Other related regulations

• Section 1910.1030 is not the only regulation related to blood and other potentially infectious materials (OPIM). Other regulations also relate to bloodborne pathogens.

29 CFR 1904

Part 1904, the Recordkeeping and Reporting Occupational Injuries and Illnesses Standard, requires employers not in partially exempted industries (see Appendix A to Subpart B to Part 1904) to record work-related punctures, cuts, lacerations, and scratches from sharp objects that are contaminated with another person’s blood or OPIM.

Covered employers will record these types of incidents as an “injury” on the OSHA 300 Log (Log of Work-Related Injuries and Illnesses). If the employee develops a bloodborne disease, the entry must be updated and recorded as an “illness.”

However, if an employee is splashed or exposed to blood or OPIM without being cut, scratched, or punctured, the incident must be recorded on the OSHA 300 Log only if it results in the diagnosis of a bloodborne illness or it meets one or more of the recording criteria of 1904.7.

To protect privacy, the employee’s name may not be entered on the OSHA 300. Subparagraphs 1904.29(b)(6) through (b)(10) discuss privacy concerns. Employers must keep a separate, confidential list of case numbers and employee names in these privacy cases so they can update the cases and provide them if asked by the government.

29 CFR 1910.120

The Hazardous Waste Operations and Emergency Response (HAZWOPER) Standard, 1910.120, covers three groups of employees:

• Workers at hazardous waste cleanup operations;
• Workers at operations involving hazardous waste treatment, storage, and/or disposal;
• Workers expected to respond to emergencies caused by the uncontrolled release of a hazardous substance.

The definition of hazardous substance includes any biological agent or infectious material that may cause disease or death. There are potential scenarios where the bloodborne and HAZWOPER standards may interface, such as:

• Workers involved in cleanup operations at hazardous waste sites involving infectious waste;
• Workers at incinerators that burn infectious waste and are permitted under a Resource Conservation and Recovery Act (RCRA) authority; and
• Workers responding to an emergency caused by the uncontrolled release of infectious materials, such as a transportation accident.

Employers of employees engaged in these types of activities must comply with the requirements in 1910.120, as well as the Bloodborne Pathogens Standard at 1910.1030. If there is a conflict or overlap, the provision that is more protective of employee safety and health applies.

29 CFR 1910.145

According to 1910.145, the Specifications for Accident Prevention Signs and Tags Standard, biohazard signs and tags are required:

• To signify the actual or potential presence of a biohazard, which is an agent infectious to humans; or
• To identify equipment, containers, rooms, materials, experimental animals, or combinations of any of these, that contain, or are contaminated with, a viable biohazard.

29 CFR 1910.1020

Records concerning employee exposure to bloodborne pathogens and records about human immunodeficiency virus (HIV) and/or hepatitis B (HBV) status are both considered employee medical records within the meaning of 1910.1020, the Access to Employee Exposure and Medical Records Standard.

29 CFR 1915.91

This regulation simply states that the requirements for biohazard signage applicable to shipyard employment are identical to the requirements set forth in 1910.145. Therefore, biohazard signs and tags are required:

• To signify the actual or potential presence of a biohazard, which is an agent infectious to humans; or
• To identify equipment, containers, rooms, materials, experimental animals, or combinations of any of these, that contain, or are contaminated with, a viable biohazard.

29 CFR 1926.21, .25, .28, and .200

Although 1910.1030 does not apply to the construction industry, employees in construction are not free from bloodborne pathogen hazards. Therefore, employees responsible for providing first aid or medical assistance at a construction site are expected to receive basic instruction in bloodborne pathogen hazards, as well as vaccination and follow-up in the event of an exposure incident. Appropriate personal protective equipment and sharps containers must be provided.

OSHA sections 1926.21, 1926.25, 1926.28, and 1926.200, plus Section 5(a)(1) of the Occupational Safety and Health (OSH) Act, offer some protection for employees in this industry.

Related laws

• OSHA has the authority to issue regulations that apply to bloodborne pathogens through two laws, the OSH Act and the Needlestick Safety and Prevention Act.

Two laws give the Occupational Safety and Health Administration (OSHA) authority to issue regulations pertaining to bloodborne pathogens.

The OSH Act of 1970, Public Law 91-596

Section 5(a)(1) of the OSH Act states that “each employer shall furnish to each of his employees employment and a place of employment which is free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees.” This law, known as OSHA’s General Duty Clause, may be used to cite employers for failure to provide a workplace free from exposure to bloodborne pathogens. Where 1910.1030 does not apply, this clause may be used for enforcement.

See the full Occupational Safety and Health Act of 1970.

