HAZMAT Teams will fall under 1910.120(q), but there are sections of section(q) that direct us to other sections of 1910.120. One of these sections is the medical monitoring requirements for the team members. In this article, I will try and layout exactly what OSHA requires for each team member. NOTE: Text from the 1910.120 and other OSHA standards discussed in this article will be italicized.
Members of an organized and designated HAZMAT team and hazardous materials specialist shall receive a baseline physical examination and be provided with medical surveillance as required in paragraph (f) of this section.
I think that it is important to point out that the basic “respirator physical” is NOT going to meet the medical evaluation requirements for HAZWOPER. Using annual respirator physicals as the only means to evaluate response team member’s state of health just does NOT go far enough, as will be more evident as we progress through this article.
The standard sort of bounces us around when it comes to medical surveillance, but simply put there are two types of medical surveillance that need to take place: 1) annual and 2) on-scene during an active response. First, let’s discuss the annual and pre-team medical evaluations.
I.) General. Employees engaged in operations specified in paragraphs (a)(1)(i) through (a)(1)(iv) of this section and not covered by (a)(2)(iii) exceptions and employers of employees specified in paragraph (q)(9) shall institute a medical surveillance program in accordance with this paragraph.
Section (q)(9) is how we get pulled into section (f). This is just the first step to our roadmap for medical evaluations.
Employees covered. The medical surveillance program shall be instituted by the employer for the following employees:
…
1910.120(f)(2)(iv) Members of HAZMAT teams.
This is where our requirement to be in some type of medical surveillance is stated. There is other personnel called out in the standard, but for simplification of this article, I am only going to be discussing our emergency responders on a HAZMAT team.
Frequency of medical examinations and consultations. Medical examinations and consultations shall be made available by the employer to each employee covered under paragraph (f)(2) of this section on the following schedules:
1910.120(f)(3)(i) For employees covered under paragraphs
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(f)(2)(iv)
a) Prior to assignment
This means that anyone regardless of how long they have been employed at the facility MUST undergo sort of a pre-team medical evaluation, based on the role they are going to play during a response. You can have different personnel filling different roles and not all those personnel will be wearing LEVEL A suits and the likes. The attending physician needs to know this, as these evaluations will vary GREATLY if your team is set up like this. Although it is much easier for a facility to manage a team that is trained at the same levels throughout, some facilities have members who want to help but do not like the idea of walking into a chlorine cloud.
b) At least once every twelve months for each employee covered unless the attending physician believes a longer interval (not greater than biennially) is appropriate;
This is where the ANNUAL requirement comes from. Please note that even when your attending physician feels that “annual” is not necessary, the team members can NOT go beyond every two (2) year physical under any circumstances! If your team is going to bypass the ANNUAL PHYSICALS, the attending physician will want to document his/her rationale in their files. If OSHA comes knocking and you have missed the annual physicals and you try and pull this ace out of your pocket, OSHA is smart enough to pay your physician a visit to review their rationale.
c) At the termination of employment or reassignment to an area where the employee would not be covered if the employee has not had an examination within the last six months.
This one is the most tricky and the biggest pain in our behinds! This is the single most cited section when SAFTENG.net LLC does our in-depth “Emergency Response Compliance Audits”. If you have a high turnover on your teams, this only increases the headache and the opportunity for a citation. OSHA requires anyone who leaves the team for any reason to have an exit medical evaluation. If the team member has had their annual physical (or biennial physical) within the past 6 months, then we can use that recent physical to meet this requirement. This requirement drove me to include a signed “commitment letter” from all my team members for at least three years, unless of a family hardship or medical reasons. If a team is set up and managed properly, the costs of doing all the medical evaluations and training can be the majority of your costs the first several years and if you have members playing games and using the team as a political message to management, you will be spending a lot of unnecessary dollars on exit evaluations.
d) As soon as possible upon notification by an employee that the employee has developed signs or symptoms indicating possible overexposure to hazardous substances or health hazards, or that the employee has been injured or exposed above the permissible exposure limits or published exposure levels in an emergency situation;
This should be self-explanatory, but if you have questions about specific examples, feel free to ask me.
e) At more frequent times if the examining physician determines that an increased frequency of examination is medically necessary.
Just like above, the physician can change the frequency of the medical evaluations. They can require them to be done more frequently if they find a cause for such a need or they can lengthen them, but no longer than biennially.
The content of medical examinations and consultations. Medical examinations required by paragraph (f)(3) of this section shall include a medical and work history (or updated history if one is in the employee’s file) 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 any required PPE under conditions (i.e., temperature extremes) that may be expected at the worksite. (emphasis added by me).
This is where we get into the difference between this medical evaluation and the annual respirator evaluation. I should point out that when your team members participate in these HAZMAT Team medical evaluations they do NOT have to go back for a respirator medical evaluation. This HAZMAT Team evaluation will INCLUDE the respirator evaluation; in fact, most physicians will use the exact same questionnaire from 1910.134 in their HAZMAT Team evaluations. (See VI.e)
Examination by a physician and costs. All medical examinations and procedures shall be performed by or under the supervision of a licensed physician, preferably one knowledgeable in occupational medicine, and shall be provided without cost to the employee, without loss of pay, and at a reasonable time and place.
I think this is self-explanatory, but if you have any questions feel to ask or post them below.
Information provided to the physician. The employer shall provide one copy of this standard and its appendices to the attending physician and in addition the following for each employee:
- A description of the employee’s duties as they relate to the employee’s exposures,
- The employee’s exposure levels or anticipated exposure levels.
- A description of any personal protective equipment used or to be used.
- Information from previous medical examinations of the employee which is not readily available to the examining physician.
- Information required by §1910.134
Physician’s written opinion. The employer shall obtain and furnish the employee with a copy of a written opinion from the examining physician containing the following:
- The physician’s opinion as to whether the employee has any detected medical conditions which would place the employee at increased risk of material impairment of the employee’s health from work in hazardous waste operations or emergency response, or from respirator use.
- The physician’s recommended limitations upon the employee’s assigned work.
- The results of the medical examination and tests if requested by the employee.
- A statement that the employee has been informed by the physician of the results of the medical examination and any medical conditions which require further examination or treatment.
The written opinion obtained by the employer shall NOT reveal specific findings or diagnoses unrelated to occupational exposure.
Recordkeeping. An accurate record of the medical surveillance required by paragraph (f) of this section shall be retained. This record shall be retained for the period specified and meet the criteria of 29 CFR 1910.1020. The record required in paragraph (f)(8)(i) of this section shall include at least the following information:
- The name and social security number of the employee;
- Physicians’ written opinions, recommended limitations and results of examinations and tests;
- Any employee medical complaints related to exposure to hazardous substances;
- A copy of the information provided to the examining physician by the employer, with the exception of the standard and its appendices.
IX.) Any emergency response employees who exhibit signs or symptoms which may have resulted from exposure to hazardous substances during the course of an emergency incident either immediately or subsequently shall be provided with medical consultation as required in paragraph (f)(3)(ii) of this section.