WAC 296-856-30020   Medical and emergency evaluations.  

     IMPORTANT:

     • Medical evaluations completed to meet the respirator use requirements of this section also need to meet the requirements found in a separate chapter, Respirators, medical evaluations, WAC 296-842-140.

     You must:

     • Make medical evaluations available to current employees who:

     – Are exposed to formaldehyde concentrations above the action level (AL) or short-term exposure limit (STEL).

     – Are exposed to formaldehyde during an emergency situation.

     – Develops signs and symptoms commonly associated with formaldehyde exposure.

     • Make medical examinations available to current employees as deemed necessary by the LHCP after reviewing the medical disease questionnaire for employees that are presently not required to wear a respirator.

     • Complete Steps 1 through 4 of the medical evaluation process at the following times:

     – Initially, when employees are assigned to work in an area where exposure monitoring results are above the action level (AL) or above the STEL.

     – At least every twelve months from the initial medical evaluation for employees exposed to formaldehyde above the action level (AL) or the STEL.

     – Whenever the employee develops signs and symptoms commonly associated with formaldehyde.

Note: Signs and symptoms are rarely associated with formaldehyde concentrations in air less than 0.1 parts per million (ppm), and in materials at concentration levels less than 0.1 percent.
     You must:

     • Make medical evaluations available:

     – At no cost to employees, including travel costs and wages associated with any time spent obtaining the medical evaluation.

     – At reasonable times and places.

Note: • Employees who decline to receive a medical evaluation to monitor for health effects caused by formaldehyde are not excluded from receiving a separate medical evaluation for respirator use.
• If employers discourage participation in medical monitoring for health effects caused by formaldehyde, or in any way interferes with an employee's decision to continue with this program, this interference may represent unlawful discrimination under RCW 49.17.160, Discrimination against employee filing complaint, instituting proceedings, or testifying prohibited -- Procedure -- Remedy.
     Medical evaluation process:

     Step 1: Select a licensed healthcare professional (LHCP) who will conduct or supervise examinations and procedures.

     – If the LHCP is not a licensed physician, make sure individuals who conduct pulmonary function tests, have completed a training course in spirometry, sponsored by an appropriate governmental, academic, or professional institution.

Note: The LHCP must be a licensed physician or supervised by a physician.
     Step 2: Make sure the LHCP receives all of the following information before the medical evaluation is performed:

     – A copy of this chapter.

     – The helpful tools: Substance Technical Guideline for Formalin, Medical Surveillance, and Medical Disease Questionnaire.

     – A description of the duties of the employee being evaluated and how these duties relate to formaldehyde exposure.

     – The anticipated or representative exposure monitoring results for the employee being evaluated.

     – A description of the personal protective equipment (PPE) and respiratory protection each employee being evaluated uses or will use.

     – Information in your possession from previous employment-related examinations when this information is not available to the examining LHCP.

     – A description of the emergency and the exposure, when an examination is provided due to an exposure received during an emergency.

     – Instructions that the written opinions the LHCP provides to you, does not include any diagnosis or other personal medical information, and is limited to the following information:

     ▪ The LHCP's opinion about whether or not medical conditions were found that would increase the employee's risk for impairment from exposure to formaldehyde.

     ▪ Any recommended limitations for formaldehyde exposure and use of respirators or other PPE.

     ▪ A statement that the employee has been informed of medical results and medical conditions caused by formaldehyde exposure requiring further examination or treatment.

     Step 3: Make a medical evaluation available to the employee. Make sure it includes the content listed in Table 3, Content of Medical Evaluations.

     Step 4: Obtain the LHCP's written opinion for the employee's medical evaluation and make sure the employee receives a copy within five business days after you receive the written opinion.

     – Make sure the written opinion is limited to the information specified for written opinions in Step 2.

Note: If the written opinion contains specific findings or diagnoses unrelated to occupational exposure, send it back and obtain a revised version without the additional information.



Table 3

     Content of Medical Evaluations
When conducting an Include
Initial • A medical disease questionnaire that provides a work and medical history with emphasis on:
OR – Upper or lower respiratory problems
Annual evaluation – Allergic skin conditions or dermatitis
– Hyper reactive airway diseases
  – Eyes, nose, and throat irritation
• Physical examinations deemed necessary by the LHCP, that include at a minimum:
– Examinations with emphasis on evidence of irritation or sensitization of skin, eyes, and respiratory systems, and shortness of breath
– Counseling, provided by the LHCP to the employee as part of the medical examination if the LHCP determines that the employee has a medical condition that may be aggravated by formaldehyde exposure
• Pulmonary function tests for respirator users, that include at a minimum:
– Forced vital capacity (FVC)
– Forced expiratory volume in one second (FEV1)
– Forced expiratory flow (FEF)
Emergency exposure evaluation • A medical examination that includes a work history with emphasis on evidence of upper or lower respiratory problems, allergic conditions, skin reaction or hypersensitivity, and any evidence of eye, nose, or throat irritation
• Additional examinations the licensed healthcare professional (LHCP) believes appropriate, based on the employee's exposure to formaldehyde
Evaluation of reported signs and symptoms • A medical disease questionnaire that provides a work and medical history with emphasis on:
– Upper or lower respiratory problems
– Allergic skin conditions or dermatitis
– Hyper reactive airway diseases
– Eyes, nose, and throat irritation
• A physical examination if considered necessary by the LHCP that includes at a minimum:
– Examinations with emphasis on evidence of irritation or sensitization of skin, eyes, respiratory systems, and shortness of breath
– Counseling if the LHCP determines that the employee has a medical condition that may be aggravated or caused by formaldehyde exposure




[Statutory Authority: RCW 49.17.010, 49.17.040, 49.17.050, 49.17.060. 06-08-087, § 296-856-30020, filed 4/4/06, effective 9/1/06.]