier.

4. Memorandum of Understanding between the U.S. Department of Labor and the National Council of Field Labor Locals (NCFLL), AFGE, AFL-CIO, dated August 26, 1988.

D. Cancellation.

1. OSHA Instruction PER 8-2.2, October 30, 1978, is cancelled.

2. OSHA Instruction PER 8-2.3, October 30, 1978, is cancelled.

E. Action. OSHA Regional Administrators and National Office Directors shall ensure that the procedures described in this instruction are implemented.

OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

F. Background. Prior to April of 1987, OSHA did not have a standardized CSHO physical medical examination program, and all 10 Regions developed and implemented their own "CSHO Physical" program. Early in 1905, OSHA applied for and received from the Office of Personnel Management (OPM) a single Agency physical examination standard covering OSHA personnel. OPM approved these standards early in 1986. The standard is applicable to the OSHA employees described in section G. of this instruction as well as to new hires.

1. Implementation of a single Agency medical requirements standard ensures that the health of OSHA employees will be at a level which will permit them to perform job-related assignments under conditions that vary from sedentary to maximum exertion.

2. Normal work conditions also require the employee to perform in a reliable manner under adverse conditions. Routine assignments require employees to enter worksites and observe and evaluate conditions to which workers are exposed. This includes working at heights; working underground; working in confined spaces; working in emergency type situations; working in environments with chemical, physical, and biological hazards.

3. Many of these hazards are regulated by established OSHA standards which require the use of protective equipment and/or routine medical monitoring. The proper use of personal protective equipment requires an evaluation of the wearer's physical ability to utilize the equipment safely and without adverse effect to the wearer's health. Adverse conditions sometimes occur unexpectedly while others are anticipated. In the latter case, appropriate steps can be taken in an orderly and controlled manner to protect oneself and safely leave the hazard area.

4. OSHA has required affected new-hire employees to take and pass a pre-employment medical examination since April of 1987. However, annual physical examinations for on-board bargaining unit employees have been conducted only on a voluntary basis prior to the negotiation of the impact of this program with the representatives of OSHA employees, the National Council of Field Labor Locals (NCFLL).

5. Beginning in 1987 and continuing over several months, Department of Labor management representatives met with representatives of the NCFLL, AFGE, AFL-CIO, and discussed the implementation of OSHA's medical

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OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

examination program, as it would impact bargaining unit employees currently on-board. The two parties have negotiated a Memorandum of Understanding (MOU) which applies the OSHA physical and medical requirements standards and annual examination program to current OSHA bargaining unit employees covered under the program (see Appendix C).

6. This instruction implements the physical requirements standard and the OSHA annual medical examination program for currently on-board OSHA employees and incorporates the applicable terms of the negotiated MOU which was signed August 26, 1988, (the physical examination program for new hire employees is addressed in a separate instruction).

7. OSHA contracted with the U.S. Public Health Service (PHS) to provide the mandatory annual physical examinations required under this program. PHS has been providing physical examinations for new-hire employees and voluntary examinations since April of 1987. OSHA's national contract with a single agency to provide the medical examinations required under this program ensures agencywide uniformity in the administration and quality control of the examinations given.

8. None of the policies or procedures in this instruction affect existing employee options or benefits allowed them for disability retirement, Federal Workers' Compensation, and/or any other employment benefit programs.

G. Coverage. Specific positions by grade and series to which this instruction apply include:

Position Series Grades

Student Trainee GS-099 4-5 Safety Specialist GS-018 5-13 Supervisory Safety Specialist GM-018 13 Safety and Occupational Health Manager GM-018 13 Industrial Hygienist GS-690 5-13 Supervisory Industrial Hygienist GM-690 13 Safety Engineer GS-803 5-13 Supervisory Safety

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OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

1. All employees in the above-classified positions in OSHA's Regional and Area Offices are required to take the annual medical examination specified under this program. Employees in these positions are required to make regular or occasional visits to industrial worksites where they may be exposed to potentially toxic chemicals and/or physical hazards.

2. Covered employees must undergo the medical examination specified herein in order for the Agency to determine if they are physically and medically capable of performing the essential duties of the position efficiently and without hazard to themselves or others. Examinations will be provided free of charge to the employee.

3. Several OSHA standards require routine medical tests in order to monitor the health of employees who may be exposed to potentially hazardous substances or physical hazards and who must be physically capable of safely utilizing personal protective equipment. This medical standard and annual physical examination program allows OSHA to ensure compliance with currently existing OSHA standards as they pertain to OSHA employees.

4. Regional Office staff are included under the annual examination requirement because they may have to provide on-site assistance to Area Office staff concerning specific inspections. Also, they are responsible for making on-site variance inspections and therefore face potential workplace exposures to hazardous situations.

5. Student trainees are covered under this program if their tenure with the Agency will be expected to exceed a one-year period from their initial (pre-employment) examination.

6. Employees whose past work assignments with the Agency required them to make regular or occasional visits to industrial establishments where they may have been exposed to potentially toxic chemicals and/or physical hazards and whose job descriptions do not now require them to go into the field will be offered a voluntary medical examination, free of charge, every other year. Voluntary examinations will be provided to the eligible employee with the understanding that examination results pertinent to past occupational exposure will be provided to OSHA management in order for the Agency to fulfill its duties as a responsible employer under the OSH Act.

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OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

H. Annual Examinations: The annual medical examinations described in this instruction are mandatory for all individuals required to take them (See section G.), and all affected employees are required to pass the examination.

1. Failure to meet the required physical and medical qualifications will normally be considered disqualifying for employment; however, bargaining unit employees hired on or before August 26, 1988, the date of the signing of the MOU between the Department of Labor and the NCFLL, who do not meet the physical requirements of the position, will either be waived or offered a position at retained pay. (See "Waiver" and "Accommodation" as described under section J., Procedures, of this instruction.)

2. Disqualification may be averted when substantial evidence is presented to the OSHA Medical Officer and a determination is made that the individual can perform the essential functions of the job efficiently and without risk to themselves or others. The procedures for handling examination results are delineated in section J. of this instruction.

3. Bargaining unit employees will be provided thirty (30) days written notice by OSHA management of the impending annual examinations. Annual examinations will be scheduled at the convenience of the Area Director/Supervisor and will be conducted during the basic workweek of the employee. It is the responsibility of the employee to notify management of a conflict that prevents him or her from taking the examination as soon as possible. Employees who do not take the examination will be notified orally or in writing of their new examination date.

4. The results of all examinations provided under this program, whether mandatory or voluntary, are the property of the Office of Personnel Management and will be safeguarded in accordance with the OPM regulations that all government agencies must follow to protect access to employee medical records. (See OPM regulations 5 CFR 293, Subpart E, "Employee Medical File System Records.") Additionally, the Director of the OSHA Office of Occupational Medicine is responsible for ensuring that all procedures for review and handling of medical records

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are in accordance with OSHA standard 29 CFR 1910.20, "Access to Employee Exposure and Medical Records."

I. Pre-placement Examinations. Pre-placement examinations are required for currently employed OSHA employees in job classifications and series other than those described in section G., who apply and are tentatively selected for one of the covered positions. The examination that will be given will be identical to the pre-employment examination required of new hires. The results of the pre-placement examination will be handled in accordance with the terms of the negotiated agreement between DOL and the NCFLL. As with new candidates, individuals must pass the physical examination prior to being placed into an OSHA position that requires the employee to conduct regular or occasional inspections.

