OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

Subject: CSHO Medical Examinations

A. Purpose. This instruction establishes the annual CSHO MedicalExamination Program for OSHA bargaining unit employees and other positions asidentified in section G. by implementing the OSHA medical requirementsstandards for these people and requiring annual medical examinations. Thisinstruction incorporates the applicable terms of the agreement on theimplementation of this program reached between the U.S. Department of Laborand the National Council of Field Labor Locals, (NCFLL), AFGE, AFL-CIO.

B. Scope. This instruction applies OSHA-wide.

C. References.

1. Draft OSHA Instruction, April 6, 1987, Subject: OSHA MedicalRequirements Standard.

2. Coronary Risk Handbook - Estimating Risk of Coronary HeartDisease in Daily Practice, American Heart Association.

3. Memorandum to Regional Administrators, April 14, 1987, Subject:Public Health Service Contract for CSHO Physicals, from Leo Carey and EdwardBaier.

4. Memorandum of Understanding between the U.S. Department of Laborand the National Council of Field Labor Locals (NCFLL), AFGE, AFL-CIO, datedAugust 26, 1988.

D. Cancellation.

1. OSHA Instruction PER 8-2.2, October 30, 1978, is cancelled.

2. OSHA Instruction PER 8-2.3, October 30, 1978, is cancelled.

E. Action. OSHA Regional Administrators and National Office Directorsshall ensure that the procedures described in this instruction areimplemented.

OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

F. Background. Prior to April of 1987, OSHA did not have a standardizedCSHO physical medical examination program, and all 10 Regions developed andimplemented their own "CSHO Physical" program. Early in 1905, OSHA appliedfor and received from the Office of Personnel Management (OPM) a singleAgency physical examination standard covering OSHA personnel. OPM approvedthese standards early in 1986. The standard is applicable to the OSHAemployees described in section G. of this instruction as well as to newhires.

1. Implementation of a single Agency medical requirements standardensures that the health of OSHA employees will be at a level which willpermit them to perform job-related assignments under conditions that varyfrom sedentary to maximum exertion.

2. Normal work conditions also require the employee to perform in areliable manner under adverse conditions. Routine assignments requireemployees to enter worksites and observe and evaluate conditions to whichworkers are exposed. This includes working at heights; working underground;working in confined spaces; working in emergency type situations; working inenvironments with chemical, physical, and biological hazards.

3. Many of these hazards are regulated by established OSHAstandards which require the use of protective equipment and/or routinemedical monitoring. The proper use of personal protective equipment requiresan evaluation of the wearer's physical ability to utilize the equipmentsafely and without adverse effect to the wearer's health. Adverse conditionssometimes occur unexpectedly while others are anticipated. In the lattercase, appropriate steps can be taken in an orderly and controlled manner toprotect oneself and safely leave the hazard area.

4. OSHA has required affected new-hire employees to take and pass apre-employment medical examination since April of 1987. However, annualphysical examinations for on-board bargaining unit employees have beenconducted only on a voluntary basis prior to the negotiation of the impact ofthis program with the representatives of OSHA employees, the National Councilof Field Labor Locals (NCFLL).

5. Beginning in 1987 and continuing over several months, Departmentof Labor management representatives met with representatives of the NCFLL,AFGE, AFL-CIO, and discussed the implementation of OSHA's medical

OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

examination program, as it would impact bargaining unitemployees currently on-board. The two parties have negotiated a Memorandumof Understanding (MOU) which applies the OSHA physical and medicalrequirements standards and annual examination program to current OSHAbargaining unit employees covered under the program (see AppendixC).

6. This instruction implements the physical requirements standardand the OSHA annual medical examination program for currently on-board OSHAemployees and incorporates the applicable terms of the negotiated MOU whichwas signed August 26, 1988, (the physical examination program for new hireemployees is addressed in a separate instruction).

7. OSHA contracted with the U.S. Public Health Service (PHS) toprovide the mandatory annual physical examinations required under thisprogram. PHS has been providing physical examinations for new-hire employeesand voluntary examinations since April of 1987. OSHA's national contractwith a single agency to provide the medical examinations required under thisprogram ensures agencywide uniformity in the administration and qualitycontrol of the examinations given.

8. None of the policies or procedures in this instruction affectexisting employee options or benefits allowed them for disability retirement,Federal Workers' Compensation, and/or any other employment benefitprograms.

G. Coverage. Specific positions by grade and series to which thisinstruction apply include:

Position Series Grades

Student Trainee GS-099 4-5 SafetySpecialist GS-018 5-13 Supervisory Safety Specialist GM-018 13 Safety and Occupational Health Manager GM-018 13 Industrial Hygienist GS-690 5-13 Supervisory Industrial Hygienist GM-690 13 Safety Engineer GS-803 5-13 SupervisorySafety

OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

1. All employees in the above-classified positions in OSHA'sRegional and Area Offices are required to take the annual medical examinationspecified under this program. Employees in these positions are required tomake regular or occasional visits to industrial worksites where they may beexposed to potentially toxic chemicals and/or physical hazards.

2. Covered employees must undergo the medical examinationspecified herein in order for the Agency to determine if they are physicallyand medically capable of performing the essential duties of the positionefficiently and without hazard to themselves or others. Examinations will beprovided free of charge to the employee.

3. Several OSHA standards require routine medical tests in orderto monitor the health of employees who may be exposed to potentiallyhazardous substances or physical hazards and who must be physically capableof safely utilizing personal protective equipment. This medical standard andannual physical examination program allows OSHA to ensure compliance withcurrently existing OSHA standards as they pertain to OSHAemployees.

4. Regional Office staff are included under the annual examinationrequirement because they may have to provide on-site assistance to AreaOffice staff concerning specific inspections. Also, they are responsible formaking on-site variance inspections and therefore face potential workplaceexposures to hazardous situations.

5. Student trainees are covered under this program if their tenurewith the Agency will be expected to exceed a one-year period from theirinitial (pre-employment) examination.

6. Employees whose past work assignments with the Agency requiredthem to make regular or occasional visits to industrial establishments wherethey may have been exposed to potentially toxic chemicals and/or physicalhazards and whose job descriptions do not now require them to go into thefield will be offered a voluntary medical examination, free of charge, everyother year. Voluntary examinations will be provided to the eligible employeewith the understanding that examination results pertinent to pastoccupational exposure will be provided to OSHA management in order for theAgency to fulfill its duties as a responsible employer under the OSHAct.

OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

H. Annual Examinations: The annual medical examinations described in thisinstruction are mandatory for all individuals required to take them (Seesection G.), and all affected employees are required to pass the examination.

1. Failure to meet the required physical and medical qualificationswill normally be considered disqualifying for employment; however, bargainingunit employees hired on or before August 26, 1988, the date of the signing ofthe MOU between the Department of Labor and the NCFLL, who do not meet thephysical requirements of the position, will either be waived or offered aposition at retained pay. (See "Waiver" and "Accommodation" as describedunder section J., Procedures, of this instruction.)

2. Disqualification may be averted when substantial evidence ispresented to the OSHA Medical Officer and a determination is made that theindividual can perform the essential functions of the job efficiently andwithout risk to themselves or others. The procedures for handlingexamination results are delineated in section J. of thisinstruction.

3. Bargaining unit employees will be provided thirty (30) dayswritten notice by OSHA management of the impending annual examinations.Annual examinations will be scheduled at the convenience of the AreaDirector/Supervisor and will be conducted during the basic workweek of theemployee. It is the responsibility of the employee to notify management of aconflict that prevents him or her from taking the examination as soon aspossible. Employees who do not take the examination will be notified orallyor in writing of their new examination date.

