June 12, 2017

Mr. Eddie Smith
IBEW Local 2286
International Brotherhood of Electrical Workers
AFL-CIO-CLC
4850 Stone Oak Drive
Beaumont, Texas 77705

Dear Mr. Smith,

Thank you for your February 8, 2017 letter to the Occupational Safety and Health Administration's (OSHA) Directorate of Enforcement Programs. In your letter, you mentioned that the International Brotherhood of Electrical Workers (IBEW) is seeking clarification on whether OSHA's Respiratory Protection Standard, 29 CFR 1910.134, requires annual blood work to determine physical fitness for employees who wear a self-contained breathing apparatus (SCBA) infrequently. You were also called by a member of my staff for clarification of your question. This letter constitutes OSHA's interpretation only of the requirements discussed and may not be applicable to any question not delineated within your original correspondence. Your paraphrased question and our response are below.

Background: You explained that IBEW Local 2286 represents instrument and analyzer technicians at a large petrochemical facility that produces ethylene oxide. To perform their jobs, the instrument and analyzer technicians may occasionally have to wear a SCBA. The company physician requires annual blood work and the company asserts that 29 CFR 1910.134(e) gives latitude to the physician to require annual blood work as part of the physical fitness assessment for each employee that may need to wear a SCBA. The company has made the blood work mandatory and a condition of continued employment.

Question: Does any part of OSHA's Respiratory Protection Standard (29 CFR 1910.134) give the company the right to make annual blood work mandatory for all employees covered by the Standard?

Response: All employers with employees that use respirators are required to comply with the requirements of OSHA's Respiratory Protection Standard (29 CFR 1910.134). Title 29 CFR 1910.134(e) specifies the minimum requirements for medical evaluation that employers must implement to determine an employee's ability to use a respirator, but it does not require mandatory annual blood work for employees. However, according to 29 CFR 1910.134(e)(6)(i)(B), the company's physician or other licensed health care professional (PLHCP) may ask for follow-up medical evaluations in addition to the specified minimum requirements. Also, according to 29 CFR 1910.134(e)(3), where the PLHCP identifies underlying medical concerns that demonstrate the need for a follow-up medical examination of an employee, the standard requires the employer to provide that follow-up examination, including any medical tests, consultations, or diagnostic procedures that the PLHCP deems necessary.

Under 29 CFR 1910.134(e), among other requirements, an employer must:

• Provide a medical evaluation to determine an employee’s ability to use a respirator before fit testing and use.
• Identify a PLHCP to perform medical evaluations using a medical questionnaire or an initial medical examination that obtains the same information as the medical questionnaire (information required is contained in mandatory Appendix C).
• Obtain a written medical opinion regarding the employee’s ability to use the respirator from the PLHCP. Either the employer, or the PLHCP, must provide the employee with a copy of the PLHCP's written medical opinion.
• Provide additional medical evaluations under certain circumstances, such as when:
  • An employee reports medical signs or symptoms related to ability to use respirator.
  • The PLHCP, program administrator, or supervisor recommends re-evaluation.
  • Information from the respirator program, including observations made during fit testing and program evaluation, indicates a need.
  • A change occurs in workplace conditions that may substantially increase the physiological burden on an employee.

Additionally, because the petrochemical facility you mention produces ethylene oxide, the employer of the facility may also be subject to the requirements of OSHA's substance-specific standard for ethylene oxide (EtO), 29 CFR 1910.1047. Where applicable, the EtO Standard requires employers to enroll employees in a medical surveillance program in certain situations. Specifically, 29 CFR 1910.1047(i) requires medical examinations for employees who are exposed to EtO at or above its action level of 0.5 parts per million (ppm), calculated as an 8-hour time-weighted average (without regard to the use of respirators), for at least 30 days per year, or if any employees are exposed to EtO during an emergency event. Emergency means any occurrence such as, but not limited to, equipment failure, rupture of containers, or failure of control equipment that is likely to or does result in an unexpected significant release of EtO.

For employees enrolled in medical surveillance for EtO, 29 CFR 1910.1047(i)(2)(ii)(A) specifies inclusion of the following elements in the medical examination:

(1) A medical and work history with special emphasis directed to symptoms related to the pulmonary, hematologic, neurologic and reproductive systems and to the eyes and skin.
(2) A physical examination with particular emphasis given to pulmonary, hematologic, neurologic, and reproductive systems and to the eyes and skin.
(3) A complete blood count to include at least a white cell count (including differential cell count), red cell count, hematocrit, and hemoglobin.
(4) Any laboratory or other test which the examining physician deems necessary by sound medical practice.

As you can see, a complete blood count is among the required elements of employee medical examinations and is the only mandatory laboratory test required by the EtO Standard. Per 29 CFR 1910.1047(i)(2)(i)(B), medical examinations must be provided at least annually to each employee exposed at or above EtO's action level, for at least 30 days in the past year. The employer must also provide any employee exposed during an emergency with medical exams at a frequency considered to be medically appropriate, according to 1910.1047(i)(2)(i)(D).

Even if an employee does not meet the criteria (as specified above) for enrollment in the medical surveillance program for EtO, employers may adopt workplace requirements more stringent than OSHA's, such as requiring a mandatory medical examination or laboratory test as a condition of employment, as long as the examination or test is not otherwise prohibited under applicable laws and/or labor-management contracts. OSHA has clarified this aspect in an earlier interpretation, which can be accessed at: www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=INTERPRETATIONS&p_id=27082.

You might find it beneficial to review OSHA's EtO Standard and OSHA's Small Business Guide for Ethylene Oxide. Also, Appendix C to 29 CFR 1910.1047 provides medical surveillance guidelines for ethylene oxide (non-mandatory). In addition, OSHA's Safety and Health Topics page on Ethylene Oxide, at: www.osha.gov/SLTC/ethyleneoxide/, contains useful information and links to other relevant resources.

Thank you for your interest in occupational safety and health. We hope you find this information helpful. OSHA's requirements are set by statute, standards, and regulations. Our letters of interpretation do not create new or additional requirements but rather explain these requirements and how they apply to particular circumstances. This letter constitutes OSHA's interpretation of the requirements discussed. From time to time, letters are affected when the Agency updates a standar a legal decision impacts a standard, or changes in technology affect the interpretation. To assure that you are using the correct information and guidance, please consult OSHA's website at https://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