J. Procedures. It is mandatory to pass the medical examination; therefore, failing to meet the requirements contained within the medical examination means that the individual no longer meets the physical qualification requirements of the position. For employees hired after August 26, 1988, Agency management shall give consideration to granting a waiver to the employee. If the waiver cannot be granted, accommodation will be considered. However, if neither of these two exceptions are possible, procedures for the separation of the failed employee shall be initiated. All employees hired prior to August 26, 1988, who fail the examination will be either waived, accommodated at their current position or offered a different position at retained pay by the Agency. The position offered may not be at the employee's current duty station or at the employee's current title, series or grade level. The specific physical and medical parameters are found in Appendix A.

1. Waiver

a. When an employee fails the examination but has demonstrated the ability to perform his/her job in a satisfactory manner, OSHA management may request a waiver from the Agency physician. For example, an employee may marginally fail a limit on a qualification standard for hearing or vision, however, that particular employee is fully capable of

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accomplishing every other aspect of the job requirement. This fact can be shown by previous performance evaluations of the employee for the specific job.

b. When an employee fails the examination due to a condition that was known to exist by the employee and management for several years or more and management can certify that the individual is fully capable of performing his or her job, management may seek a waiver. The waiver must be based upon narrative information in the previous performance evaluations, not the rating, and discussions with a responsible physician of the Office of Occupational Medicine. This process assumes that any performance deficiency that existed has been stated in previous evaluations and that the evaluations are accurate.

c. Request for a waiver is generated by management at either the Regional or Area Office level and must be approved by the Regional Administrator. The request is then forwarded to the Office of Occupational Medicine, within 15 days of notification that an employee did not pass the examination, for review and a written response. The Office of Occupational Medicine will respond to the Regional Administrator within 10 days to either concur or disagree with the waiver.

d. Waivers are good only until the next examination or when other evidence arises indicating that the condition has changed. Failure to obtain a waiver implies that the employee who has failed the examination has a condition that prevents him/her from performing the full range of duties of the position. The Agency medical officer will concur with the waiver only if, in his or her opinion, the employee would not harm or endanger him- or herself, or others when performing a full range of duties.

e. If management is not successful in obtaining a waiver or chooses not to seek a waiver, it can then seek accommodation. Seeking a waiver and accommodation at the same time is not permitted.

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2. Second Medical Opinion.

a. If an employee fails to meet the physical requirements and is not granted a waiver, an employee may obtain at his or her option another examination, limited to the area of disqualification, by a physician of choice. This examination will be conducted by the nearest qualified physician from the employee's official duty station. The medical examination will be paid for by the Department of Labor and will be conducted on official time.

b. Medical information provided by an employee's physician of choice may be supplied by the employee and will be utilized by management and the Office of Occupational Medicine in the decision to grant a waiver or an accommodation. This information must be provided within 30 days of the employee's notice of failure to meet the physical qualifications.

3. Accommodation.

a. Agency management may exercise the option of reasonable accommodation for an employee who cannot pass the examination and who cannot receive a waiver. The process of accommodating an employee involves job reassignment or job restriction as directed by Agency management. Only management may seek accommodation of employees under this program.

b. Accommodation for an employee who has not passed the medical examination and who does not receive a waiver begins with a discussion between Agency management (including employee's supervisor, Area Director, and Regional Administrator) and the Office of Occupational Medicine's physician on what restrictions or limitations may have to be placed on the individual employee.

c. These limitations may be temporary, in the case of a correctable condition, or they may be permanent. Accommodation for permanently restrictive conditions will be considered on a case-by-case basis.

d. Requests for accommodation will be forwarded from the Regional Administrator to the Office of Occupational Medicine within 15 working days of notification that an employee has failed the medical examination and

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denied a waiver. The request for accommodation will include the accommodation plan describing how the employee will be accommodated (i.e., job restriction or job reassignment). The purpose of forwarding the accommodation plan to the Office of Occupational Medicine is to obtain a physician's review to ensure that the steps of the accommodation plan are medically adequate.

e. The Office of Occupational Medicine will respond to the Regional Administrator in writing within 10 days of receipt.

f. The final decision on accommodation will be made by the Regional Administrator.

g. This program does not change current procedures that field offices are presently using for accommodation for a temporary condition such as a broken leg or pregnancy. If an adverse medical condition is correctable (i.e., hernia or high blood pressure), OSHA may require treatment for that condition and establish a reasonable deadline at which time the condition must be corrected.

K. Responsibilities.

1. Regional Administrators and Area Directors.

a. Regional Administrators and Area Directors are responsible for implementing the CSHO Medical Examination program mandated by this instruction.

b. Regional Administrators and Area Directors are responsible for notifying individuals who have failed the examinations specified under this instruction and initiating action appropriate to the specific case.

c. Requests for waivers or accommodations are the responsibility of the Regional Administrator. These requests must be coordinated with the Office of Occupational Medicine, the Office of Field Programs and the Directorate of Administrative Programs.

d. Regional Administrators are responsible for locating and contacting the U.S. Public Health Service (PHS) medical facilities that will be utilized within the

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Region for providing the required examinations. Any difficulties or problems involving OSHA's national contract with PHS shall be brought by the Regional Administrator to the attention of the Director of technical Support. In addition, each Region must coordinate and maintain a listing of contact persons in order to facilitate communication between OSHA and PHS.

2. The Office of Occupational Medicine and Directorate of Technical Support.

a. The Director of Technical Support is responsible for negotiating and securing the national contract to provide the examinations required under this program. Any difficulties or problems that arise regarding the administration of the national contract with the Public Health Service will be resolved by the Directorate of Technical Support as the Agency's representative.

b. The Office of Occupational Medicine is responsible for reviewing all medical opinions and test results of employees forwarded to it for accuracy and consistency.

c. The Office of Occupational Medicine shall provide, in a timely manner, written responses to the Regions for all waivers and accommodations requested under this program.

d. The Director of the Office of Occupational Medicine shall ensure that all procedures for review and handling of OSHA medical records are in accordance with OSHA standard 29 CFR 1910.20 and the Office of Personnel Management's 5 CFR 293, Subpart E. This includes establishing and maintaining a confidential storage and retrieval system so that individual records can be kept.

e. The Director of Technical Support shall establish a system that tracks failure notifications and their status. This will provide a check and balance system for the Regions.

3. The Directorate of Administrative Programs and the Office of Field Programs.

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OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

a. The Directorate of Administrative Programs and the Office of Field Programs shall provide guidance and assistance to the Regions for the application of this program.

b. Review of Regional accommodation plans submitted to the National Office shall be coordinated by the Office of Field Programs in order to ensure national consistency of application.

John A. Pendergrass Assistant Secretary

DISTRIBUTION: National, Regional and Area Offices Compliance Officers

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OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

Appendix A

OSHA MEDICAL EXAMINATION PROGRAM

FOR COMPLIANCE SAFETY AND HEALTH OFFICERS

A. Purpose. OSHA Compliance Safety and Health Officers (CSHOs) make inspections of industrial establishments to observe and evaluate conditions to which workers are exposed.

1. During these inspections, CSHOs may be exposed to potentially hazardous situations and substances. The implementation and application of a single Agency medical requirements standard to all affected employees ensures that the health of OSHA employees will be at a level that permits them to perform job-related assignments safely, effectively, and without hazard to themselves or others.