4. The results of all examinations provided under this program,whether mandatory or voluntary, are the property of the Office of PersonnelManagement and will be safeguarded in accordance with the OPM regulationsthat all government agencies must follow to protect access to employeemedical records. (See OPM regulations 5 CFR 293, Subpart E, "EmployeeMedical File System Records.") Additionally, the Director of the OSHA Officeof Occupational Medicine is responsible for ensuring that all procedures forreview and handling of medical records

OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

are in accordance with OSHA standard 29 CFR 1910.20, "Access toEmployee Exposure and Medical Records."

I. Pre-placement Examinations. Pre-placement examinations are requiredfor currently employed OSHA employees in job classifications and series otherthan those described in section G., who apply and are tentatively selectedfor one of the covered positions. The examination that will be given will beidentical to the pre-employment examination required of new hires. Theresults of the pre-placement examination will be handled in accordance withthe terms of the negotiated agreement between DOL and the NCFLL. As with newcandidates, individuals must pass the physical examination prior to beingplaced into an OSHA position that requires the employee to conduct regular oroccasional inspections.

J. Procedures. It is mandatory to pass the medical examination;therefore, failing to meet the requirements contained within the medicalexamination means that the individual no longer meets the physicalqualification requirements of the position. For employees hired after August26, 1988, Agency management shall give consideration to granting a waiver tothe employee. If the waiver cannot be granted, accommodation will beconsidered. However, if neither of these two exceptions are possible,procedures for the separation of the failed employee shall be initiated. Allemployees hired prior to August 26, 1988, who fail the examination will beeither waived, accommodated at their current position or offered a differentposition at retained pay by the Agency. The position offered may not be atthe employee's current duty station or at the employee's current title,series or grade level. The specific physical and medical parameters arefound in Appendix A.

1. Waiver

a. When an employee fails the examination but has demonstratedthe ability to perform his/her job in a satisfactory manner, OSHA managementmay request a waiver from the Agency physician. For example, an employee maymarginally fail a limit on a qualification standard for hearing or vision,however, that particular employee is fully capable of

OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

accomplishing every other aspect of the job requirement. This fact can be shown by previous performance evaluations of the employeefor the specific job.

b. When an employee fails the examination due to a conditionthat was known to exist by the employee and management for several years ormore and management can certify that the individual is fully capable ofperforming his or her job, management may seek a waiver. The waiver must bebased upon narrative information in the previous performance evaluations, notthe rating, and discussions with a responsible physician of the Office ofOccupational Medicine. This process assumes that any performance deficiencythat existed has been stated in previous evaluations and that the evaluationsare accurate.

c. Request for a waiver is generated by management at eitherthe Regional or Area Office level and must be approved by the RegionalAdministrator. The request is then forwarded to the Office of OccupationalMedicine, within 15 days of notification that an employee did not pass theexamination, for review and a written response. The Office of OccupationalMedicine will respond to the Regional Administrator within 10 days to eitherconcur or disagree with the waiver.

d. Waivers are good only until the next examination or whenother evidence arises indicating that the condition has changed. Failure toobtain a waiver implies that the employee who has failed the examination hasa condition that prevents him/her from performing the full range of duties ofthe position. The Agency medical officer will concur with the waiver onlyif, in his or her opinion, the employee would not harm or endanger him- orherself, or others when performing a full range of duties.

e. If management is not successful in obtaining a waiver orchooses not to seek a waiver, it can then seek accommodation. Seeking awaiver and accommodation at the same time is not permitted.

7

OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

2. Second Medical Opinion.

a. If an employee fails to meet the physical requirements andis not granted a waiver, an employee may obtain at his or her option anotherexamination, limited to the area of disqualification, by a physician ofchoice. This examination will be conducted by the nearest qualifiedphysician from the employee's official duty station. The medical examinationwill be paid for by the Department of Labor and will be conducted on officialtime.

b. Medical information provided by an employee's physician ofchoice may be supplied by the employee and will be utilized by management andthe Office of Occupational Medicine in the decision to grant a waiver or anaccommodation. This information must be provided within 30 days of theemployee's notice of failure to meet the physicalqualifications.

3. Accommodation.

a. Agency management may exercise the option of reasonableaccommodation for an employee who cannot pass the examination and who cannotreceive a waiver. The process of accommodating an employee involves jobreassignment or job restriction as directed by Agency management. Onlymanagement may seek accommodation of employees under thisprogram.

b. Accommodation for an employee who has not passed themedical examination and who does not receive a waiver begins with adiscussion between Agency management (including employee's supervisor, AreaDirector, and Regional Administrator) and the Office of OccupationalMedicine's physician on what restrictions or limitations may have to beplaced on the individual employee.

c. These limitations may be temporary, in the case of acorrectable condition, or they may be permanent. Accommodation forpermanently restrictive conditions will be considered on a case-by-casebasis.

d. Requests for accommodation will be forwarded from theRegional Administrator to the Office of Occupational Medicine within 15working days of notification that an employee has failed the medicalexamination and

OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

denied a waiver. The request for accommodation will includethe accommodation plan describing how the employee will be accommodated(i.e., job restriction or job reassignment). The purpose of forwarding theaccommodation plan to the Office of Occupational Medicine is to obtain aphysician's review to ensure that the steps of the accommodation plan aremedically adequate.

e. The Office of Occupational Medicine will respond to theRegional Administrator in writing within 10 days of receipt.

f. The final decision on accommodation will be made by theRegional Administrator.

g. This program does not change current procedures that fieldoffices are presently using for accommodation for a temporary condition suchas a broken leg or pregnancy. If an adverse medical condition is correctable(i.e., hernia or high blood pressure), OSHA may require treatment for thatcondition and establish a reasonable deadline at which time the conditionmust be corrected.

K. Responsibilities.

1. Regional Administrators and Area Directors.

a. Regional Administrators and Area Directors are responsiblefor implementing the CSHO Medical Examination program mandated by thisinstruction.

b. Regional Administrators and Area Directors are responsiblefor notifying individuals who have failed the examinations specified underthis instruction and initiating action appropriate to the specificcase.

c. Requests for waivers or accommodations are theresponsibility of the Regional Administrator. These requests must becoordinated with the Office of Occupational Medicine, the Office of FieldPrograms and the Directorate of Administrative Programs.

d. Regional Administrators are responsible for locating andcontacting the U.S. Public Health Service (PHS) medical facilities that willbe utilized within the

OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

Region for providing the required examinations. Anydifficulties or problems involving OSHA's national contract with PHS shall bebrought by the Regional Administrator to the attention of the Director oftechnical Support. In addition, each Region must coordinate and maintain alisting of contact persons in order to facilitate communication between OSHAand PHS.

2. The Office of Occupational Medicine and Directorate of TechnicalSupport.

a. The Director of Technical Support is responsible fornegotiating and securing the national contract to provide the examinationsrequired under this program. Any difficulties or problems that ariseregarding the administration of the national contract with the Public HealthService will be resolved by the Directorate of Technical Support as theAgency's representative.

b. The Office of Occupational Medicine is responsible forreviewing all medical opinions and test results of employees forwarded to itfor accuracy and consistency.

c. The Office of Occupational Medicine shall provide, in atimely manner, written responses to the Regions for all waivers andaccommodations requested under this program.

d. The Director of the Office of Occupational Medicine shallensure that all procedures for review and handling of OSHA medical recordsare in accordance with OSHA standard 29 CFR 1910.20 and the Office ofPersonnel Management's 5 CFR 293, Subpart E. This includes establishing andmaintaining a confidential storage and retrieval system so that individualrecords can be kept.

e. The Director of Technical Support shall establish a systemthat tracks failure notifications and their status. This will provide acheck and balance system for the Regions.

