April 5, 2004

Raymond K. Meister, MD, MPH
Public Health Medical Officer II
Occupational Lead Poisoning Prevention Program
Occupational Health Branch
1515 Clay Street, Suite 1901
Oakland, CA 94612

Dear Dr. Meister:

Thank you for your September 29, 2003 letter to the Occupational Safety and Health Administration (OSHA) regarding blood lead level reporting requirements. You requested an explanation of the requirements that OSHA places on clinical laboratories regarding blood lead results they supply to healthcare providers in connection with the general industry and construction lead standards (29 CFR 1910.1025 and 29 CFR 1926.62, respectively).

Responsibility for complying with the medical surveillance, recordkeeping, and blood lead proficiency testing requirements of the standard belongs to the employer whose workers are exposed to lead.

There is no requirement under either of OSHA's lead standards that blood lead laboratories report the OSHA levels at which additional employer obligations are triggered. Likewise, there is no requirement in these standards to report a blood lead level (BLL) of 40µg/dL as "normal." The standards require that blood lead level sampling and analysis be conducted by a laboratory licensed by the Centers for Disease Control and Prevention (CDC) which has received a satisfactory grade in blood lead proficiency testing from CDC in the prior twelve months.

As stated in your letter, the geometric mean BLL in the United States for adults is 1.6µg/dL, far below the workplace exposure level of 40µg/dL, which triggers additional medical monitoring and laboratory evaluations. While 40µg/dL is a reference for the purposes of the OSHA standard and the employer's obligation, it is understandable that presentation of this information and use of the term "reference" may be confusing to clinicians who are unfamiliar with lead toxicity.

Although OSHA lead standards do not cover the reports provided by laboratories to clinicians, we would consider it beneficial that laboratories use this opportunity to educate the clinician regarding both the OSHA requirements (levels which trigger additional employer obligations under the lead standards) and other pertinent levels. This will ensure that the most useful information is presented to those responsible for treatment and subsequent action -- the family physician, the occupational physician, and the employer.

As you know, California is an OSHA State Plan State. That is to say, occupational safety and health concerns are overseen and enforced by a state agency under a federally approved plan. You may wish to determine if occupational safety and health standards in the State of California address this issue. Further information can be obtained by contacting:

Charles Cake, Acting Director
California Department of Industrial Relations
455 Golden Gate Avenue - 10th Floor
San Francisco, California 94102
Phone (415) 703-5050
Fax (415) 703-5059

Thank you for your interest in this matter. I hope that this response provides the information you were seeking. Please be aware that OSHA requirements are set by statute, standards, and regulations. Our interpretation letters explain these requirements and how they apply to particular circumstances, but they cannot create additional employer obligations. This letter constitutes OSHA's interpretation of the requirements discussed. Note that our enforcement guidance may be affected by changes to OSHA rules. Also, from time to time we update our guidance in response to new information. To keep apprised of such developments, you can consult OSHA's website at http://www.osha.gov. If you have any further questions, please feel free to contact the Office of Health Enforcement at 202-693-2190.

Sincerely,


John L. Henshaw
Assistant Secretary