2. OSHA has contracted with the U.S. Public Health Service (PHS) to provide the physical examinations required under the CSHO Medical Examination Program. OSHA's contract with a single agency to provide these examinations serves to ensure agencywide uniformity in the administration and quality control of the necessary examinations.

B. Physical Requirements Rationale. Following is a general description of the physical requirements of the positions affected by the OSHA Medical Examination Program.

1. The duties of these positions require employees to perform under conditions that vary from sedentary to maximum exertion. Normal work conditions also require the employee to perform in a reliable manner under adverse conditions. Employees must examine and report on potentially hazardous worksite conditions. This may include working at heights, underground, in confined spaces, in poorly lighted facilities, in emergency situations, and working in environments with chemical, physical, and biological hazards which are regulated by the OSH Act.

2. Many of the hazards CSHOs may face are regulated by established OSHA standards which require the use of personal protective equipment and/or routine medical monitoring. The proper use of personal protective

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equipment requires an evaluation of the wearer's ability to utilize the equipment safely, without adverse effect to the wearer's health. Adverse conditions sometimes occur unexpectedly, while others are anticipated and appropriate steps can be taken in an orderly and controlled manner to protect oneself and safely leave the hazard area.

3. Before entrance on duty and routinely during employment, applicants and employees in these positions must undergo a medical examination and be physically and medically capable of performing the essential duties of the position efficiently and without hazard to themselves or others.

4. Routine medical evaluations serve to monitor the employee's health status to ensure that he or she maintains a condition which would meet the criteria of this standard. In addition, routine medical monitoring tracks conditions which may develop as a result of exposure to toxic materials which have latent periods for symptom development.

5. Failure to meet the required physical and medical qualifications will usually be considered disqualifying, except when there is sufficient evidence that individuals can perform the essential functions of the job efficiently and without risk to themselves or others, with or without reasonable accommodation.

C. Medical Examination Parameters.

1. Vision.

a. Physical Requirement.

Distant visual acuity must be at least 20/40 in each eye with or without corrective lenses; distant binocular acuity of at least 20/40 with or without corrective lenses. Near visual acuity must be corrected to at least 20/40 in each eye;

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near binocular acuity of at least 20/40 with or without corrective lenses. Field of vision at 90 degrees in the horizontal meridian in each eye. Ability to distinguish the colors red, amber, and green.

b. Work Activity.

Routinely assigned to areas where: the reading of comprehensive literature is necessary; both near and far visual acuity are necessary for hazard recognition; potentially life threatening environments exist (therefore, accurate reading of the type of personal protective equipment is necessary); color coded warning signs represent hazardous conditions. Routine utilization of finely calibrated equipment.

c. Rationale.

A CSHO inspects workplaces where potential safety and health hazards exist or can spontaneously occur. Once these hazards occur, a compliance officer must be capable of determining what actions are appropriate in order to safeguard the safety and health of the CSHO and others. These actions will always require both near and far visual acuity. For example, quickly ascertaining the condition of a respirator to use in the case of an emergency egress situation. (This requires reading finely calibrated air gauges.) While making routine inspections, a compliance officer will encounter situations where full field of vision will be necessary in order to avoid a serious accident. For example, while working on high scaffolding, it may be necessary to rapidly descend. Normal field of vision is necessary to perform this activity safely with a full-face respirator.

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2. Hearing.

a. Requirement.

Average hearing loss in the better ear cannot be greater than 40 decibels at 500 Hz., 1,000 Hz., and 2,000 Hz., with or without a hearing aid.

b. Work Activity.

CSHOs are routinely assigned to areas where a broad spectrum of physical hazards exist, including environmental noise levels above 90 decibels.

c. Rationale.

It is important that a compliance officer have an established hearing level in order to communicate and give instructions in a noisy environment. During the course of daily activities, it is important for a compliance officer to hear instructions and communications in order to ensure safety. A greater than 40 decibel loss of speech frequency in the better ear may interfere with the CSHO's ability to communicate under noisy conditions.

3. Musculo-Skeletal.

a. Requirement.

Both hands, arms, legs, and feet. No impairment of the use of a leg, a foot, an arm, a hand, the fingers, back or neck which would most likely interfere with the functional requirements of this position. No established medical history or clinical diagnosis of rheumatic, arthritic, orthopedic, muscular, neuromuscular, or vascular disease which would interfere with the ability to perform the functional requirements of this position.

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b. Work Activity.

A compliance officer is required to perform moderate lifting, carrying, walking and standing. A compliance officer will routinely be required to ascend or descend heights in order to safely egress from a potentially hazardous area. During routine activities, a compliance officer must carry portable scientific equipment.

c. Rationale.

It is imperative that a compliance officer have no impairment of the hands, arms, legs, feet, back or neck which would prevent performing the functional requirements of moderate lifting, carrying, reaching above the shoulder, standing, walking and climbing. An established medical history of arthritis or muscular pathology that would interfere with these functional requirements would cause a potentially hazardous situation in the workplace.

4. Cardio-Pulmonary.

a. Requirement.

No current clinical diagnosis of myocardial infarction, angina pectoris, coronary insufficiency, atherosclerosis, thrombosis, or any other cardiovascular or cardiopulmonary disease that would likely cause syncope, dyspnea, collapse, or cardiac failure. Those employees who, upon undergoing exercise testing in compliance with the requirements of this program, are found to have a result indicating high likelihood of cardiac disease will be referred to their personal physician for appropriate treatment. No established medical history or clinical diagnosis of cardiac or respiratory dysfunction likely to interfere with the ability to wear a respirator.

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b. Work Activity.

A compliance officer will routinely be required to: perform moderate lifting, carrying, walking and standing; ascend or descend heights in order to safely egress from a potentially hazardous area; wear a negative pressure air-purifying respirator; operate a motor vehicle, including a 4-wheel drive vehicle.

c. Rationale.

Since compliance officers will routinely be required to rapidly egress from heights or depths, it is imperative that no established medical history of cardiac or pulmonary disease exists. It is known that carrying heavy equipment while ascending or descending great heights places an excess burden on the cardio-pulmonary system. Therefore, it is imperative that the cardio-vascular system be without pathology. Since a compliance officer is required to wear a negative pressure respirator, it is imperative and in compliance with OSHA standard 1910.134 that a physician medically qualify the officer to wear such a respirator. It is known that pre-existing cardiac or respiratory disease can prevent an individual from wearing such a respirator.

D. Medical Examination Requirements.

1. General. The medical examination required herein will be conducted by a physician experienced in occupational medicine, preferably by a physician who is a member of the American College of Occupational Medicine. The examining physician or institution will provide special instructional material (such as necessary fasting periods or special eating instructions) to OSHA management which will in turn provide this information to the CSHO prior to the examination.

2. History. Review of the employee's history must be conducted in regard to personal and family medical history and a work history including occupational exposures to chemical and physical hazards.

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a. Included in this Appendix is the DOL Medical Form, the OSHA 179, that was developed for the OSHA Medical Program. This multi-page form will be utilized for recording the affected OSHA employee's medical and occupational history. This form must be completed by the employee and provided to the physician prior to the examination.

b. There shall be an examining room discussion between the CSHO and the physician regarding medical history, with special attention given to the questionnaire on occupational exposures to chemical and physical hazards.

c. The development of the medical history is to be inclusive of what is commonly termed multi-phasic screening.