3. The Directorate of Administrative Programs and the Office ofField Programs.

OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

a. The Directorate of Administrative Programs and the Office ofField Programs shall provide guidance and assistance to the Regions for theapplication of this program.

b. Review of Regional accommodation plans submitted to theNational Office shall be coordinated by the Office of Field Programs in orderto ensure national consistency of application.

John A. Pendergrass Assistant Secretary

DISTRIBUTION: National, Regional and Area Offices Compliance Officers

OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

A. Purpose. OSHA Compliance Safety and Health Officers (CSHOs) makeinspections of industrial establishments to observe and evaluate conditionsto which workers are exposed.

1. During these inspections, CSHOs may be exposed to potentiallyhazardous situations and substances. The implementation and application of asingle Agency medical requirements standard to all affected employees ensuresthat the health of OSHA employees will be at a level that permits them toperform job-related assignments safely, effectively, and without hazard tothemselves or others.

2. OSHA has contracted with the U.S. Public Health Service (PHS)to provide the physical examinations required under the CSHO MedicalExamination Program. OSHA's contract with a single agency to provide theseexaminations serves to ensure agencywide uniformity in the administration andquality control of the necessary examinations.

B. Physical Requirements Rationale. Following is a general description ofthe physical requirements of the positions affected by the OSHA MedicalExamination Program.

1. The duties of these positions require employees to performunder conditions that vary from sedentary to maximum exertion. Normal workconditions also require the employee to perform in a reliable manner underadverse conditions. Employees must examine and report on potentiallyhazardous worksite conditions. This may include working at heights,underground, in confined spaces, in poorly lighted facilities, in emergencysituations, and working in environments with chemical, physical, andbiological hazards which are regulated by the OSH Act.

2. Many of the hazards CSHOs may face are regulated byestablished OSHA standards which require the use of personal protectiveequipment and/or routine medical monitoring. The proper use of personalprotective

OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

equipment requires an evaluation of the wearer's ability toutilize the equipment safely, without adverse effect to the wearer's health. Adverse conditions sometimes occur unexpectedly, while others are anticipatedand appropriate steps can be taken in an orderly and controlled manner toprotect oneself and safely leave the hazard area.

3. Before entrance on duty and routinely during employment,applicants and employees in these positions must undergo a medicalexamination and be physically and medically capable of performing theessential duties of the position efficiently and without hazard to themselvesor others.

4. Routine medical evaluations serve to monitor the employee'shealth status to ensure that he or she maintains a condition which would meetthe criteria of this standard. In addition, routine medical monitoringtracks conditions which may develop as a result of exposure to toxicmaterials which have latent periods for symptom development.

5. Failure to meet the required physical and medicalqualifications will usually be considered disqualifying, except when there issufficient evidence that individuals can perform the essential functions ofthe job efficiently and without risk to themselves or others, with or withoutreasonable accommodation.

C. Medical Examination Parameters.

1. Vision.

a. Physical Requirement.

Distant visual acuity must be at least 20/40 in each eyewith or without corrective lenses; distant binocular acuity of at least 20/40with or without corrective lenses. Near visual acuity must be corrected toat least 20/40 in each eye;

OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

near binocular acuity of at least 20/40 with or withoutcorrective lenses. Field of vision at 90 degrees in the horizontal meridianin each eye. Ability to distinguish the colors red, amber, andgreen.

b. Work Activity.

Routinely assigned to areas where: the reading ofcomprehensive literature is necessary; both near and far visual acuity arenecessary for hazard recognition; potentially life threatening environmentsexist (therefore, accurate reading of the type of personal protectiveequipment is necessary); color coded warning signs represent hazardousconditions. Routine utilization of finely calibratedequipment.

c. Rationale.

A CSHO inspects workplaces where potential safety and healthhazards exist or can spontaneously occur. Once these hazards occur, acompliance officer must be capable of determining what actions areappropriate in order to safeguard the safety and health of the CSHO andothers. These actions will always require both near and far visual acuity. For example, quickly ascertaining the condition of a respirator to use in thecase of an emergency egress situation. (This requires reading finelycalibrated air gauges.) While making routine inspections, a complianceofficer will encounter situations where full field of vision will benecessary in order to avoid a serious accident. For example, while workingon high scaffolding, it may be necessary to rapidly descend. Normal field ofvision is necessary to perform this activity safely with a full-facerespirator.

OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

2. Hearing.

a. Requirement.

Average hearing loss in the better ear cannot be greaterthan 40 decibels at 500 Hz., 1,000 Hz., and 2,000 Hz., with or without ahearing aid.

b. Work Activity.

CSHOs are routinely assigned to areas where a broad spectrumof physical hazards exist, including environmental noise levels above 90decibels.

c. Rationale.

It is important that a compliance officer have anestablished hearing level in order to communicate and give instructions in anoisy environment. During the course of daily activities, it is importantfor a compliance officer to hear instructions and communications in order toensure safety. A greater than 40 decibel loss of speech frequency in thebetter ear may interfere with the CSHO's ability to communicate under noisyconditions.

3. Musculo-Skeletal.

a. Requirement.

Both hands, arms, legs, and feet. No impairment of the useof a leg, a foot, an arm, a hand, the fingers, back or neck which would mostlikely interfere with the functional requirements of this position. Noestablished medical history or clinical diagnosis of rheumatic, arthritic,orthopedic, muscular, neuromuscular, or vascular disease which wouldinterfere with the ability to perform the functional requirements of thisposition.

OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

b. Work Activity.

A compliance officer is required to perform moderatelifting, carrying, walking and standing. A compliance officer will routinelybe required to ascend or descend heights in order to safely egress from apotentially hazardous area. During routine activities, a compliance officermust carry portable scientific equipment.

c. Rationale.

It is imperative that a compliance officer have noimpairment of the hands, arms, legs, feet, back or neck which would preventperforming the functional requirements of moderate lifting, carrying,reaching above the shoulder, standing, walking and climbing. An establishedmedical history of arthritis or muscular pathology that would interfere withthese functional requirements would cause a potentially hazardous situationin the workplace.

4. Cardio-Pulmonary.

a. Requirement.

No current clinical diagnosis of myocardial infarction,angina pectoris, coronary insufficiency, atherosclerosis, thrombosis, or anyother cardiovascular or cardiopulmonary disease that would likely causesyncope, dyspnea, collapse, or cardiac failure. Those employees who, uponundergoing exercise testing in compliance with the requirements of thisprogram, are found to have a result indicating high likelihood of cardiacdisease will be referred to their personal physician for appropriatetreatment. No established medical history or clinical diagnosis of cardiac orrespiratory dysfunction likely to interfere with the ability to wear arespirator.

OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

b. Work Activity.

A compliance officer will routinely be required to: performmoderate lifting, carrying, walking and standing; ascend or descend heightsin order to safely egress from a potentially hazardous area; wear a negativepressure air-purifying respirator; operate a motor vehicle, including a4-wheel drive vehicle.

c. Rationale.

Since compliance officers will routinely be required torapidly egress from heights or depths, it is imperative that no establishedmedical history of cardiac or pulmonary disease exists. It is known thatcarrying heavy equipment while ascending or descending great heights placesan excess burden on the cardio-pulmonary system. Therefore, it is imperativethat the cardio-vascular system be without pathology. Since a complianceofficer is required to wear a negative pressure respirator, it is imperativeand in compliance with OSHA standard 1910.134 that a physician medicallyqualify the officer to wear such a respirator. It is known that pre-existingcardiac or respiratory disease can prevent an individual from wearing such arespirator.