Needlestick Safety and Prevention Act, Public Law 106-430, November 6, 2000

The Needlestick Safety and Prevention Act was signed into law (Public Law 106-430) on November 6, 2000. It directed OSHA to do the following:

• Revise the Bloodborne Pathogens Standard to include new examples in the definition of engineering controls;
• Require exposure control plans to reflect changes in technology that eliminate or reduce exposure to bloodborne pathogens;
• Require employers to document consideration and implementation of safer medical devices in their exposure control plans each year;
• Require employers to gather and document input from non-manager employees who are responsible for direct patient care in the identification, evaluation, and selection of engineering and work practice controls; and
• Require certain employers to establish and maintain a log of percutaneous injuries from contaminated sharps.

OSHA published these revisions to 1910.1030 on January 18, 2001, with an effective date of April 18, 2001.

Who’s protected?

• All employees with occupational exposure are protected by 1910.1030.
• To have occupational exposure, workers must be able to reasonably anticipate contact with blood or OPIM in the course of their job duties.

All employees who have occupational exposure must be trained in bloodborne pathogens procedures. This applies to all classifications of employees: full-time, part-time, contract, and temporary.

“Occupational exposure” refers to reasonably anticipated contact with blood or other potentially infectious materials (OPIM), in contrast to an “exposure incident,” in which actual contact occurs.

For bloodborne pathogens training to be required for an employee, contact with blood or OPIM must be reasonably anticipated, and this contact must result from the performance of the employee’s duties.

As an example, an office worker would not reasonably anticipate having contact with blood or OPIM. However, if the office worker is assigned to perform first aid when coworkers are bleeding, then that employee is considered to have occupational exposure.

Related job classifications

Job duties do not need to be healthcare-related to be covered. The Occupational Safety and Health Administration (OSHA) doesn’t list jobs or tasks with occupational exposure, so this is left to employers to determine.

If only some employees in a job class have occupational exposure, the employer must identify which tasks in those jobs present occupational exposure.

Some job classifications that may have occupational exposure include:

• First-aid providers;*
• Paramedics and emergency medical technicians;
• Physicians, nurses, and emergency room personnel;
• Home healthcare workers;
• Dentists and dental workers;
• Substance abuse clinic workers;
• Blood bank and plasma center workers;
• Medical examiners and morticians;
• Laboratory technicians;
• Medical equipment repair workers;
• Plumbers and pipefitters;
• Custodian and maintenance workers;
• Housekeeping and laundry personnel;
• Security and correctional officers;
• Law enforcement officers;
• Waste haulers and sorters; and
• Fire brigade/Firefighting team members.

_{*The first-aid provider category includes (1) employees designated to perform first aid, (2) employees who render first aid only as a collateral duty, and (3) employees who routinely provide first aid to fellow employees with the knowledge of the employer and fall de facto under this designation even if the employer has not officially designated the employee as a first-aid provider. Good Samaritans are not included unless they otherwise meet criteria (1), (2), or (3).}

Contract and temporary workers

In contract situations, both the contractor employer and the client share responsibility for ensuring that contract employees are protected. Likewise, for temporary employees, both the staffing agency and host employer are considered joint employers of those employees. In either scenario, it’s in the interest of both employers to ensure that the required training is provided.

• Contract employees: An OSHA letter of interpretation from September 1992 explains that the contractor that employs the worker is expected to provide required vaccinations, generic training in universal precautions, and any follow-up evaluation after an exposure incident. The contractor’s client (commonly referred to as the host employer), who creates and controls hazards, must provide site-specific training and personal protective equipment (PPE) and is responsible for controlling exposures.
• Temporary employees: OSHA Temporary Worker Initiative Bulletin No. 6 says that when a staffing agency supplies temporary employees to a business, the agency and the host employer are considered joint employers of those workers. Both are responsible for ensuring that the temporary employees are properly protected against bloodborne pathogens. However, the employers may decide to divide up the compliance responsibility. Generally, the two employers split responsibilities as follows:

In addition, the employer who has day-to-day supervision over the temporary employees, typically the host employer, is required under 29 CFR 1904 to maintain a log of occupational injuries and illnesses, including for temporary workers. The Bloodborne Pathogens Standard requires that this employer must also keep a sharps injury log to record percutaneous (through the skin) injuries from contaminated sharps, including injuries to temporary employees. [Source: Temporary Worker Initiative Bulletin No. 6, OSHA 3888-09 2016]

Who’s not protected?

• Not every person is protected by 1910.1030, even in the industries that it covers.
• Non-employees such as unpaid students and volunteers are not covered, nor are Good Samaritans.

Even when an employer is in general industry or shipyards, not everyone in the workplace is protected by 1910.1030.

Non-employees

The Occupational Safety and Health Administration (OSHA) defines an employee as an “employee of an employer who is employed in a business of his employer which affects commerce.” If someone in the workplace is not an “employee” by definition, then that person is not protected.