3. Specific Examination Tests and Requirements. The physical examination should include, but not be limited to a review of the following: head and neck, including visual tests, an examination of the ears, nose and throat, an examination of the respiratory, cardiovascular and central and peripheral nervous systems, an examination of the abdomen, rectum, and genito-urinary system, an examination of the spine and other musculoskeletal systems, and an examination of the skin. Specific tests/measurement to be obtained include:

a. Height and weight.

b. Temperature, pulse, respiration rate, blood pressure.

c. Eye examination, including:

(1) Visual acuity, near and far. (2) Depth perception. (3) Accommodation. (4) Field of vision. (5) Fundiscopic.

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d. Cardio-pulmonary evaluation, which shall include the following:

(1) Resting twelve-lead electrocardiogram with interpretation.

(2) A sub-maximal exercise test with a twelve-lead EKG will be required of those employees found to be in a category of risk greater than 18 per 100 according to the Coronary Risk Handbook published by the American Heart Association.

(3) Pulmonary Function Evaluation:

(a) FVC, FEVl, FEVl/FVC ratio. (b) Permanent record of flow curves must be included in the patient's report.

(4) Chest X-ray (PA) 14 x 17 inches as a baseline. The frequency of the chest x-ray shall be:

Frequency of Chest Roentgenograms

Years As Age of Employee CSHO 15-35 35-45 45+

0-10 every 5 yrs every 5 yrs every 5 yrs

10+ every 5 yrs every 5 yrs every 1 yr

e. Comprehensive laboratory profile, including:

(1) Urinalysis (including microscopic). (2) Hemocult. (3) CBC. (4) Test chemical groups (done after 12-hour fast):

(a) Chloride, bicarbonate. (b) Glucose. (c) Blood urea nitrogen. (d) Creatinine. (e) Uric acid.

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(f) LDH, SGOT, SGPT, GGTP. (g) Alkaline phosphatase. (h) Bilirubin. (i) Total protein. (j) Albumin and globulin. (k) Cholesterol. (l) Triglycerides. (m) HDL Cholesterol. (n) Potassium. (o) Calcium. (p) Blood lead, if indicated. A blood lead and zinc protoporphyrin should be done when there is a history of lead exposure or when the test is indicated in the physician's judgment.

f. Audiometric Testing:

(1) An otoscopic examination, otological history, and audiometric test shall be administered by an otolaryngologist, audiologist, or certified audiometric technician.

(2) Audiometric facilities, equipment, calibration procedures, and technician certification shall meet the requirements outlined in 29 CFR 1910.95.

(3) The results of the otoscopic examination, otological history and audiometric tests shall be reviewed by an otolaryngologist, audiologist, or other qualified physician. Retesting and providing written results back to the compliance officer as described in 1910.95(j) shall be followed. Abnormalities and/or significant threshold shifts shall be communicated to the patient along with any recommendations for appropriate professional referral.

g. Personal Protective Equipment Evaluation. The examining physician will evaluate the following results to determine the employee's ability to utilize personal protective equipment including a

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negative pressure air-purifying respirator and protective clothing.

(1) Medical Occupational History: Conditions such as myocardial infarction, angina, severe emphysema, the existence of a very serious claustrophobic condition or any significant cardiac or pulmonary condition that would result in the inability to wear a respirator should be disqualifying.

(2) Physical Examination: Findings such as severe facial asymmetry, beard, obvious cardiac or pulmonary pathology should also be disqualifying.

(3) Pulmonary Function Test: Evidence of moderate to severe restrictive or obstructive airway pattern should be disqualifying.

(4) Chest X-ray: Evidence of cardio-pulmonary pathology should be disqualifying.

(5) Electrocardiogram: Obvious cardiac disease should be disqualifying.

E. Reporting Requirements.

1. Examining Physician (PHS) to the Employee. The examining physician will generate personal medical reports for all employees examined and mail them to their private residence within 15 working days of the date that the employee is examined. The results will list each test, individually indicating whether a result is normal or abnormal and, if appropriate, a recommendation for referral to the employee's private physician will be made. A copy of the completed OSHA-178 form will also be sent to the employee's residence. In addition, the personal medical report will contain:

a. The physician's opinion as to whether the employee has any detected medical condition(s) which would place the employee at increased risk of material

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health impairment from work exposures and practices.

b. Determination of the employee's ability to wear a respirator or any other personal protective equipment.

2. Examining Physician to OSHA's Office of Occupational Medicine. The examining physician will forward to the Office of Occupational Medicine the following:

a. A written opinion as to whether the employee's health is at increased risk of material impairment from his or her work environment.

b. A written statement regarding the employee's ability to wear a respirator or other protective equipment.

c. A written statement that the employee has been informed in writing by the physician of the results of the medical examination.

d. The examining physician shall utilize the appropriate DOL Medical Forms, the OSHA-179 and OSHA-178 forms that were developed for the OSHA Medical Program.

F. Medical Records.

1. Upon completion of the medical examination, the physician shall forward to the Office of Occupational Medicine, U.S. DOL/OSHA, 200 Constitution Ave., N.W., Room N3653, Washington, D.C., 20210, each compliance officer's complete medical record. The envelope shall be marked CONFIDENTIAL and the package shall include:

a. Completed medical/occupational history forms, the OSHA-179 form.

b. Completed physical examination forms, including the OSHA-178 form.

c. All laboratory test results.

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d. Chest X-ray (radiograph and interpretation).

e. Pulmonary function test.

f. Audiometric test results.

2. These documents shall be maintained in accordance with the Office of Personnel Management's 5 CFR 293, Subpart E, "Employee Medical File System Records." They shall be in a secured, central location within the Office of Occupational Medicine and under the supervision of the Medical Records Officer for the duration of the time period necessary for National Office review. After this time, the employee's file will be entered into and stored in OSHA's medical records computer system. Hard copies of employee's records and records for former employees will be located in an Employee Medical Folder (EMF) and stored in the Federal Records Center operated by the National Archives and Records Administration (NARA) for a period of 30 years after employment in accordance with OSHA standard 29 CFR 1910.20.

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OSHA Medical Program -- Employee History

U.S. Department of Labor Occupational Safety and Health Administration To be completed by Employee ------------------------------------------------------------------------------ | Present Information | ------------------------------------------------------------------------------ Name Date of Birth (Yr., Mo., Day) Date of Visit (Yr., Mo., Day)

______________________________________________________________________________

Employer ______________________________________________________________________________

Employer's Address Employer's Phone Number ______________________________________________________________________________

Type of Medical Exam Preemployment|_| Preplacement|_| Annual|_| ______________________________________________________________________________

Job Title ______________________________________________________________________________

Job Description ______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Sex |_|F |_|M Social Security Number ______________________________________________________________________________

Personal Physician ------------------------------------------------------------------------------ Name

______________________________________________________________________________

Address Physician's Phone Number ______________________________________________________________________________

______________________________________________________________________________

When were you last examined by him/her? ______________________________________________________________________________

Past Medical History ------------------------------------------------------------------------------ List significant medical illness, and all hospitalizations.