D. Medical Examination Requirements.

1. General. The medical examination required herein will beconducted by a physician experienced in occupational medicine, preferably bya physician who is a member of the American College of Occupational Medicine. The examining physician or institution will provide special instructionalmaterial (such as necessary fasting periods or special eating instructions)to OSHA management which will in turn provide this information to the CSHOprior to the examination.

2. History. Review of the employee's history must be conductedin regard to personal and family medical history and a work history includingoccupational exposures to chemical and physical hazards.

OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

a. Included in this Appendix is the DOL Medical Form, theOSHA 179, that was developed for the OSHA Medical Program. This multi-pageform will be utilized for recording the affected OSHA employee's medical andoccupational history. This form must be completed by the employee andprovided to the physician prior to the examination.

b. There shall be an examining room discussion between theCSHO and the physician regarding medical history, with special attentiongiven to the questionnaire on occupational exposures to chemical and physicalhazards.

c. The development of the medical history is to be inclusiveof what is commonly termed multi-phasic screening.

3. Specific Examination Tests and Requirements. The physicalexamination should include, but not be limited to a review of the following: head and neck, including visual tests, an examination of the ears, nose andthroat, an examination of the respiratory, cardiovascular and central andperipheral nervous systems, an examination of the abdomen, rectum, andgenito-urinary system, an examination of the spine and other musculoskeletalsystems, and an examination of the skin. Specific tests/measurement to beobtained include:

a. Height and weight.

b. Temperature, pulse, respiration rate, blood pressure.

c. Eye examination, including:

(1) Visual acuity, near and far. (2) Depth perception. (3) Accommodation. (4) Field of vision. (5) Fundiscopic.

OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

d. Cardio-pulmonary evaluation, which shall include thefollowing:

(1) Resting twelve-lead electrocardiogram withinterpretation.

(2) A sub-maximal exercise test with a twelve-lead EKGwill be required of those employees found to be in a category of risk greaterthan 18 per 100 according to the Coronary Risk Handbook published by theAmerican Heart Association.

(a) FVC, FEVl, FEVl/FVC ratio. (b) Permanent record offlow curves must be included in the patient'sreport.

(4) Chest X-ray (PA) 14 x 17 inches as a baseline. Thefrequency of the chest x-ray shall be:

Years As Age of Employee CSHO 15-35 35-45 45+

0-10 every 5 yrs every 5 yrs every 5 yrs

10+ every 5 yrs every 5 yrs every 1 yr

e. Comprehensive laboratory profile, including:

(1) Urinalysis (including microscopic). (2) Hemocult.(3) CBC. (4) Test chemical groups (done after 12-hourfast):

(a) Chloride, bicarbonate. (b) Glucose. (c) Bloodurea nitrogen. (d) Creatinine. (e) Uric acid.

OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

(f) LDH, SGOT, SGPT, GGTP. (g) Alkaline phosphatase.(h) Bilirubin. (i) Total protein. (j) Albumin and globulin. (k) Cholesterol. (l) Triglycerides. (m) HDL Cholesterol. (n) Potassium. (o) Calcium. (p) Blood lead, if indicated. A blood lead and zinc protoporphyrinshould be done when there is a history of lead exposure or when the test isindicated in the physician's judgment.

f. Audiometric Testing:

(1) An otoscopic examination, otological history, andaudiometric test shall be administered by an otolaryngologist, audiologist,or certified audiometric technician.

(2) Audiometric facilities, equipment, calibrationprocedures, and technician certification shall meet the requirements outlinedin 29 CFR 1910.95.

(3) The results of the otoscopic examination, otologicalhistory and audiometric tests shall be reviewed by an otolaryngologist,audiologist, or other qualified physician. Retesting and providing writtenresults back to the compliance officer as described in 1910.95(j) shall befollowed. Abnormalities and/or significant threshold shifts shall becommunicated to the patient along with any recommendations for appropriateprofessional referral.

g. Personal Protective Equipment Evaluation. The examiningphysician will evaluate the following results to determine the employee'sability to utilize personal protective equipment including a

OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

negative pressure air-purifying respirator and protectiveclothing.

(1) Medical Occupational History: Conditions such asmyocardial infarction, angina, severe emphysema, the existence of a veryserious claustrophobic condition or any significant cardiac or pulmonarycondition that would result in the inability to wear a respirator should bedisqualifying.

(2) Physical Examination: Findings such as severe facialasymmetry, beard, obvious cardiac or pulmonary pathology should also bedisqualifying.

(3) Pulmonary Function Test: Evidence of moderate tosevere restrictive or obstructive airway pattern should bedisqualifying.

(4) Chest X-ray: Evidence of cardio-pulmonary pathologyshould be disqualifying.

(5) Electrocardiogram: Obvious cardiac disease should bedisqualifying.

E. Reporting Requirements.

1. Examining Physician (PHS) to the Employee. The examiningphysician will generate personal medical reports for all employees examinedand mail them to their private residence within 15 working days of the datethat the employee is examined. The results will list each test, individuallyindicating whether a result is normal or abnormal and, if appropriate, arecommendation for referral to the employee's private physician will be made. A copy of the completed OSHA-178 form will also be sent to the employee'sresidence. In addition, the personal medical report will contain:

a. The physician's opinion as to whether the employee has anydetected medical condition(s) which would place the employee at increasedrisk of material

OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

b. Determination of the employee's ability to wear arespirator or any other personal protective equipment.

2. Examining Physician to OSHA's Office of Occupational Medicine. The examining physician will forward to the Office of Occupational Medicinethe following:

a. A written opinion as to whether the employee's health is atincreased risk of material impairment from his or her workenvironment.

b. A written statement regarding the employee's ability towear a respirator or other protective equipment.

c. A written statement that the employee has been informed inwriting by the physician of the results of the medicalexamination.

d. The examining physician shall utilize the appropriate DOLMedical Forms, the OSHA-179 and OSHA-178 forms that were developed for theOSHA Medical Program.

F. Medical Records.

1. Upon completion of the medical examination, the physician shallforward to the Office of Occupational Medicine, U.S. DOL/OSHA, 200Constitution Ave., N.W., Room N3653, Washington, D.C., 20210, each complianceofficer's complete medical record. The envelope shall be marked CONFIDENTIALand the package shall include:

a. Completed medical/occupational history forms, the OSHA-179form.

b. Completed physical examination forms, including theOSHA-178 form.

c. All laboratory test results.

OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

d. Chest X-ray (radiograph and interpretation).

e. Pulmonary function test.

f. Audiometric test results.

2. These documents shall be maintained in accordance with theOffice of Personnel Management's 5 CFR 293, Subpart E, "Employee Medical FileSystem Records." They shall be in a secured, central location within theOffice of Occupational Medicine and under the supervision of the MedicalRecords Officer for the duration of the time period necessary for NationalOffice review. After this time, the employee's file will be entered into andstored in OSHA's medical records computer system. Hard copies of employee'srecords and records for former employees will be located in an EmployeeMedical Folder (EMF) and stored in the Federal Records Center operated by theNational Archives and Records Administration (NARA) for a period of 30 yearsafter employment in accordance with OSHA standard 29 CFR 1910.20.

OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

OSHA Medical Program -- Employee History

U.S. Department of Labor Occupational Safety andHealth Administration To be completed by Employee------------------------------------------------------------------------------ | Present Information |------------------------------------------------------------------------------ Name Date of Birth (Yr., Mo., Day) Date of Visit (Yr., Mo.,Day)

______________________________________________________________________________

Employer______________________________________________________________________________

Employer's Address Employer's Phone Number______________________________________________________________________________

Type of Medical Exam Preemployment|_| Preplacement|_| Annual|_|______________________________________________________________________________

Job Title______________________________________________________________________________

Job Description______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Sex |_|F |_|M Social Security Number______________________________________________________________________________

Personal Physician------------------------------------------------------------------------------ Name

______________________________________________________________________________

Address Physician's Phone Number______________________________________________________________________________

______________________________________________________________________________

When were you last examined by him/her?______________________________________________________________________________

Past Medical History------------------------------------------------------------------------------ List significant medical illness, and all hospitalizations.