For example, a private school may have students who work there, or a non-profit organization may have volunteers. Unpaid students and volunteers aren’t employees, so they’re not covered.

Good Samaritans

Section 1910.1030 also does not cover Good Samaritans. For example, if an employee helps a coworker who has a nosebleed or is bleeding as the result of a fall, this isn’t considered an occupational exposure unless first aid is one of that employee’s job duties.

For occupational exposure to exist, an employee’s job must involve reasonably anticipated contact with blood or other potentially infectious materials (OPIM). Good Samaritan acts can’t be reasonably anticipated by an employer, so they don’t qualify. Therefore, anyone who helps another person at work is not covered unless they are assigned or expected to do this.

OSHA concluded that it would be needlessly burdensome to require employers to implement 1910.1030 based on the chance of an employee having contact with blood or OPIM during a task that’s not required.

Trainer qualifications

• Bloodborne pathogens training can be given by a variety of professionals, as long as they have expertise in bloodborne pathogen hazards and OSHA requirements in general and as related to the specific workplace.
• If a workplace seems to have training deficiencies, OSHA will look at the trainer’s qualifications to verify competence.

Bloodborne pathogens training must be conducted by someone who is knowledgeable about bloodborne pathogen hazards, and the required training elements as they relate to the specific workplace.

Possible trainers include a variety of healthcare professionals such as infection control practitioners, nurse practitioners, registered nurses, occupational health professionals, physician’s assistants, and emergency medical technicians. However, a trainer does not need to be a healthcare professional. Non-healthcare professionals, such as but not limited to industrial hygienists, epidemiologists, and professional trainers, may conduct the training if they have the necessary knowledge of the subject matter covered by the training program as it relates to the workplace. One way, but not the only way, knowledge can be demonstrated is if the person received specialized training. If no one at a workplace is qualified to do the training, the employer may need to send employees outside to get trained or bring a trainer in.

In some workplaces, such as dental or physicians’ offices, the individual employer may conduct the training, given the necessary knowledge of bloodborne pathogen hazards and the subject matter specified by the Occupational Safety and Health Administration (OSHA) in paragraphs (g)(2)(vii)(A) through (N) of 1910.1030.

If an OSHA inspector finds training deficiencies in a workplace, the inspector will look at the specialized courses, degrees, or work experience of that workplace’s trainer to verify competence. G

Training elements

• The training can be somewhat flexible to meet employees’ needs but must at a minimum cover the required training elements listed in the Bloodborne Pathogens Standard.
• Some required elements include OSHA and site-specific regulations; recognizing, preventing, and treating exposure; measures such as PPE, vaccinations, and warning labels; and post-exposure evaluation and follow-up.

The provisions for employee bloodborne pathogens training are performance oriented, with flexibility allowed to tailor the program to the employee’s background and responsibilities. However, the training elements listed in subparagraph (g)(2)(vii) of the Bloodborne Pathogens Standard must be covered, and some elements call for site-specific information.

At a minimum, the training program must include the following elements:

• An accessible copy of the regulatory text of 1910.1030 and an explanation of its contents;
• A general explanation of the epidemiology and symptoms of bloodborne diseases;
• An explanation of the modes of transmission of bloodborne pathogens;
• An explanation of the employer’s exposure control plan and how an employee can get a copy of the written plan;
• An explanation of how to recognize tasks and other activities that may involve exposure to blood or other potentially infectious materials (OPIM);
• An explanation of methods to prevent or reduce exposure, such as appropriate engineering controls, work practices, and personal protective equipment (PPE), including the uses and limitations of these methods;
• Information about PPE, including its types, selection, proper use, location, removal, handling, decontamination, and disposal;
• Information on the hepatitis B vaccine, including its effectiveness and safety, how it is given, the benefits of being vaccinated, and that it is offered free of charge;
• Information on the appropriate actions to take and people to contact in an emergency involving blood or OPIM;
• An explanation of the procedure to follow if an exposure incident occurs, including how to report the incident and what medical follow-up will be made available;
• Information on the post-exposure evaluation and follow-up that the employer is required to provide for the employee following an exposure incident;
• An explanation of the warning signs, labels, and color-coding required by subparagraph (g)(1) of 1910.1030; and
• An opportunity for interactive questions and answers with the person conducting the training session.

When to train

• Employees with occupational exposure should receive bloodborne pathogens training before they begin working in any position where exposure may occur, at least annually thereafter, and whenever changes to tasks or procedures may affect their occupational exposure.