Hospitalization? illness or Condition Yes No Approximate Date(s) Of Hospitaliztion ------------------------------------------------------------------------------ a. |__| |__| ------------------------------------------------------------------------------ b. |__| |__| ------------------------------------------------------------------------------ c. |__| |__| ------------------------------------------------------------------------------

------------------------------------------------------------------------------

Privacy Act ------------------------------------------------------------------------------ In accordance with the Privacy Act of 1974(Public Law No. 93-579, 5 U.S.C. 552a), you are hereby notified that:

Section 3301 of Title 5 to the U.S. Code authorizes collection of this information. The primary use of this information is to determine suitability of persons for service or assignments, report medical conditions required by law, and aid in preventive health care. The informaiton becomes part of the Employee Medical Folder which is maintained and protected in accordance with OPM regulations 5 CFR 293, Subpart E, and OSHA standard 29 CFR 1910.20. These records are also protected by the Privacy Act of 1974, 5 U.S.C. 552a and are covered by OPM/GOVT-10, Employee Medical File System Records. The social security number is requested in order to more accurately identify and retrieve health care records of individuals. Providing the requested information is voluntary but failure to do so may result in the Agency's inability to process application for employment or inability to determine suitability for employment. Without this information OSHA will not be able to determine if the employee can meet the physical requirements of the position. ------------------------------------------------------------------------------

Page 1 OSHA 179 1/89

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OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

OSHA Medical Program -- Employee History

U.S. Department of Labor Occupational Safety and Health Administration

-----------------------------------------------------------------------------

Check Yes or No to answer each question and give specific information when asked.

______________________________________________________________________________

Cardiovascular Genitourinary ------------------------------------------------------------------------------ Yes No Yes No |_| |_|Heart Murmur |_| |_|Nephritis

|_| |_|Angina/Chest Pain |_| |_|Kidney Disease

(indicate Type)______________

|_| |_|Heart Attack |_| |_|Urinary infection

|_| |_|High Blood Pressure |_| |_|Kidney/Urinary

Bladder Stones |_| |_|Vascular Disease in Arms/Legs |_| |_|Blood/Protein in Urine |_| |_|Other Heart Disorders(Specify) |_| |_|Venereal Disease

        ______________________________          |_|    |_|Other Kidney or
                                                  Bladder Disorders (Specify)

______________________________________________________________________________

Gastrointestinal Blood ------------------------------------------------------------------------------ Yes No Yes No |_| |_|Peptic Ulcer |_| |_|Anemia

|_| |_|Hiatal Hernia |_| |_|Problems with blood

clotting/bleeding |_| |_|Hepatitis |_| |_|Sickle Cell

|_| |_|Gall Bladder Disease |_| |_|Other BloodDisorders

(Specify)___________

|_| |_|Liver Disease/Jaundice ___________________

|_| |_|Cirrhosis

|_| |_|Other Liver Disorders (Specify)

_______________________________

______________________________________________________________________________

Skin Eye ------------------------------------------------------------------------------ Yes No Yes No |_| |_|Psoriasis |_| |_|Require Corrective Lenses |_| |_|Eczema |_| |_|Glaucoma

|_| |_|Contact Dermatitis |_| |_|Cataracts |_| |_|Other Skin Disorders (Specify) |_| |_|Optic Neuritis

______________________________ |_| |_|Eye Infection

                                                |_|    |_|Other Eye Disorders
                                                         (Specify)____________

______________________________________________________________________________

Pulmonary Nervous System ------------------------------------------------------------------------------ Yes No Yes No |_| |_|Pneumonia |_| |_|Seizure Disorder |_| |_|Pleurisy |_| |_|Stroke |_| |_|Asthma |_| |_|Peripheral Neuritis |_| |_|Bronchitis |_| |_|Other Nervous |_| |_|Emphysema Disorder (Specify) |_| |_|Bronchiectasis ____________________

|_| |_|Tuberculosis |_| |_|Silicosis |_| |_|Asbestosis |_| |_|Other Lung Disorders (Specify) ------------------------------------------------------------------------------

Page 2

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OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

OSHA Medical Program -- Employee History

U.S. Department of Labor Occupational Safety and Health Administration ------------------------------------------------------------------------------ Check Yes or No to answer each question and give specific information when asked. ------------------------------------------------------------------------------ Ear, Nose and Throat Musculoskeletal ------------------------------------------------------------------------------ Yes No Yes No |_| |_|Chronic Sinusitis |_| |_|Rheumatoid Arthritis |_| |_|Impaired Hearing |_| |_|Other Injuries |_| |_|Ringing in the Ears |_| |_|Back Injury |_| |_|Easy Nasal Bleeding |_| |_|Degenerative Disc Disease |_| |_|Nasal Allergies |_| |_|Sciatica/disc herniation |_| |_|Tonsillectomy |_| |_|Bone lesions/ Infection |_| |_|Other Ear, Nose, Throat Disorder |_| |_|Other Musculoskeletal (Specify) Disorder (Specify) ________________________________ ____________________

________________________________ ____________________

------------------------------------------------------------------------------

General ------------------------------------------------------------------------------ Yes No |_| |_|Thyroid Disease/Golter |_| |_|Hernia (Specifytype) |_| |_|Diabetes ____________________

|_| |_|Gout |_| |_|Cancer (Specify Site) |_| |_|Frequent Night Sweats/Fever ____________________

|_| |_|Hemorrhoids |_| |_|Dental/Gum Problems

(Specify)____________

                                               |_|    |_|Other Conditions or
                                                          Disease Not Listed
                                                         (Specify)____________

______________________________________________________________________________

Family History ------------------------------------------------------------------------------ If any of your family noted in the following table has had any of the stated conditions, please indicate by the appropriate code number.

Code: 1 - Father 2 - Mother 3 - Grandparent 4 - Brother/Sister 5 - My Children

__ Allergy (Asthma, eczema, hay fever __ Blood Disease

__ Cancer or Leukemia __ Cirrhosis

__ Congenital malformation __ Diabetes

__ Emphysema __ Epilepsy (Seizures)

__ Hypertension __ Kidney Disease

__ Migraine Headaches __ Rheumatic Heart Disease

__ Sickle Cell Disease __ Tuberculosis

__ Other Disease Not Listed (Please Specify)

____________________________________________

Yes No |_| |_| Is your father still living? If "No", at what age did he die? What was the cause of death?

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

|_| |_| Is your Mother still living? If "No", at what age did she die?

What was the cause of death? ______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Page 3

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OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

OSHA Medical Program -- Employee History

U.S. Department of Labor Occupational Safety and Health Administration

______________________________________________________________________________

Check Yes or No to answer each question and give specific information when asked.

______________________________________________________________________________

General Health Tobacco Use ------------------------------------------------------------------------------ Yes No |_|Never smoked regularly |_| |_|Have you been examined or treated |_|Used to smoke regularly by a doctor within the last year? If "Yes", for what?_______________________ How many years did you smoke?