Hospitalization? illness or Condition Yes No Approximate Date(s) OfHospitaliztion------------------------------------------------------------------------------ a. |__| |__|------------------------------------------------------------------------------ b. |__| |__|------------------------------------------------------------------------------ c. |__| |__|------------------------------------------------------------------------------

------------------------------------------------------------------------------

Privacy Act------------------------------------------------------------------------------ In accordance with the Privacy Act of 1974(Public Law No. 93-579, 5 U.S.C.552a), you are hereby notified that:

Section 3301 of Title 5 to the U.S. Code authorizes collection of thisinformation. The primary use of this information is to determine suitabilityof persons for service or assignments, report medical conditions required bylaw, and aid in preventive health care. The informaiton becomes part of theEmployee Medical Folder which is maintained and protected in accordance withOPM regulations 5 CFR 293, Subpart E, and OSHA standard 29 CFR 1910.20. These records are also protected by the Privacy Act of 1974, 5 U.S.C. 552aand are covered by OPM/GOVT-10, Employee Medical File System Records. Thesocial security number is requested in order to more accurately identify andretrieve health care records of individuals. Providing the requestedinformation is voluntary but failure to do so may result in the Agency'sinability to process application for employment or inability to determinesuitability for employment. Without this information OSHA will not be ableto determine if the employee can meet the physical requirements of theposition.------------------------------------------------------------------------------

Page 1 OSHA 179 1/89

OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

OSHA Medical Program -- Employee History

U.S. Department of Labor Occupational Safety andHealth Administration

-----------------------------------------------------------------------------

Check Yes or No to answer each question and give specific information whenasked.

______________________________________________________________________________

Cardiovascular Genitourinary------------------------------------------------------------------------------ Yes No Yes No |_| |_|HeartMurmur |_| |_|Nephritis

|_| |_|Angina/Chest Pain |_| |_|Kidney Disease

(indicate Type)______________

|_| |_|Heart Attack |_| |_|Urinary infection

|_| |_|High Blood Pressure |_| |_|Kidney/Urinary

Bladder Stones |_| |_|Vascular Disease in Arms/Legs |_| |_|Blood/Protein in Urine |_| |_|Other Heart Disorders(Specify) |_| |_|Venereal Disease

        ______________________________          |_|    |_|Other Kidney or                                                  Bladder Disorders (Specify)

______________________________________________________________________________

Gastrointestinal Blood------------------------------------------------------------------------------ Yes No Yes No |_| |_|PepticUlcer |_| |_|Anemia

|_| |_|Hiatal Hernia |_| |_|Problems with blood

clotting/bleeding |_| |_|Hepatitis |_| |_|Sickle Cell

|_| |_|Gall Bladder Disease |_| |_|Other BloodDisorders

(Specify)___________

|_| |_|Liver Disease/Jaundice ___________________

|_| |_|Cirrhosis

|_| |_|Other Liver Disorders (Specify)

_______________________________

______________________________________________________________________________

Skin Eye------------------------------------------------------------------------------ Yes No Yes No |_| |_|Psoriasis |_| |_|Require Corrective Lenses|_| |_|Eczema |_| |_|Glaucoma

|_| |_|Contact Dermatitis |_| |_|Cataracts |_| |_|Other Skin Disorders (Specify) |_| |_|Optic Neuritis

______________________________ |_| |_|Eye Infection

                                                |_|    |_|Other Eye Disorders                                                         (Specify)____________

______________________________________________________________________________

Pulmonary Nervous System------------------------------------------------------------------------------ Yes No Yes No |_| |_|Pneumonia |_| |_|Seizure Disorder |_| |_|Pleurisy |_| |_|Stroke |_| |_|Asthma |_| |_|Peripheral Neuritis |_| |_|Bronchitis |_| |_|Other Nervous |_| |_|Emphysema Disorder (Specify) |_| |_|Bronchiectasis ____________________

|_| |_|Tuberculosis |_| |_|Silicosis |_| |_|Asbestosis |_| |_|OtherLung Disorders (Specify)------------------------------------------------------------------------------

OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

OSHA Medical Program -- Employee History

U.S. Department of Labor Occupational Safety andHealth Administration------------------------------------------------------------------------------ Check Yes or No to answer each question and give specific information whenasked.------------------------------------------------------------------------------ Ear, Nose and Throat Musculoskeletal------------------------------------------------------------------------------ Yes No Yes No |_| |_|ChronicSinusitis |_| |_|Rheumatoid Arthritis |_| |_|Impaired Hearing |_| |_|Other Injuries |_| |_|Ringing in the Ears |_| |_|Back Injury |_| |_|EasyNasal Bleeding |_| |_|Degenerative Disc Disease |_| |_|Nasal Allergies |_| |_|Sciatica/disc herniation|_| |_|Tonsillectomy |_| |_|Bone lesions/Infection |_| |_|Other Ear, Nose, Throat Disorder |_| |_|OtherMusculoskeletal (Specify) Disorder(Specify) ________________________________ ____________________

________________________________ ____________________

------------------------------------------------------------------------------

General------------------------------------------------------------------------------ Yes No |_| |_|Thyroid Disease/Golter |_| |_|Hernia(Specifytype) |_| |_|Diabetes ____________________

|_| |_|Gout |_| |_|Cancer (SpecifySite) |_| |_|Frequent Night Sweats/Fever ____________________

|_| |_|Hemorrhoids |_| |_|Dental/Gum Problems

(Specify)____________

                                               |_|    |_|Other Conditions or                                                          Disease Not Listed                                                         (Specify)____________

______________________________________________________________________________

Family History------------------------------------------------------------------------------ If any of your family noted in the following table has had any of thestated conditions, please indicate by the appropriate code number.

Code: 1 - Father 2 - Mother 3 - Grandparent 4 - Brother/Sister 5 - MyChildren

__ Allergy (Asthma, eczema, hay fever __ Blood Disease

__ Cancer or Leukemia __ Cirrhosis

__ Congenital malformation __ Diabetes

__ Emphysema __ Epilepsy (Seizures)

__ Hypertension __ Kidney Disease

__ Migraine Headaches __ Rheumatic Heart Disease

__ Sickle Cell Disease __ Tuberculosis

__ Other Disease Not Listed (Please Specify)

____________________________________________

Yes No |_| |_| Is your father still living? If "No", at what age didhe die? What was the cause of death?

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

|_| |_| Is your Mother still living? If "No", at what age did she die?

What was the cause of death?______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

OSHA Medical Program -- Employee History

U.S. Department of Labor Occupational Safety andHealth Administration

______________________________________________________________________________

Check Yes or No to answer each question and give specific information whenasked.

______________________________________________________________________________

General Health Tobacco Use------------------------------------------------------------------------------ Yes No |_|Never smoked regularly|_| |_|Have you been examined or treated |_|Used to smoke regularlyby a doctor within the last year? If "Yes", for what?_______________________ How many years did you smoke?