Once the jobs and tasks with occupational exposure are identified, employers can quickly find out which employees have occupational exposure. These employees must be trained in accordance with 1910.1030(g)(2). Information and training are required:

• At the time of initial assignment to tasks with occupational exposure. This means prior to being placed in positions where occupational exposure may occur.
• At least annually thereafter. This means at least once every 12 months (within a period not exceeding 365 days). Training should be provided on a date reasonably close to the anniversary date. If the annual refresher cannot be completed by the anniversary, the employer should maintain a record indicating why the training is delayed and when the training will be done.
• When changes affect an employee’s occupational exposure. Changes include modification of tasks or procedures or the institution of new tasks or procedures. The additional training may be limited to addressing the new exposures created.

How to train

• Bloodborne pathogens training must be made available by employers during paid work hours at no cost to the employees.
• Training must take into account employees’ comprehension and be provided in languages, education levels, and formats that they can understand.
• Training can be provided in a variety of formats, as long as it includes real-time trainer interaction, site-specific information, and hands-on practice.

It’s the employer’s responsibility to institute a bloodborne pathogens training program and ensure employee participation.

Bloodborne pathogen information and training must be provided during paid working hours, at no cost to the employee. Other considerations in how to train involve trainee comprehension, training format, opportunities for questions, and hands-on training.

Comprehension

Training content and vocabulary must be appropriate for trainees’ education level, literacy, and language. In practical terms, instruction needs to be provided using both a language and vocabulary trainees can understand. If a trainee does not speak or comprehend English, instruction must be provided in a language the trainee can understand. Moreover, if the trainee’s vocabulary is limited, the training must account for that limitation. If a trainee is illiterate, then instruction should be available that requires no reading; telling the trainee to read training materials doesn’t satisfy the training obligation.

Format

The Occupational Safety and Health Administration (OSHA) doesn’t restrict the training format that employers use. Audiovisuals, classroom instruction, interactive video, and online and computer-based training are all good tools that can be used as part of an effective training program. Using a variety of audio, visual, and online tools may allow the training to fit with different learning styles and levels of experience among trainees.

However, acceptable training requires interaction and site-specific information. Training the employees solely by means of a film or video without the opportunity for a discussion would constitute a violation. Similarly, a generic online or computer program, even an interactive one, is not sufficient, unless the employer:

• Supplements this training with the site-specific information required (e.g., the location of the exposure control plan and the procedures to be followed if an exposure incident occurs); and
• A trainer is available for interaction.

Opportunities for questions

During training, it is critical that trainees have the opportunity to ask questions and receive answers where material is unfamiliar to them. Frequently, a trainee may be unable to go further with the training or to understand related training content until a response is received. Therefore, under the standard, trainees must have direct access to a qualified trainer during training. However, the trainer does not need to be in the room with the trainee. OSHA’s requirement may be met if trainees have direct access to a trainer by way of a telephone hotline. Email is not considered direct access, unless the trainer is available to answer emailed questions as soon as they arise.

Hands-on training

Sufficient hands-on training is important because it allows trainees to interact with equipment and tools in the presence of a qualified trainer and to learn or refresh their skills through experience. It gives the trainer a chance to assess whether the trainees have mastered the proper techniques.

Must-read OSHA interpretations

While OSHA offers many letters of interpretation on 1910.1030, two letters are especially helpful for an employer looking to comply with the bloodborne pathogens training requirements:

• Appropriateness of computer-based interactive training programs to satisfy required OSHA training, OSHA letter of interpretation, 6/11/1997
• Appropriateness of the usage of video presentations in meeting the OSHA bloodborne training requirements, OSHA letter of interpretation, 8/28/1996

Vaccination

• Employers are required to provide hepatitis B vaccination free of charge to workers with occupational exposure.
• Employers cannot require pre- or post-vaccination screening for antibodies but may make it available.
• Employees who decline the vaccination can decide to get it later, as long as they still have occupational exposure.

Currently, the only vaccine required by the Occupational Safety and Health Administration (OSHA) is the hepatitis B vaccine series.

Hepatitis B is a liver infection caused by the hepatitis B virus (HBV). Hepatitis infection represents a significant occupational hazard to all workers who contact blood or certain body fluids from infected persons. Although many people with hepatitis B may feel or look ill, many people with a hepatitis B infection are unaware that they have contracted the virus.

The best way to prevent hepatitis B is by getting vaccinated. The vaccine stimulates the immune system to protect against the virus. After the vaccine is given, the body makes antibodies that protect against the virus. An antibody is a substance found in the blood that is produced in response to a virus invading the body. These antibodies will fight off the infection if the person is exposed to HBV in the future.

The Centers for Disease Control and Prevention (CDC) say the hepatitis B vaccine is safe and effective.

Vaccine availability

Employers must make the hepatitis B vaccine and vaccination series available at no cost to all employees who have occupational exposure. Booster doses are not currently recommended by the CDC, but if that recommendation changes, those boosters must also be offered.

