WAC 296-155-17621
Medical surveillance. (1) General.
(a) The employer shall make available initial medical
surveillance to employees occupationally exposed on any day to
lead at or above the action level. Initial medical
surveillance consists of biological monitoring in the form of
blood sampling and analysis for lead and zinc protoporphyrin
levels.
(b) The employer shall institute a medical surveillance
program in accordance with subsections (2) and (3) of this
section for all employees who are or may be exposed by the
employer at or above the action level for more than thirty
days in any consecutive twelve months;
(c) The employer shall assure that all medical
examinations and procedures are performed by or under the
supervision of a licensed physician.
(d) The employer shall make available the required
medical surveillance including multiple physician review under
subsection (3)(c) without cost to employees and at a
reasonable time and place.
(2) Biological monitoring.
(a) Blood lead and ZPP level sampling and analysis. The
employer shall make available biological monitoring in the
form of blood sampling and analysis for lead and zinc
protoporphyrin levels to each employee covered by subsection
(1)(a) and (b) of this section on the following schedule:
(i) For each employee covered by subsection (1)(b) of
this section, at least every two months for the first six
months and every six months thereafter;
(ii) For each employee covered by subsection (1)(a) or
(b) of this section whose last blood sampling and analysis
indicated a blood lead level at or above 40 µg/dl, at least
every two months. This frequency shall continue until two
consecutive blood samples and analyses indicate a blood lead
level below 40 µg/dl; and
(iii) For each employee who is removed from exposure to
lead due to an elevated blood lead level at least monthly
during the removal period.
(b) Follow-up blood sampling tests. Whenever the results
of a blood lead level test indicate that an employee's blood
lead level exceeds the numerical criterion for medical removal
under WAC 296-155-17623 (1)(a), the employer shall provide a
second (follow-up) blood sampling test within two weeks after
the employer receives the results of the first blood sampling
test.
(c) Accuracy of blood lead level sampling and analysis. Blood lead level sampling and analysis provided pursuant to
this WAC 296-155-176 shall have an accuracy (to a confidence
level of ninety-five percent) within plus or minus fifteen
percent or 6 µg/dl, whichever is greater, and shall be
conducted by a laboratory approved by OSHA.
(d) Employee notification.
(i) Within five working days after the receipt of
biological monitoring results, the employer shall notify each
employee in writing of their blood lead level; and
(ii) The employer shall notify each employee whose blood
lead level exceeds 40 µg/dl that the standard requires
temporary medical removal with Medical Removal Protection
benefits when an employee's blood lead level exceeds the
numerical criterion for medical removal under WAC 296-155-17623 (1)(a).
(3) Medical examinations and consultations.
(a) Frequency. The employer shall make available medical
examinations and consultations to each employee covered by
subsection (1)(b) of this section on the following schedule:
(i) At least annually for each employee for whom a blood
sampling test conducted at any time during the preceding
twelve months indicated a blood lead level at or above 40
µg/dl;
(ii) As soon as possible, upon notification by an
employee either that the employee has developed signs or
symptoms commonly associated with lead intoxication, that the
employee desires medical advice concerning the effects of
current or past exposure to lead on the employee's ability to
procreate a healthy child, that the employee is pregnant, or
that the employee has demonstrated difficulty in breathing
during a respirator fitting test or during use; and
(iii) As medically appropriate for each employee either
removed from exposure to lead due to a risk of sustaining
material impairment to health, or otherwise limited pursuant
to a final medical determination.
(b) Content. The content of medical examinations made
available pursuant to subdivision (a)(ii) and (iii) of this
subsection shall be determined by an examining physician and,
if requested by an employee, shall include pregnancy testing
or laboratory evaluation of male fertility. Medical
examinations made available pursuant to subdivision (a)(i) of
this subsection shall include the following elements:
(i) A detailed work history and a medical history, with
particular attention to past lead exposure (occupational and
nonoccupational), personal habits (smoking, hygiene), and past
gastrointestinal, hematologic, renal, cardiovascular,
reproductive and neurological problems;
(ii) A thorough physical examination, with particular
attention to teeth, gums, hematologic, gastrointestinal,
renal, cardiovascular, and neurological systems. Pulmonary
status should be evaluated if respiratory protection will be
used;
(iii) A blood pressure measurement;
(iv) A blood sample and analysis which determines:
(A) Blood lead level;
(B) Hemoglobin and hematocrit determinations, red cell
indices, and examination of peripheral smear morphology;
(C) Zinc protoporphyrin;
(D) Blood urea nitrogen; and,
(E) Serum creatinine;
(v) A routine urinalysis with microscopic examination;
and
(vi) Any laboratory or other test relevant to lead
exposure which the examining physician deems necessary by
sound medical practice.