__________________________________________ _____________________________

__________________________________________ How many packs per day?__________________________________________ _____________________________

__________________________________________ How long ago did you stop?__________________________________________ _____________________________

__________________________________________ Yes No__________________________________________ |_| |_|Do you smokenow?____

__________________________________________ If "Yes", for how manyyears? __________________________________________ _____________________________

__________________________________________ How many packs per day onthe Yes No average?_____________________

|_| |_| Have you lost more than five pounds Cigars/Pipe:

within the last 6 months? Yes No Yes No Have you noticedany swelling or |_| |_| Ever smoke? |_| |_| lumps in your breast,neck, armpits, _____________________________

groin or elsewhere during the past Alcohol Use year? -----------------------------

If "Yes", specify site______________________ On the average, how much ofHave you experienced the following signs/ the following do you drinkper symptoms within the past year: week? Yes No Beer:_______Cans |_| |_|Frequentheadache/dizziness Wine:_______Glasses |_| |_|Frequent bowelproblems (Constipation Whiskey/Liquor:____Jiggers or diarrhea) _____________________________

|_| |_|Swelling of the lower extremities or Medication

eyelids -----------------------------

|_| |_|Frequent shortness of breath, cough Please indicate any

         or morning phlegm                       medications you are taking.                                                 Include nonprescriptionIndicate what you believe your health status     medications, such as aspirin,is now:                                          laxitives, vitamins, etc.|_|Excellent                                     _____________________________

|_|Good _____________________________

|_|Fair Reproductive History|_|Poor -----------------------------

____________________________________________ Yes No Have you or yourHobbies |_| |_| spouse beenunable -------------------------------------------- to havechildren? Do you have any present or past hobbies (e.g., If "Yes", specifyreason, if arts/crafts, gunning, furniture refinishing) or known:_______________________

or home construction/gardening activities that _____________________________

may have exposed you to any hazards? Yes No Have you everhad Yes No |_| |_| any childrenborn |_| |_| If YES, specify activities and kind with ahandicap or of materials used: congenital

_____________________________________________ malformation?_____________________________________________ If "Yes",specify:___________

_____________________________________________ _____________________________

_____________________________

Allergies ----------------------------- Yes No Are you allergic |_| |_| to anything you can think of? If "Yes",specify:___________

_____________________________

OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

OSHA Medical Program -- Employee History

U.S. Department of Labor Occupational Safety andHealth Administration------------------------------------------------------------------------------ Occupational History------------------------------------------------------------------------------ How long have you been in present job? _____Years _____Months Indicateany job related illness or injuries you have experienced since working inpresent job.

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Check Yes or No to answer each question and give specific information whenasked.------------------------------------------------------------------------------ In your work are you now, or have you been exposed to any of the followingagents? Exposure Present Past Exposure Present Past

Inorganic Fluorides |_| |_| Pesticides |_| |_|Lead |_| |_| Bacteria or Viruses |_| |_|Benzene |_| |_| Primate Animals |_| |_|Coke Oven Emissions |_| |_| Vibrating Tools |_| |_|Inorganic Arsenic |_| |_| Ionizing Radiation |_| |_|Methylene Chloride |_| |_| Non-ionizing Radiation|_| |_|Vinyl Chloride |_| |_| Glycol Ethers |_| |_|Toluene Diisocyanate |_| |_| Ethylene Oxide |_| |_|Excessive Noise |_| |_| Formaldehyde |_| |_|Nitrogen Oxides |_| |_| Crystalline Silica |_| |_| Others: Nitric Acid |_| |_| _____________________|_| |_| Ammonia |_| |_| _____________________|_| |_| Beryllium |_| |_| _____________________|_| |_| Phosgene |_| |_| _____________________|_| |_| Allyl Chloride |_| |_| _____________________|_| |_| Asbestos |_| |_| Suspect or Known Carcinogens|_| |_|-----------------------------------------------------------------------------

-----------------------------------------------------------------------------

OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

OSHA Medical Program -- Employee History

U.S. Department of Labor Occupational Safety andHealth Administration

_____________________________________________________________________________

Exposure History-----------------------------------------------------------------------------List all jobs, beginning with your present job, including parttime jobs. Beas specific as possible. Use additional sheets as needed.-----------------------------------------------------------------------------Name of Employer|Dates Worked|Job Title| Duties |List the Health|Type of |From | To | |Performed|HazardsExposed |Protective | | | | |To (i.e. noise,|Equipment | | | | |Lead, Solvents)|Worn (i.e. | | | | | |Earplugs, | | | | | |Respirator)-----------------------------------------------------------------------------

-----------------------------------------------------------------------------

-----------------------------------------------------------------------------

-----------------------------------------------------------------------------

-----------------------------------------------------------------------------

-----------------------------------------------------------------------------

-----------------------------------------------------------------------------

-----------------------------------------------------------------------------

-----------------------------------------------------------------------------

-----------------------------------------------------------------------------

OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

OSHA Medical Program -- Physician's Report

U.S. Department of Labor Occupational Safety and HealthAdministration To be completed by examining Physician-----------------------------------------------------------------------------This information is for official and medically confidential uses only andwill not be released to unauthorized persons. The release of this informationis subject to the Privacy Act.-----------------------------------------------------------------------------Physical Examination-----------------------------------------------------------------------------Name ID#

_____________________________________________________________________________

Type of Examination Date Time_____________________________________________________________________________

Weight Temp Resp_____________________________________________________________________________

Height Pulse BP_____________________________________________________________________________

Normal Abnormal Clinical Evaluation Normal Abnormal ClinicalEvaluation

 |_|     |_|     General Appearance       |_|    |_|      Vascular system                                                          (varicosities, etc.) |_|     |_|     Head, face, neck, scalp  |_|    |_|      Abdomen & Viscera                                                          (include hernia) |_|     |_|     Nose (septum)            |_|    |_|      Anus & Rectum |_|     |_|     Sinuses                  |_|    |_|      G-U System |_|     |_|     Mouth and Throat         |_|    |_|      Upper Extremities |_|     |_|     Ears (general)           |_|    |_|      Lower Extremities |_|     |_|     Drums (perforation)      |_|    |_|      Spine, other                                                          musculoskeletal |_|     |_|     Ophthalmoscopic          |_|    |_|      Skin, lymphatics |_|     |_|     Pupils (equality &       |_|    |_|      Neurological                         reaction)        |_|    |_|      Peripheral |_|     |_|     Ocular motility          |_|    |_|      Cranial nerves |_|     |_|     Lungs & Chest (include   |_|    |_|      Deep tendon reflexes                 breasts) |_|     |_|     Heart (thrust, size, rhythm, sounds)-----------------------------------------------------------------------------Comments

-----------------------------------------------------------------------------

Summary of Findings_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

Based on this Medical Evaluation: 1. This employee is, is not (circle)medically fit to wear a respirator.

__________________________________

2. This employee has, has no (circle) Typed or Printed Name ofPhysician detected medical condition which would place him/her at increasedrisk of __________________________________

material health impairment for work Signature Dateexposures and practices. (if positive, please elaborate below.)

3. This employee has, has not (circle) been informed in writing of theresults of the medical examination.

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

                                                                      OSHA 178                                                                          1/89

OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

The Occupational Safety and Health Administration (OSHA) is vitallyconcerned with safeguarding the occupational health and safety of itsCompliance Safety and Health Officers. The prevention of work relatedillness and injury depends on awareness of risk, control of the workenvironment, the proper use of protective equipment, and careful attention tosafe work practices. OSHA is committed to providing a safe work environmentand promoting healthful and safe work practices for every Compliance Officer,and the responsibility for occupational health and safety is shared byeveryone in the Agency. As part of this effort, OSHA has developed anAgency-wide occupational medical monitoring program for Compliance Safety andHealth Officers and other employees covered under the program. This handbookwill acquaint you with the program and answer questions about the program.