Vaccinations must be made available at a time and place that’s convenient for employees.

Employers must offer the hepatitis B vaccine and vaccination series after initial training and within 10 working days of initial assignment to employees who have occupational exposure, unless:

• The employee has previously received the complete hepatitis B vaccination series,
• Antibody testing reveals that the employee is immune, or
• Medical reasons prevent the employee from being vaccinated.

The employee has the option to decline the vaccination and follow-up programs.

General requirements for vaccination

The vaccine must be performed by (or under) the supervision of a licensed physician or other licensed healthcare professional, whose legally permitted scope of practice includes independently performing the vaccination.

Vaccinations need to follow the current recommendations of the U.S. Public Health Service. This simply means the CDC guidelines.

Cost of vaccination

Vaccination must be at no cost to the employee. This means, among other things, no “out of pocket” expense. Employers can’t require employees to use healthcare insurance to pay for the vaccine unless the employer pays all of the cost of the health insurance and there are no deductibles, copayments, or other expenses. A reimbursement process would also violate the no-cost rule, as would requiring workers to pay back the cost of the vaccine if they leave their jobs before a specified time period.

First aid providers and Good Samaritans

First aid is often a collateral, not a primary, duty of an employee. If an employer fails to provide the vaccination to employees for whom first aid is not a major job task, OSHA can cite the employer but will not issue a fine if the following conditions are met:

• These types of first aiders are addressed specifically in the employer’s written plan;
• The employer documents events requiring first aid;
• First aiders are trained to report first-aid events; and
• The vaccine is made available to first aiders within 24 hours of a first-aid event, regardless of whether an exposure incident occurred.

If workers’ potential bloodborne pathogen exposure results from Good Samaritan acts that are not part of their job duties, employers aren’t required to offer them the vaccine. However, OSHA recommends that the employer offer Good Samaritans post-exposure evaluation and follow-up, which may include vaccination.

Construction industry

While 1910.1030 does not apply to the construction industry, employees in construction are not free from bloodborne pathogen hazards. Therefore, OSHA has indicated that employees responsible for providing first aid or medical assistance at a construction site are expected to receive vaccination and follow-up in the event of an exposure incident.

In a letter of interpretation dated January 26, 1993, OSHA was asked about the provision of the hepatitis B vaccine to employees in the construction industry who have occupational exposure to blood or other potentially infectious materials. The letter explains, “Section 5(a)(1) of the [Occupational Safety and Health Act], which requires employers to furnish a workplace which is free from recognized hazards which may cause or are likely to cause death or serious physical harm, may be applied where appropriate to the construction industry … It is under the General Duty Clause that OSHA may require, where appropriate, the provision of the hepatitis B vaccine to those employees who have occupational exposure [in construction]."

Universal precautions

• Section 1910.1030 requires universal precautions, which refers to treating all blood and OPIM as though it’s infectious.
• Two alternative infection control methods, BSI and standard precautions, are stricter than universal precautions and thus acceptable to OSHA.

Universal precautions is an approach to infection control under which all human blood and other potentially infectious materials (OPIM) are treated as if known to be infectious for human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), and other bloodborne pathogens.

Universal precautions treat all people in the workplace the same way, removing any reason to speculate about anyone’s infection or risk status. If an employer has a policy of treating the blood or OPIM of some patients as potentially infectious and the blood or OPIM of others (e.g., the elderly or children) as not infectious, this is an Occupational Safety and Health Administration (OSHA) violation.

Universal precautions are to be observed in all situations where there is a potential for contact with blood or OPIM, whether or not this contact arises as part of a job duty. This is similar to an approach that is followed in hospitals and other healthcare facilities. If it’s difficult or impossible to differentiate between body fluid types, all body fluids are to be considered potentially infectious, and universal precautions must be observed.

Two alternative concepts in infection control, body substance isolation (BSI) and standard precautions, are discussed below. These concepts are acceptable alternatives to universal precautions, provided that facilities using them fulfill all other requirements of the Bloodborne Pathogens Standard.

Implementing universal precautions

Paragraph (d) of the Bloodborne Pathogens Standard sets forth the method by which employers must protect their employees from the hazards of bloodborne pathogens and comply with 1910.1030 through the use of universal precautions, engineering controls, work practice controls, personal protective equipment (PPE), proper housekeeping, and handling of regulated waste.

Body substance isolation

One alternative to universal precautions is called body substance isolation (BSI). This is an infection control method that defines all body fluids and substances as infectious, not just blood and OPIM as in the Bloodborne Pathogens Standard.

BSI is an acceptable alternative to universal precautions as long as facilities adhere to all other provisions of 1910.1030.