__________________________________________ _____________________________

__________________________________________ How many packs per day? __________________________________________ _____________________________

__________________________________________ How long ago did you stop? __________________________________________ _____________________________

__________________________________________ Yes No __________________________________________ |_| |_|Do you smoke now?____

__________________________________________ If "Yes", for how many years? __________________________________________ _____________________________

__________________________________________ How many packs per day on the Yes No average?_____________________

|_| |_| Have you lost more than five pounds Cigars/Pipe:

within the last 6 months? Yes No Yes No Have you noticed any swelling or |_| |_| Ever smoke? |_| |_| lumps in your breast, neck, armpits, _____________________________

groin or elsewhere during the past Alcohol Use year? -----------------------------

If "Yes", specify site______________________ On the average, how much of Have you experienced the following signs/ the following do you drink per symptoms within the past year: week? Yes No Beer:_______Cans |_| |_|Frequent headache/dizziness Wine:_______Glasses |_| |_|Frequent bowel problems (Constipation Whiskey/Liquor:____Jiggers or diarrhea) _____________________________

|_| |_|Swelling of the lower extremities or Medication

eyelids -----------------------------

|_| |_|Frequent shortness of breath, cough Please indicate any

         or morning phlegm                       medications you are taking.
                                                 Include nonprescription
Indicate what you believe your health status     medications, such as aspirin,
is now:                                          laxitives, vitamins, etc.
|_|Excellent                                     _____________________________

|_|Good _____________________________

|_|Fair Reproductive History |_|Poor -----------------------------

____________________________________________ Yes No Have you or your Hobbies |_| |_| spouse been unable -------------------------------------------- to have children? Do you have any present or past hobbies (e.g., If "Yes", specify reason, if arts/crafts, gunning, furniture refinishing) or known:_______________________

or home construction/gardening activities that _____________________________

may have exposed you to any hazards? Yes No Have you ever had Yes No |_| |_| any children born |_| |_| If YES, specify activities and kind with a handicap or of materials used: congenital

_____________________________________________ malformation? _____________________________________________ If "Yes", specify:___________

_____________________________________________ _____________________________

_____________________________

Allergies ----------------------------- Yes No Are you allergic |_| |_| to anything you can think of? If "Yes", specify:___________

_____________________________

Page 4

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OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

OSHA Medical Program -- Employee History

U.S. Department of Labor Occupational Safety and Health Administration ------------------------------------------------------------------------------ Occupational History ------------------------------------------------------------------------------ How long have you been in present job? _____Years _____Months Indicate any job related illness or injuries you have experienced since working in present job.

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Check Yes or No to answer each question and give specific information when asked. ------------------------------------------------------------------------------ In your work are you now, or have you been exposed to any of the following agents? Exposure Present Past Exposure Present Past

Inorganic Fluorides |_| |_| Pesticides |_| |_| Lead |_| |_| Bacteria or Viruses |_| |_| Benzene |_| |_| Primate Animals |_| |_| Coke Oven Emissions |_| |_| Vibrating Tools |_| |_| Inorganic Arsenic |_| |_| Ionizing Radiation |_| |_| Methylene Chloride |_| |_| Non-ionizing Radiation|_| |_| Vinyl Chloride |_| |_| Glycol Ethers |_| |_| Toluene Diisocyanate |_| |_| Ethylene Oxide |_| |_| Excessive Noise |_| |_| Formaldehyde |_| |_| Nitrogen Oxides |_| |_| Crystalline Silica |_| |_| Others: Nitric Acid |_| |_| _____________________ |_| |_| Ammonia |_| |_| _____________________ |_| |_| Beryllium |_| |_| _____________________ |_| |_| Phosgene |_| |_| _____________________ |_| |_| Allyl Chloride |_| |_| _____________________ |_| |_| Asbestos |_| |_| Suspect or Known Carcinogens |_| |_| -----------------------------------------------------------------------------

-----------------------------------------------------------------------------

Page 5

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OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

OSHA Medical Program -- Employee History

U.S. Department of Labor Occupational Safety and Health Administration

_____________________________________________________________________________

Exposure History ----------------------------------------------------------------------------- List all jobs, beginning with your present job, including parttime jobs. Be as specific as possible. Use additional sheets as needed. ----------------------------------------------------------------------------- Name of Employer|Dates Worked|Job Title| Duties |List the Health|Type of | From | To | |Performed|HazardsExposed |Protective | | | | |To (i.e. noise,|Equipment | | | | |Lead, Solvents)|Worn (i.e. | | | | | |Earplugs, | | | | | |Respirator) -----------------------------------------------------------------------------

| | | | | |

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| | | | | |

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| | | | | |

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| | | | | |

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| | | | | |

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| | | | | |

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| | | | | |

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| | | | | |

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OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

OSHA Medical Program -- Physician's Report

U.S. Department of Labor Occupational Safety and Health Administration To be completed by examining Physician ----------------------------------------------------------------------------- This information is for official and medically confidential uses only and will not be released to unauthorized persons. The release of this information is subject to the Privacy Act. ----------------------------------------------------------------------------- Physical Examination ----------------------------------------------------------------------------- Name ID#

_____________________________________________________________________________

Type of Examination Date Time _____________________________________________________________________________

Weight Temp Resp _____________________________________________________________________________

Height Pulse BP _____________________________________________________________________________

Normal Abnormal Clinical Evaluation Normal Abnormal ClinicalEvaluation

 |_|     |_|     General Appearance       |_|    |_|      Vascular system
                                                          (varicosities, etc.)
 |_|     |_|     Head, face, neck, scalp  |_|    |_|      Abdomen & Viscera
                                                          (include hernia)
 |_|     |_|     Nose (septum)            |_|    |_|      Anus & Rectum
 |_|     |_|     Sinuses                  |_|    |_|      G-U System
 |_|     |_|     Mouth and Throat         |_|    |_|      Upper Extremities
 |_|     |_|     Ears (general)           |_|    |_|      Lower Extremities
 |_|     |_|     Drums (perforation)      |_|    |_|      Spine, other
                                                          musculoskeletal
 |_|     |_|     Ophthalmoscopic          |_|    |_|      Skin, lymphatics
 |_|     |_|     Pupils (equality &       |_|    |_|      Neurological
                         reaction)        |_|    |_|      Peripheral
 |_|     |_|     Ocular motility          |_|    |_|      Cranial nerves
 |_|     |_|     Lungs & Chest (include   |_|    |_|      Deep tendon reflexes
                 breasts)
 |_|     |_|     Heart (thrust, size, rhythm, sounds)
-----------------------------------------------------------------------------
Comments

-----------------------------------------------------------------------------

Summary of Findings _____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

Based on this Medical Evaluation: 1. This employee is, is not (circle) medically fit to wear a respirator.

__________________________________

2. This employee has, has no (circle) Typed or Printed Name of Physician detected medical condition which would place him/her at increased risk of __________________________________

material health impairment for work Signature Date exposures and practices. (if positive, please elaborate below.)

3. This employee has, has not (circle) been informed in writing of the results of the medical examination.

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

                                                                      OSHA 178
                                                                          1/89

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OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

APPENDIX B

EMPLOYEE HANDBOOK

MEDICAL MONITORING PROGRAM

FOR OSHA

COMPLIANCE SAFETY AND HEALTH OFFICERS

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OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

OVERVIEW

The Occupational Safety and Health Administration (OSHA) is vitally concerned with safeguarding the occupational health and safety of its Compliance Safety and Health Officers. The prevention of work related illness and injury depends on awareness of risk, control of the work environment, the proper use of protective equipment, and careful attention to safe work practices. OSHA is committed to providing a safe work environment and promoting healthful and safe work practices for every Compliance Officer, and the responsibility for occupational health and safety is shared by everyone in the Agency. As part of this effort, OSHA has developed an Agency-wide occupational medical monitoring program for Compliance Safety and Health Officers and other employees covered under the program. This handbook will acquaint you with the program and answer questions about the program.

BACKGROUND

Prior to April of 1987, OSHA did not have a standardized CSHO physical examination program, and all ten Regions developed and implemented their own "CSHO Physical" program. Early in 1985, OSHA applied for and later received from the Office of Personnel Management (OPM) a single Agency physical examination standard covering OSHA personnel. The implementation of a single Agency physical requirements standard ensures that the health of OSHA employees will be at a level which will permit them to perform job-related assignments under conditions that vary from sedentary to maximum exertion.