Prior to April of 1987, OSHA did not have a standardized CSHO physicalexamination program, and all ten Regions developed and implemented their own"CSHO Physical" program. Early in 1985, OSHA applied for and later receivedfrom the Office of Personnel Management (OPM) a single Agency physicalexamination standard covering OSHA personnel. The implementation of a singleAgency physical requirements standard ensures that the health of OSHAemployees will be at a level which will permit them to perform job-relatedassignments under conditions that vary from sedentary to maximum exertion.

Normal work conditions also require the employee to perform in a reliablemanner under adverse conditions. Routine assignments require employees toenter work sites and observe and evaluate conditions to which workers areexposed. This includes working at heights; working underground; working inconfined spaces; working in emergency situations; and working in environmentswith chemical, physical, and biological hazards. Many of these hazards areregulated by established OSHA standards which require the use of protectiveequipment and/or routine medical monitoring. The proper use of personalprotective equipment requires an evaluation of the wearer's physical abilityto utilize the equipment safely, and without adverse effect to the wearer'shealth. Adverse conditions sometimes occur unexpectedly while others areanticipated and appropriate steps can be taken in an orderly and controlledmanner to protect oneself and safely leave the hazard area.

OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

OSHA has required affected new-hire employees to take and pass apre-employment medical examination since April, 1987. However, annualphysical examinations for on-board bargaining unit employees have beenconducted only on a voluntary basis prior to the negotiation of the impact ofthis program with the representatives of OSHA employees, the National Councilof Field Labor Locals (NCFLL). Beginning in 1987 and continuing over severalmonths, Department of Labor management representatives met withrepresentatives of the NCFLL, AFGE, AFL-CIO, and discussed the implementationof OSHA's medical examination program as it would impact currently on-board,bargaining unit employees. The two parties have negotiated a Memorandum ofUnderstanding (MOU) which extends the OSHA physical and medical requirementsstandards and annual examination program to include on-board, bargaining unitOSHA employees covered under the program.

1. What is Occupational Medical Monitoring?

Medical monitoring is watching over the health of employees who maybe exposed to potentially harmful chemical agents or physical hazards bymeans of periodic medical examinations. It is an effort to detect and preventadverse effects of occupational exposures. An Agency-wide occupationalmedical monitoring program for Compliance Safety and Health Officers has beendeveloped. (See OSHA Instruction ADM: CSHO Medical Examinations.)

This program consists of a medical/occupational history review,physical examination, specific blood testing, hearing test, vision test andreview of cardio-pulmonary system. All of the medical test results arereviewed by the examining physician and physicians within OSHA's Office ofOccupational Medicine. This review allows the physicians to determine ifyour work environment may be adversely affecting your health.

2. Why is a Medical Monitoring Program Necessary?

Compliance Safety and Health Officers have duties that may involvepotential exposure to a wide variety of toxic substances or potentiallyharmful working conditions.

OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

Medical monitoring can aid in:

O Early recognition of unsuspected health risks

O Monitoring the effectiveness of protective measures taken forknown risks

O Prompt initiation of corrective action and appropriate medical care

O Evaluation of health factors in safe work performance

O Possible study of long-term subtle health effects based onemployee occupational exposure data

O Periodic fitness re-certification of employees whose work involvesunique physical stresses, such as respirator use.

3. Who is included?

A mandatory medical surveillance program will cover all employeeswhose assignments currently include, or included at times in the past,working conditions involving, exposure to potentially toxic materials orphysical hazards. Employees currently working in conditions where exposureto potentially toxic materials may exist will be included in an annualmedical surveillance program. Those employees who are reassigned or promotedto a position within the scope of the medical surveillance program will havea pre-placement and subsequent annual medical examinations as prescribedwithin this text.

Specific positions by grade and series covered.

OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

Position Series Grades

Student Trainee GS-099 4-5 Safety Specialist GS-018 5-13 Supervisory Safety Specialist GM-018 13 Safety and Occupational Health Manager GM-018 13 Industrial Hygienist GS-690 5-13Supervisory Industrial Hygienist GM-690 13Safety Engineer GS-803 5-13 Supervisory SafetyEngineer GM-803 13

Regional Office staff are included under the annual examination requirementbecause they may have to provide on-site assistance to Area Office staffconcerning specific inspections, they are responsible for making on-sitevariance inspections and may face potential workplace exposures to hazardoussituations.

Student trainees are covered under this program if their tenure with theAgency will be expected to exceed a one-year period from their initial(pre-employment) examination.

Employees whose past work assignments with the Agency required them to makeregular or occasional visits to industrial establishments where they may havebeen exposed to potentially toxic chemicals and/or physical hazards and whosejob descriptions do not now require them to go into the field will be offereda voluntary medical examination, free of charge, every other year. Voluntaryexaminations will be provided to the eligible employee with the understandingthat examination results pertinent to past occupational exposure are theproperty of the Government and will be provided to the OSHA Office ofOccupational Medicine in order for the Agency to fulfill its duties as aresponsible employer under the OSH Act.

OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

4. Who Pays for the Examination?

The examinations fees are paid by the Agency. OSHA has contractedwith the U.S. Public Health Service (PHS) to provide the mandatory annualphysical examinations required under this program. PHS has been providingphysical examinations for new-hire employees and voluntary examinations sinceApril, 1987. OSHA's national contract with a single agency to provide themedical examinations required under this program assures Agencywideuniformity in the administration and quality control of the examinationsgiven.

5. How are the Examinations Arranged?

Employees will be provided thirty (30) days written notice by OSHAmanagement of the impending annual examination date and location.

In those cases where possible (i.e., for those individuals nothaving to travel from an out-of-town location to the examining site), as muchof the clinical work-up as feasible shall be completed prior to thephysician's examination. The clinical findings shall be available for theexamining physician's review at the time of the examining room discussionbetween the employee and physician.

Scheduling times for examinations must be flexible in order toaccommodate the varied schedules of OSHA compliance officers and theinconveniences involved in their having to travel from out-of-town locationsto the examining site. However, the scheduling of examinations should allowthe examinations to be done on official time.

6. What is the Scope of the Examination and How Frequently is it Given?

The monitoring examinations and tests are designed to screen forevidence of adverse health effects from occupational exposures and to surveythe systems of the body most likely to be affected by such exposures. OSHA'smedical monitoring program is not intended as a substitute for general healthcare or periodic checkups by a personal physician.

OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

The first, or baseline, examination consists of a detailed medicaland occupational history, a physical examination, and selected blood andurine tests. Additional tests, such as hearing, lung function, and specialblood tests, are also included. The physicians use this information todetermine if there are adverse effects from exposures and to determineability to wear personal protective equipment (e.g. respirator).

Ideally, the frequency and content of subsequent monitoringexaminations should be determined by the nature of the occupational exposuresand risks. Active Compliance Safety and Health Officers will be effectivelymonitored by annual examinations.

Those employees who have had potential hazardous exposure in thepast, but who are currently not performing such activities, will be monitoredevery two years.

7. What is Done with the Examination Findings?

Examination findings are reviewed in a two step process.

The first step is the review by the examining physician. Thisincludes reviewing medical/occupational history, physical examinationfindings, and specialized testing. The examining physician then forwardshis/her findings and determinations to the physicians at OSHA'S Office ofOccupational Medicine. The Office of Occupational Medicine then reviewsthese findings for accuracy and consistency.

Employee medical examination will be maintained in accordance withthe Office of Personnel Management's 5 CFR 293, Subpart E, "Employee MedicalFile System Records." They will be in a secured, central location withinOSHA's Office of Occupational Medicine and under the supervision of theMedical Records Officer for the duration of the time period necessary forNational Office review. After this time, the employee's file will be enteredinto and stored in OSHA's medical records computer system. Hard copies ofemployee's records and records for former employees will be located in anEmployee Medical Folder (EMF) and stored in the Federal Records Centeroperated by the National Archives and Records Administration (NARA) for aperiod of 30 years after employment in accordance with OSHA standard 29 CFR1910.20.

OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

8. How to get a copy of Medical Records?

The examining physician will generate personal medical reports forall employees examined and mail them to their private residence within 15working days of the date that the employee is examined. The results willlist each test, individually indicating whether a result is normal orabnormal and if appropriate, a recommendation for referral to the employee'sprivate physician will be made.

If after 1 (one) year there is a need for an employee to get anadditional copy of his/her medical records, a request in writing should besent to:

Medical Records Officer Office of Occupational Medicine U.S.Department of Labor - OSHA Room N3653 200 Constitution Avenue, N.W.Washington, D.C. 20210

When submitting a request the individual must furnish the followinginformation in order to locate and identify the record sought:

1. Full name 2. Date of Birth 3. Social Security Number 4. Agency Name and location 5. Date of exam if known 6. Signature

Your occupational health and safety depends on careful attention to properworking conditions and practices. Remember that your medical monitoringexamination aids in the prevention of occupationally-related illness and inthe protection and maintenance of your health. All findings will be handledin a responsible and confidential manner and in accordance with OSHA standard29 CFR 1910.20 and OPM standard 5 CFR 293, Subpart E, and the Privacy Act.

OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

I. INTRODUCTION:

This is a Memorandum of Understanding (MOU) entered into between the U.S.Department of Labor (DOL) and the National Council of Field Labor Locals(NCFLL), AFGE, AFL-CIO, in accordance with the applicable provisions of themaster DOL-NCFLL Agreement.

II. SUBJECT:

This MOU covers the agreement reached between the parties over the impactand implementation of the OSHA physical and medical requirements.

1. A bargaining unit employee hired on or before (E.O.D.) the signing ofthis MOU who does not meet the physical requirements of the position, willeither be waived or be offered a position at retained pay.

2. In the event a bargaining unit employee hired after the signing of thisMOU fails to meet the physical requirements based upon the medicalexamination, a waiver will be considered by the Department. In the eventthat a waiver is not granted to an employee an accommodation will beconsidered.

3. A bargaining unit employee who is not granted a waiver and offered aposition at retained pay outside their commuting area, will have relocationexpenses paid according to appropriate government regulations.

4. In determining whether or not a waiver will be granted an employee'sperformance history in OSHA, as well as medical history, will be taken intoconsideration.

5. If an employee fails to meet the physical requirements and is notgranted a waiver, an employee may have at his/her option another examination,limited to the area of disqualification, by a physician of choice. Thisexamination will be conducted by the nearest qualified physician from theemployee's official duty station. The cost of the medical examination willbe paid for by the Department and will be conducted on official time.

If there is a dispute between the results of the two examinations as towhether an employee has failed to meet the physical requirements andmanagement takes a personnel action and the employee grieves the action in atimely manner, the action will be stayed for 180 days or until an arbitratormakes a decision, whichever comes first. In this case the NCFLL may take thedispute to arbitration bypassing Steps I and II of the grievance procedure.

OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

6. Medical information provided by an employee's physician of choice maybe supplied by the employee and will be utilized by management and the Officeof Occupational Medicine in the decision to grant a waiver or accommodation.This information must be provided within 30 days of the employee's notice offailure to meet the physical qualifications.

7. A bargaining unit employee tentatively selected, subject to meeting thephysical requirements but not appointed due to failure to meet a physicalstandard and through appeal or litigation is determined to be qualified, willbe afforded an appropriate remedy in accordance with the Master Agreement.

8. The term "medical waiver" will be defined to term "waiver". The lastsentence in paragraph #2 will be changed to "The Office of OccupationalMedicine will respond to the Regional Administrator within 10 days to eitherconcur or disagree with the waiver." In the next paragraph the last sentencewill be changed from "...grant the waiver..." to "...concurs with thewaiver..."

9. Management will comply with maintenance of records in accordance with29 CFR 1910.20.

10. Consistent with law, rule or regulation the Office of OccupationalMedicine will notify an employee when a copy of their medical records arerequested.

11. During the medical examination to determine medical qualification forOSHA compliance officers, no tests for drugs or the AIDS virus will beconducted.

12. Medical examinations of bargaining unit employees will begin no earlierthan 90 calendar days of this signing of the MOU. all physical examinationsshall be scheduled during the basic workweek of the employee.

13. Subject to provisions of the Privacy Act and The Freedom of InformationAct, the President of the NCFLL shall be provided annually the number ofemployees who were examined, number of employees who received waivers, numberof employees who received accommodations and type of accommodations. Suchdata shall also include the names, dates, office location, age and sex.

14. A bargaining unit employee will be given 30 days written notice of theupcoming exam in writing. It is the responsibility of the employee to notifymanagement of a conflict that would prevent him/her from taking the exam assoon as possible. An employee who does not take the exam will be notifiedorally or in writing of their new examination date.

15. Employees who are required to take a mandatory medical examination willbe examined by a physician experienced in occupational health, selected,provided by and paid for by the Agency.

OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

16. Any dispute over the implementation and interpretation of this programwill be handled in accordance with Articles 15 and 16 of the DOL-NCFLL MasterAgreement.

17. Consistent with law or rule or regulation, the examining physician willnot reveal diagnosis or condition unrelated to employment to any party. Theexamining physician shall inform the employee directly of the diagnosis orconditions unrelated to employment.

18. OSHA Medical Program Forms shall include the wording "The release ofthis information may be subject to the Privacy Act."

19. Temporary conditions will not disqualify an employee (i.e., pregnancy,surgery, mononucleosis, etc.). Temporary conditions will be handled inaccordance with the procedures described on Page 5. A temporaryaccommodation is for those conditions that can be corrected or controlledwithin a reasonable time.

20. The on-site union representative at each locality where the OSHA logs onthe job injury and illness are posted will be given a copy of such posting.

21. As a part of the mandatory medical examination program and to providedata, all OSHA employees may document any exposure to chemical hazardscontacted on-the-job by utilizing CA forms.

22. OSHA employees, as specified by the draft Instruction dated April 6,1987, page 2, will be covered by this program.

23. No OSHA employee will be required to provide a POV to take a medicalexamination.

24. A copy of this memorandum of Understanding (MOU) will be provided to allbargaining unit employees.

At the next scheduled Regional Labor-Management Relations Committee meetingone of the four members of the NCFLL bargaining team (Burg, Rios, Ramirez,Yarman) will be allowed four hours to meet with the designated localrepresentatives identified in Column (4) of the chart on page 7 of theDOL-NCFLL Master Agreement. The designated local representatives identifiedin Column (4) shall have four hours to meet with one of the NCFLL bargainingteam members.

25. A list of bargaining unit employees, who fail the physical requirementsbased upon the medical examinations, will be provided to the President of theNCFLL subject to the provisions of the Privacy Act and the Freedom ofInformation Act, every February of each year.

26. Either party reserves the right to appeal issues of negotiability andduty to bargain regarding OSHA proposed mandatory physicals, followingnegotiations over the impact and

OSHA Instruction PER 8-2.5 MAR 31 1989 Directorate of Technical Support

implementation of the physical standards by the medical examination.

27. At the National Labor Management Relations Committee meeting closest theanniversary date of the signing of this MOU, the parties shall discuss theinformation provided in item 13 of this Agreement. At that time this MOU maybe reopened by mutual consent of the parties.

FOR THE DEPARTMENT FOR THE NCFLL

ISAAC W. COLE FRANK BURG STANLEY H.ELLIOTT JESSE M. RIOS STEPHEN J. MALLINGER RON YARMAN ERIC H. M. RAMIREZ

C-4