Standard precautions

Another alternative to universal precautions is known as standard precautions. This term refers to the minimum infection prevention measures that apply to all patient care, regardless of the suspected or confirmed infection status of a patient, in any setting where healthcare is delivered.

Standard precautions include:

• Hand hygiene,
• PPE,
• Respiratory hygiene and cough etiquette,
• Safe injection practices, and
• Safe handling of potentially contaminated equipment or surfaces.

For the Centers for Disease Control and Prevention (CDC), standard precautions have replaced earlier guidance relating to universal precautions and BSI. Standard precautions are more stringent than universal precautions and are therefore acceptable to OSHA. However, OSHA currently only requires universal precautions.

Engineering controls

• Engineering controls eliminate or reduce bloodborne pathogen exposure by either removing the hazard or isolating the worker from exposure.
• Examples of engineering controls include safer medical devices, puncture-proof sharps disposal containers, and handwashing facilities.
• Engineering controls must be inspected and maintained or replaced on a regular basis to ensure they’re functioning as intended.

Engineering controls are devices that eliminate or reduce employee exposure to bloodborne pathogens in the workplace by either removing the hazard or isolating the worker from exposure.

Engineering controls should be used in combination with work practice controls to eliminate or minimize employee exposure. Where occupational exposure remains after institution of these controls, personal protective equipment (PPE) must also be used.

Types and locations of engineering controls

Examples of engineering controls include:

• Self-sheathing needles;
• Special containers for contaminated sharp instruments;
• Needleless systems; and
• Sharps with engineered sharps injury protection, meaning non-needle sharps or needle devices with built-in safety measures.

Engineering controls must be readily available in the area where they’re likely to be needed. Puncture-resistant sharps disposal containers must be easily accessible and located in areas where needles, syringes, or other sharp instruments are commonly used.

The Occupational Safety and Health Administration (OSHA) does not require employers to provide personal sharps containers for employees who use lancets or insulin syringes for personal therapeutic reasons. However, to eliminate potential exposures to other employees, the employer may strongly insist that these employees bring their own sharps containers to the workplace.

Sharps used by employees for illegal drug use are covered under company-specific policies, which should be addressed when relevant during training.

According to OSHA, mouthpieces, resuscitation bags, pocket masks, or other ventilation devices are considered personal protective equipment; therefore, these would not fall under the engineering control category.

Maintenance of engineering controls

Engineering controls must be examined and maintained or replaced on a scheduled basis to ensure that each control is maintained and that it provides the protection intended. Regularly scheduled inspections are required to confirm, for instance:

• Protective shields have not been removed or broken; and
• Physical, mechanical, or replacement-dependent controls are functioning effectively.

Research labs and production facilities

Employers will want to note that human immunodeficiency virus (HIV) and hepatitis B virus (HBV) research labs and production facilities may have more stringent engineering control requirements under 1910.1030(e).

Work practice controls

• Work practice controls reduce the possibility of exposure by changing the way tasks are performed.
• These include practices for dealing with contaminated material such as sharps, specimens, and laundry; handwashing and PPE; and eating and drinking restrictions.

Work practice controls reduce the possibility of exposure by changing the way tasks are performed. These include appropriate practices for handling and disposing of contaminated sharps, handling specimens, handling laundry, and cleaning contaminated surfaces and items.

Examples include:

• Restricting eating, drinking, smoking, and similar activities in areas where exposure is likely;
• Wearing appropriate personal protective equipment (PPE);
• Washing hands when contaminated and after removing gloves;
• Flushing eyes with a readily available eyewash facility when eyes are contaminated by splashes, spray, spatter, or droplets of blood or OPIM;
• Checking equipment for contamination and decontaminating it;
• Avoiding using the mouth to pipette or suction blood or other potentially infectious materials (OPIM); and
• Immediately disposing of sharps in a sharps container.

All procedures involving blood or OPIM must be performed in such a manner as to minimize spattering, generating droplets, splashing, and spraying.

Disposal receptacles

Bags or receptacles containing regulated waste must be labeled or color-coded according to the requirements of the Bloodborne Pathogens Standard. Regulated waste is defined at 1910.1030(b).

Restrictions

In work areas where there is a reasonable likelihood of occupational exposure, safe work practices include restricting eating, drinking, smoking, applying cosmetics or lip balm, and the handling of contact lenses. Food and drink should not be stored in refrigerators or other locations where blood or OPIM are kept.

Contaminated equipment

Equipment, other than PPE, that during the course of operations could become contaminated with blood or OPIM must be checked routinely. It must be decontaminated prior to servicing or shipping, unless the employer can demonstrate that decontamination of the equipment or portions of it is not feasible.