(c) Multiple physician review mechanism.
(i) If the employer selects the initial physician who
conducts any medical examination or consultation provided to
an employee by WAC 296-155-176, the employee may designate a
second physician:
(A) To review any findings, determinations or
recommendations of the initial physician; and
(B) To conduct such examinations, consultations, and
laboratory tests as the second physician deems necessary to
facilitate this review.
(ii) The employer shall promptly notify an employee of
the right to seek a second medical opinion after each occasion
that an initial physician conducts a medical examination or
consultation pursuant to WAC 296-155-176. The employer may
condition its participation in, and payment for, the multiple
physician review mechanism upon the employee doing the
following within fifteen days after receipt of the foregoing
notification, or receipt of the initial physician's written
opinion, whichever is later:
(A) The employee informing the employer that they intend
to seek a second medical opinion; and
(B) The employee initiating steps to make an appointment
with a second physician.
(iii) If the findings, determinations or recommendations
of the second physician differ from those of the initial
physician, then the employer and the employee shall assure
that efforts are made for the two physicians to resolve any
disagreement.
(iv) If the two physicians have been unable to quickly
resolve their disagreement, then the employer and the employee
through their respective physicians shall designate a third
physician:
(A) To review any findings, determinations or
recommendations of the prior physicians; and
(B) To conduct such examinations, consultations,
laboratory tests and discussions with the prior physicians as
the third physician deems necessary to resolve the
disagreement of the prior physicians.
(v) The employer shall act consistent with the findings,
determinations and recommendations of the third physician,
unless the employer and the employee reach an agreement which
is otherwise consistent with the recommendations of at least
one of the three physicians.
(d) Information provided to examining and consulting
physicians.
(i) The employer shall provide an initial physician
conducting a medical examination or consultation under WAC 296-155-176 with the following information:
(A) A copy of this regulation for lead including all
Appendices;
(B) A description of the affected employee's duties as
they relate to the employee's exposure;
(C) The employee's exposure level or anticipated exposure
level to lead and to any other toxic substance (if
applicable);
(D) A description of any personal protective equipment
used or to be used;
(E) Prior blood lead determinations; and
(F) All prior written medical opinions concerning the
employee in the employer's possession or control.
(ii) The employer shall provide the foregoing information
to a second or third physician conducting a medical
examination or consultation under WAC 296-155-176 upon request
either by the second or third physician, or by the employee.
(e) Written medical opinions.
(i) The employer shall obtain and furnish the employee
with a copy of a written medical opinion from each examining
or consulting physician which contains only the following
information:
(A) The physician's opinion as to whether the employee
has any detected medical condition which would place the
employee at increased risk of material impairment of the
employee's health from exposure to lead;
(B) Any recommended special protective measures to be
provided to the employee, or limitations to be placed upon the
employee's exposure to lead;
(C) Any recommended limitation upon the employee's use of
respirators, including a determination of whether the employee
can wear a powered air purifying respirator if a physician
determines that the employee cannot wear a negative pressure
respirator; and
(D) The results of the blood lead determinations.
(ii) The employer shall instruct each examining and
consulting physician to:
(A) Not reveal either in the written opinion or orally,
or in any other means of communication with the employer,
findings, including laboratory results, or diagnoses unrelated
to an employee's occupational exposure to lead; and
(B) Advise the employee of any medical condition,
occupational or nonoccupational, which dictates further
medical examination or treatment.
(f) Alternate physician determination mechanisms. The
employer and an employee or authorized employee representative
may agree upon the use of any alternate physician
determination mechanism in lieu of the multiple physician
review mechanism provided by subdivision (c) of this
subsection so long as the alternate mechanism is as
expeditious and protective as the requirements contained in
this section.
(4) Chelation.
(a) The employer shall assure that any person whom he
retains, employs, supervises or controls does not engage in
prophylactic chelation of any employee at any time.
(b) If therapeutic or diagnostic chelation is to be
performed by any person in subdivision (a) of this subsection,
the employer shall assure that it be done under the
supervision of a licensed physician in a clinical setting with
thorough and appropriate medical monitoring and that the
employee is notified in writing prior to its occurrence.
[Statutory Authority: Chapter 49.17 RCW. 93-22-054 (Order
93-07), § 296-155-17621, filed 10/29/93, effective 12/10/93.]