Normal work conditions also require the employee to perform in a reliable manner under adverse conditions. Routine assignments require employees to enter work sites and observe and evaluate conditions to which workers are exposed. This includes working at heights; working underground; working in confined spaces; working in emergency situations; and working in environments with chemical, physical, and biological hazards. Many of these hazards are regulated by established OSHA standards which require the use of protective equipment and/or routine medical monitoring. The proper use of personal protective equipment requires an evaluation of the wearer's physical ability to utilize the equipment safely, and without adverse effect to the wearer's health. Adverse conditions sometimes occur unexpectedly while others are anticipated and appropriate steps can be taken in an orderly and controlled manner to protect oneself and safely leave the hazard area.

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OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

OSHA has required affected new-hire employees to take and pass a pre-employment medical examination since April, 1987. However, annual physical examinations for on-board bargaining unit employees have been conducted only on a voluntary basis prior to the negotiation of the impact of this program with the representatives of OSHA employees, the National Council of Field Labor Locals (NCFLL). Beginning in 1987 and continuing over several months, Department of Labor management representatives met with representatives of the NCFLL, AFGE, AFL-CIO, and discussed the implementation of OSHA's medical examination program as it would impact currently on-board, bargaining unit employees. The two parties have negotiated a Memorandum of Understanding (MOU) which extends the OSHA physical and medical requirements standards and annual examination program to include on-board, bargaining unit OSHA employees covered under the program.

QUESTIONS AND ANSWERS

1. What is Occupational Medical Monitoring?

Medical monitoring is watching over the health of employees who may be exposed to potentially harmful chemical agents or physical hazards by means of periodic medical examinations. It is an effort to detect and prevent adverse effects of occupational exposures. An Agency-wide occupational medical monitoring program for Compliance Safety and Health Officers has been developed. (See OSHA Instruction ADM: CSHO Medical Examinations.)

This program consists of a medical/occupational history review, physical examination, specific blood testing, hearing test, vision test and review of cardio-pulmonary system. All of the medical test results are reviewed by the examining physician and physicians within OSHA's Office of Occupational Medicine. This review allows the physicians to determine if your work environment may be adversely affecting your health.

2. Why is a Medical Monitoring Program Necessary?

Compliance Safety and Health Officers have duties that may involve potential exposure to a wide variety of toxic substances or potentially harmful working conditions.

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OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

Medical monitoring can aid in:

O Early recognition of unsuspected health risks

O Monitoring the effectiveness of protective measures taken for known risks

O Prompt initiation of corrective action and appropriate medical care

O Evaluation of health factors in safe work performance

O Possible study of long-term subtle health effects based on employee occupational exposure data

O Periodic fitness re-certification of employees whose work involves unique physical stresses, such as respirator use.

3. Who is included?

A mandatory medical surveillance program will cover all employees whose assignments currently include, or included at times in the past, working conditions involving, exposure to potentially toxic materials or physical hazards. Employees currently working in conditions where exposure to potentially toxic materials may exist will be included in an annual medical surveillance program. Those employees who are reassigned or promoted to a position within the scope of the medical surveillance program will have a pre-placement and subsequent annual medical examinations as prescribed within this text.

Specific positions by grade and series covered.

B-4

OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

Position Series Grades

Student Trainee GS-099 4-5 Safety Specialist GS-018 5-13 Supervisory Safety Specialist GM-018 13 Safety and Occupational Health Manager GM-018 13 Industrial Hygienist GS-690 5-13 Supervisory Industrial Hygienist GM-690 13 Safety Engineer GS-803 5-13 Supervisory Safety Engineer GM-803 13

Regional Office staff are included under the annual examination requirement because they may have to provide on-site assistance to Area Office staff concerning specific inspections, they are responsible for making on-site variance inspections and may face potential workplace exposures to hazardous situations.

Student trainees are covered under this program if their tenure with the Agency will be expected to exceed a one-year period from their initial (pre-employment) examination.

Employees whose past work assignments with the Agency required them to make regular or occasional visits to industrial establishments where they may have been exposed to potentially toxic chemicals and/or physical hazards and whose job descriptions do not now require them to go into the field will be offered a voluntary medical examination, free of charge, every other year. Voluntary examinations will be provided to the eligible employee with the understanding that examination results pertinent to past occupational exposure are the property of the Government and will be provided to the OSHA Office of Occupational Medicine in order for the Agency to fulfill its duties as a responsible employer under the OSH Act.

B-5

OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

4. Who Pays for the Examination?

The examinations fees are paid by the Agency. OSHA has contracted with the U.S. Public Health Service (PHS) to provide the mandatory annual physical examinations required under this program. PHS has been providing physical examinations for new-hire employees and voluntary examinations since April, 1987. OSHA's national contract with a single agency to provide the medical examinations required under this program assures Agencywide uniformity in the administration and quality control of the examinations given.

5. How are the Examinations Arranged?

Employees will be provided thirty (30) days written notice by OSHA management of the impending annual examination date and location.

In those cases where possible (i.e., for those individuals not having to travel from an out-of-town location to the examining site), as much of the clinical work-up as feasible shall be completed prior to the physician's examination. The clinical findings shall be available for the examining physician's review at the time of the examining room discussion between the employee and physician.

Scheduling times for examinations must be flexible in order to accommodate the varied schedules of OSHA compliance officers and the inconveniences involved in their having to travel from out-of-town locations to the examining site. However, the scheduling of examinations should allow the examinations to be done on official time.

6. What is the Scope of the Examination and How Frequently is it Given?

The monitoring examinations and tests are designed to screen for evidence of adverse health effects from occupational exposures and to survey the systems of the body most likely to be affected by such exposures. OSHA's medical monitoring program is not intended as a substitute for general health care or periodic checkups by a personal physician.

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OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

The first, or baseline, examination consists of a detailed medical and occupational history, a physical examination, and selected blood and urine tests. Additional tests, such as hearing, lung function, and special blood tests, are also included. The physicians use this information to determine if there are adverse effects from exposures and to determine ability to wear personal protective equipment (e.g. respirator).

Ideally, the frequency and content of subsequent monitoring examinations should be determined by the nature of the occupational exposures and risks. Active Compliance Safety and Health Officers will be effectively monitored by annual examinations.

Those employees who have had potential hazardous exposure in the past, but who are currently not performing such activities, will be monitored every two years.

7. What is Done with the Examination Findings?

Examination findings are reviewed in a two step process.

The first step is the review by the examining physician. This includes reviewing medical/occupational history, physical examination findings, and specialized testing. The examining physician then forwards his/her findings and determinations to the physicians at OSHA'S Office of Occupational Medicine. The Office of Occupational Medicine then reviews these findings for accuracy and consistency.

Employee medical examination will be maintained in accordance with the Office of Personnel Management's 5 CFR 293, Subpart E, "Employee Medical File System Records." They will be in a secured, central location within OSHA's Office of Occupational Medicine and under the supervision of the Medical Records Officer for the duration of the time period necessary for National Office review. After this time, the employee's file will be entered into and stored in OSHA's medical records computer system. Hard copies of employee's records and records for former employees will be located in an Employee Medical Folder (EMF) and stored in the Federal Records Center operated by the National Archives and Records Administration (NARA) for a period of 30 years after employment in accordance with OSHA standard 29 CFR 1910.20.