Contaminated needles and sharps

The following are work practice controls to reduce the possibility of cuts or skin punctures involving contaminated sharps:

• Contaminated needles must not be cut or broken.
• Contaminated needles must not be bent, removed, or recapped unless it can be demonstrated that no alternative is feasible or that such action is required by a specific medical procedure.
• Any recapping or removing of contaminated needles must be done using a mechanical device or one-handed technique.
• Employees should pick up blood- or OPIM-contaminated broken glass, metal shavings, or other sharp items using tongs or a plastic scoop — never by hand.
• Blood tube holders with needles attached must be immediately discarded into a sharps container after the device’s safety feature is activated.
• Contaminated used blades must not be bent or broken.
• Contaminated reusable sharps must immediately (or as soon as possible after use) be placed in puncture-resistant, leak-proof containers, labeled as a biohazard, or color-coded red until properly reprocessed.

Research labs and production facilities

Employers will want to note that human immunodeficiency virus (HIV) and hepatitis B virus (HBV) research labs and production facilities may have more stringent work practice control requirements under 1910.1030(e).

Personal protective equipment

• PPE is specialized clothing or equipment, such as gloves, masks, and aprons, worn to protect against a hazard.

Personal protective equipment (PPE) is a key factor in controlling exposure to blood or other potentially infective materials (OPIM). PPE is specialized clothing or equipment worn by an employee for protection against a hazard.

Examples of PPE include:

• Gloves;
• Masks, eye protection, and face shields;
• Gowns, aprons, laboratory coats, clinic jackets, and similar outer garments;
• Surgical caps, hoods, and shoe covers or boots; and
• Mouthpieces, resuscitation bags, pocket masks, or other ventilation devices.

General work clothes (e.g., uniforms, pants, shirts, or blouses) not intended to function as protection against a hazard are not considered to be PPE. However, if laboratory jackets or uniforms are intended to protect the worker’s body or clothing from contamination, they’re considered PPE.

PPE is required when there’s occupational exposure after engineering and work practice controls are in place, and in situations when those controls aren’t feasible. The employer is responsible for providing appropriate and easily accessible PPE at no cost to the employee, and for laundering, decontaminating, maintaining, and replacing it as necessary.

Research labs and production facilities

Employers will want to note that human immunodeficiency virus (HIV) and hepatitis B virus (HBV) research labs and production facilities may have more stringent PPE requirements under 1910.1030(e).

Housekeeping practices

• OSHA requires both cleaning and decontamination of surfaces and equipment that are or might be contaminated with blood or OPIM.
• The best practice for cleaning up liquid blood or OPIM is to use an absorbent and a scraper rather than mopping it up.

Housekeeping involves cleaning floors, work surfaces, and equipment. Visible contamination is easy to address when housekeeping because blood or other potentially infectious materials (OPIM) can be seen on surfaces or equipment. However, bloodborne pathogens and OPIM can remain infectious for up to seven days and may not be visible, so it is very important to use disinfectants and techniques approved by the Environmental Protection Agency (EPA) when cleaning in areas that are, or may be, contaminated.

Decontamination is not the same as cleaning. Decontamination refers to using physical or chemical means to remove, inactivate, or destroy bloodborne pathogens on a surface or item to the point where they are no longer capable of transmitting infectious particles, and the surface or item is rendered safe for handling, use, or disposal.

Generally, work surfaces must be cleaned and decontaminated when contaminated with blood or OPIM, after medical or other procedures, and at the end of the work shift. Equipment must also be cleaned and decontaminated after contact with blood or OPIM.

It is the employer’s responsibility to ensure that the workplace is kept clean and sanitary. This includes determining and implementing a cleaning schedule that includes decontamination tasks or procedures. The decontamination schedule will depend on the location within the facility, the type of surfaces being cleaned, the type of contamination, and the tasks and procedures being performed in the area.

Decontamination procedures

Mopping up liquid blood or OPIM may only spread it around by splashing. It’s safer to use a loose absorbent material. Absorbent material and a small disposable scraper and dustpan are often included in commercially available body fluid cleanup kits.

After the liquid is absorbed, the material should be carefully scraped into a dustpan, then disposed of in a biohazard bag or receptacle. After that, the area must be decontaminated with an acceptable disinfectant. EPA-registered tuberculocides or sterilants (see “Tools for Cleanup” below) are appropriate.

The Occupational Safety and Health Administration (OSHA) also says using fresh household bleach diluted to the appropriate strength for the cleanup job at hand is also an effective disinfectant; although, bleach may cause damage to some medical instruments and therefore cannot be used in all cases. An April 30, 1993, OSHA letter of interpretation explains, “Under the bloodborne pathogens standard, OSHA requires that contaminated items and surfaces be decontaminated with an appropriate disinfectant … Solutions of 5.25 sodium hypochlorite (household bleach) diluted between 1:10 and 1:100 with water are considered appropriate for this purpose.”

