April 5, 2012

Mr. Jim Monarski
Region 2 Project Manager
Wisconsin Hospital Emergency Preparedness Program
3400 Ministry Parkway
Weston, WL 54403

Dear Mr. Monarski:

Thank you for your December 14, 2011, letter to the Occupational Safety and Health Administration's (OSHA's) Directorate of Enforcement Programs. You requested clarification of the medical surveillance requirements under OSHA's Hazardous Waste Operations and Emergency Response (HAZWOPER) Standard, 29 CFR 1910.120. Your questions are paraphrased below, followed by our responses. This letter constitutes OSHA's interpretation only of the requirements discussed and may not be applicable to any question not detailed in your original correspondence.

Background: You assist hospitals in following OSHA's Best Practices for Hospital Based First Receivers publication and complying with the HAZWOPER Standard, 29 CFR 1910.120.

Question 1: What are the mandatory elements that must be included in a baseline physical examination under 29 CFR 1910.120(q)(9)(i)? Are there mandatory exclusionary criteria?

Response: Although hospitals designated by a planning committee or by a hazardous waste site as decontamination facilities must comply with paragraph (q) of OSHA's HAZWOPER standard for purposes of community emergency response, the first receivers at the hospital who will receive and treat contaminated victims do not need to receive a baseline physical examination. The relevant provision, 29 CFR 1910.120(q)(9)(i), requires baseline examinations only for HAZMAT team members and hazardous materials specialists. Under 29 CFR 1910.120(q)(9)(ii), however, any emergency response employees, including first receivers, who exhibit signs or symptoms that may have resulted from exposure to hazardous substances during an emergency incident must be provided with medical consultation in accordance with 29 CFR 1910.120(f)(3)(ii).

Medical examinations required by the HAZWOPER standard must include a medical and work history with special emphasis on symptoms related to the handling of hazardous substances and health hazards, and to fitness for duty (including the ability to wear required PPE under conditions that may be expected at the worksite). [29 CFR 1910.120(f)(4)(i)]. However, the HAZWOPER standard does not otherwise dictate the content of any required medical examinations or consultations. The determination of what to include in an exam or consultation (e.g., blood pressure, blood testing, pulmonary function, etc.) is left to the discretion of the attending physician. [29 CFR 1910.120(f)(4)(ii)]. Moreover, the HAZWOPER standard does not set any specific exclusionary criteria. The physician should base his or her medical examination, and monitoring and exclusion criteria, if any, on the worker's exposures (or likely exposures), as well as the worker's duties and responsibilities.

Finally, please note that Federal OSHA's standards and enforcement authority do not extend to employees of state or local governments. With respect to HAZWOPER, state and local public sector employees, including many first receivers at public hospitals, are covered by the states that operate OSHA-approved State Plans (see http://www.osha.gov/dcsp/osp/index.html). In states without State Plans, these workers are covered by the Environmental Protection Agency (EPA) (see 40 CFR Part 3 11). State Plan states set and enforce standards, such as the HAZWOPER standard, which are identical to or "at least as effective as" Federal OSHA standards, and therefore may have more stringent or supplemental requirements. EPA's HAZWOPER standard was adopted to cover public sector workers who are not covered by the OSHA standard. For consistency, OSHA interprets the HAZWOPER standard for EPA.

Question 2: What happens if an employer does not follow the specific practices described in the sample procedures contained in "Appendix H: Examples of Medical Monitoring For First Receivers, Including Information on Heat Stress" in OSHA's Best Practices for Hospital Based First Receivers publication?

Response: The First Receivers publication is a guidance document that provides practical information to assist hospitals in developing and implementing emergency management plans that address the protection of hospital-based emergency department personnel during the receipt of contaminated victims from mass casualty incidents occurring at locations other than the hospital. It is not mandatory for an employer to follow the sample medical monitoring plans found in Appendix H of that document.

Thank you for your interest in occupational safety and health. We hope you find this information helpful. 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,



Thomas Galassi, Director
Directorate of Enforcement Programs