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OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

8. How to get a copy of Medical Records?

The examining physician will generate personal medical reports for all employees examined and mail them to their private residence within 15 working days of the date that the employee is examined. The results will list each test, individually indicating whether a result is normal or abnormal and if appropriate, a recommendation for referral to the employee's private physician will be made.

If after 1 (one) year there is a need for an employee to get an additional copy of his/her medical records, a request in writing should be sent to:

Medical Records Officer Office of Occupational Medicine U.S. Department of Labor - OSHA Room N3653 200 Constitution Avenue, N.W. Washington, D.C. 20210

When submitting a request the individual must furnish the following information in order to locate and identify the record sought:

1. Full name 2. Date of Birth 3. Social Security Number 4. Agency Name and location 5. Date of exam if known 6. Signature

SUMMARY

Your occupational health and safety depends on careful attention to proper working conditions and practices. Remember that your medical monitoring examination aids in the prevention of occupationally-related illness and in the protection and maintenance of your health. All findings will be handled in a responsible and confidential manner and in accordance with OSHA standard 29 CFR 1910.20 and OPM standard 5 CFR 293, Subpart E, and the Privacy Act.

B-8

OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

Appendix C

MEMORANDUM OF UNDERSTANDING

BETWEEN THE

U.S. DEPARTMENT OF LABOR

AND THE

NATIONAL COUNCIL OF FIELD LABOR LOCALS

I. INTRODUCTION:

This is a Memorandum of Understanding (MOU) entered into between the U.S. Department of Labor (DOL) and the National Council of Field Labor Locals (NCFLL), AFGE, AFL-CIO, in accordance with the applicable provisions of the master DOL-NCFLL Agreement.

II. SUBJECT:

This MOU covers the agreement reached between the parties over the impact and implementation of the OSHA physical and medical requirements.

1. A bargaining unit employee hired on or before (E.O.D.) the signing of this MOU who does not meet the physical requirements of the position, will either be waived or be offered a position at retained pay.

2. In the event a bargaining unit employee hired after the signing of this MOU fails to meet the physical requirements based upon the medical examination, a waiver will be considered by the Department. In the event that a waiver is not granted to an employee an accommodation will be considered.

3. A bargaining unit employee who is not granted a waiver and offered a position at retained pay outside their commuting area, will have relocation expenses paid according to appropriate government regulations.

4. In determining whether or not a waiver will be granted an employee's performance history in OSHA, as well as medical history, will be taken into consideration.

5. If an employee fails to meet the physical requirements and is not granted a waiver, an employee may have at his/her option another examination, limited to the area of disqualification, by a physician of choice. This examination will be conducted by the nearest qualified physician from the employee's official duty station. The cost of the medical examination will be paid for by the Department and will be conducted on official time.

If there is a dispute between the results of the two examinations as to whether an employee has failed to meet the physical requirements and management takes a personnel action and the employee grieves the action in a timely manner, the action will be stayed for 180 days or until an arbitrator makes a decision, whichever comes first. In this case the NCFLL may take the dispute to arbitration bypassing Steps I and II of the grievance procedure.

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OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

6. Medical information provided by an employee's physician of choice may be supplied by the employee and will be utilized by management and the Office of Occupational Medicine in the decision to grant a waiver or accommodation. This information must be provided within 30 days of the employee's notice of failure to meet the physical qualifications.

7. A bargaining unit employee tentatively selected, subject to meeting the physical requirements but not appointed due to failure to meet a physical standard and through appeal or litigation is determined to be qualified, will be afforded an appropriate remedy in accordance with the Master Agreement.

8. The term "medical waiver" will be defined to term "waiver". The last sentence in paragraph #2 will be changed to "The Office of Occupational Medicine will respond to the Regional Administrator within 10 days to either concur or disagree with the waiver." In the next paragraph the last sentence will be changed from "...grant the waiver..." to "...concurs with the waiver..."

9. Management will comply with maintenance of records in accordance with 29 CFR 1910.20.

10. Consistent with law, rule or regulation the Office of Occupational Medicine will notify an employee when a copy of their medical records are requested.

11. During the medical examination to determine medical qualification for OSHA compliance officers, no tests for drugs or the AIDS virus will be conducted.

12. Medical examinations of bargaining unit employees will begin no earlier than 90 calendar days of this signing of the MOU. all physical examinations shall be scheduled during the basic workweek of the employee.

13. Subject to provisions of the Privacy Act and The Freedom of Information Act, the President of the NCFLL shall be provided annually the number of employees who were examined, number of employees who received waivers, number of employees who received accommodations and type of accommodations. Such data shall also include the names, dates, office location, age and sex.

14. A bargaining unit employee will be given 30 days written notice of the upcoming exam in writing. It is the responsibility of the employee to notify management of a conflict that would prevent him/her from taking the exam as soon as possible. An employee who does not take the exam will be notified orally or in writing of their new examination date.

15. Employees who are required to take a mandatory medical examination will be examined by a physician experienced in occupational health, selected, provided by and paid for by the Agency.

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OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

16. Any dispute over the implementation and interpretation of this program will be handled in accordance with Articles 15 and 16 of the DOL-NCFLL Master Agreement.

17. Consistent with law or rule or regulation, the examining physician will not reveal diagnosis or condition unrelated to employment to any party. The examining physician shall inform the employee directly of the diagnosis or conditions unrelated to employment.

18. OSHA Medical Program Forms shall include the wording "The release of this information may be subject to the Privacy Act."

19. Temporary conditions will not disqualify an employee (i.e., pregnancy, surgery, mononucleosis, etc.). Temporary conditions will be handled in accordance with the procedures described on Page 5. A temporary accommodation is for those conditions that can be corrected or controlled within a reasonable time.

20. The on-site union representative at each locality where the OSHA logs on the job injury and illness are posted will be given a copy of such posting.

21. As a part of the mandatory medical examination program and to provide data, all OSHA employees may document any exposure to chemical hazards contacted on-the-job by utilizing CA forms.

22. OSHA employees, as specified by the draft Instruction dated April 6, 1987, page 2, will be covered by this program.

23. No OSHA employee will be required to provide a POV to take a medical examination.

24. A copy of this memorandum of Understanding (MOU) will be provided to all bargaining unit employees.

At the next scheduled Regional Labor-Management Relations Committee meeting one of the four members of the NCFLL bargaining team (Burg, Rios, Ramirez, Yarman) will be allowed four hours to meet with the designated local representatives identified in Column (4) of the chart on page 7 of the DOL-NCFLL Master Agreement. The designated local representatives identified in Column (4) shall have four hours to meet with one of the NCFLL bargaining team members.

25. A list of bargaining unit employees, who fail the physical requirements based upon the medical examinations, will be provided to the President of the NCFLL subject to the provisions of the Privacy Act and the Freedom of Information Act, every February of each year.

26. Either party reserves the right to appeal issues of negotiability and duty to bargain regarding OSHA proposed mandatory physicals, following negotiations over the impact and

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OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

implementation of the physical standards by the medical examination.

27. At the National Labor Management Relations Committee meeting closest the anniversary date of the signing of this MOU, the parties shall discuss the information provided in item 13 of this Agreement. At that time this MOU may be reopened by mutual consent of the parties.

Effective the 26th day of August, 1988

FOR THE DEPARTMENT FOR THE NCFLL

ISAAC W. COLE FRANK BURG STANLEY H. ELLIOTT JESSE M. RIOS STEPHEN J. MALLINGER RON YARMAN ERIC H. M. RAMIREZ

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