Employees must also properly dispose of or decontaminate any tools they used in cleanup. If it’s necessary to disinfect equipment used during cleanup that has been exposed to blood or OPIM, they should do so in a sink dedicated to industrial use. It’s a good idea not to use a bathroom, break room, or kitchen sink where employees will be likely to wash their hands, apply cosmetics, or clean dishes or food items.

Specific issues

Some cleanup work procedures depend on the type of pathogen or material involved, as well as whether it’s a healthcare or non-healthcare setting. For example, OSHA provides guidance for workers and employers in non-healthcare/non-laboratory settings on cleaning and decontamination of Ebola on surfaces. (View the OSHA Fact Sheet “Cleaning and Decontamination of Ebola on Surfaces.” OSHA also has guidance and requirements for healthcare workers.

In addition, healthcare workers/employers can review the CDC’s “Procedures for Safe Handling and Management of Ebola-Associated Waste.”

Work surfaces and containers

All equipment and working surfaces that could have become contaminated must be cleaned and decontaminated as necessary. If thorough decontamination can’t be done immediately, employees should label the equipment stating which parts of the equipment remain contaminated so that other employees are aware of the hazard and know to take precautions.

All coverings used for protecting working surfaces, such as plastic wrap, foil, and impervious-backed absorbent paper, should be removed and replaced as soon as possible after they have been contaminated, or at the end of the work shift if there’s a possibility that they became contaminated during the shift.

All bins, pails, cans, and similar reusable receptacles that are reasonably likely to become contaminated with blood or OPIM must be inspected and decontaminated on a regularly scheduled basis. After visible contamination, these must be cleaned and decontaminated immediately, or as soon as possible.

Sharp objects

Broken glassware that may be contaminated must be picked up only by using mechanical means such as tongs, brush and dustpan, or forceps — never with bare or gloved hands. Contaminated reusable items, such as sharps, may not be stored or processed in a way that requires employees to reach into containers where they can’t see or safely handle the contents.

Research labs and production facilities

Employers will want to note that human immunodeficiency virus (HIV) and hepatitis B virus (HBV) research labs and production facilities may have more stringent housekeeping practice requirements under 1910.1030(e).

Waste disposal practices

• Any waste that contains and might release blood or OPIM is classified as regulated waste, requiring specific disposal procedures.
• Regulated waste must be disposed of in secure, clearly identifiable biohazard containers.

Proper disposal of biohazard waste is essential for preventing exposure to bloodborne pathogens. One major element of this process is using biohazard receptacles so that no one accidentally handles the waste container without recognizing its potential dangers.

“Regulated waste” must be placed in closeable, leak-proof, and appropriately labeled or colored containers that are built to contain all contents during handling, storing, transporting, or shipping.

Regulated waste is defined as:

• Liquid or semi-liquid blood or other potentially infectious materials (OPIM);
• Contaminated items that would release liquid or semi-liquid blood or OPIM if compressed;
• Items that are caked with dried blood or OPIM and could release these materials during handling;
• Contaminated sharps; and
• Pathological and microbiological wastes containing blood or OPIM.

The Occupational Safety and Health Administration (OSHA) does not generally consider the following to be regulated waste:

• Adhesive bandages used for minor cuts and scrapes,
• Facial tissue used to stop a bloody nose, and
• Feminine hygiene products.

While not regulated waste, these items should be discarded in waste containers that are lined in order to prevent contact with the contents.

OSHA notes, however, that it is the employer’s responsibility to determine which job classifications or specific tasks and procedures involve occupational exposure. For example, the employer must determine whether employees can come into contact with blood during the normal handling of waste, from initial pickup through disposal in the outgoing trash.

The amount of blood is not a good determining factor because the Bloodborne Pathogens Standard is concerned with an item’s level of saturation. Ten milliliters of blood on a disposable bed sheet would appear as a spot (not regulated waste), while the same amount of blood on a cotton ball would drip (regulated waste).

Appropriate disposal for regulated waste can mean using red or labeled sharps containers for contaminated sharps. However, for contaminated waste other than sharps, it means using red leak-proof bags, or bags and receptacles marked prominently with biohazard labels. (See Labels, tags, signs, symbols, and colors section.)

Regulating bodies other than OSHA may call for more stringent disposal practices. Infectious waste disposal is primarily regulated at the state level, so employers should be aware of (and train employees in) any requirements made by their state’s environmental agency. In addition, employees must be trained in their company’s disposal practices if those practices include disposal of items beyond those items listed in OSHA’s definition of regulated waste.

Waste disposal in the construction industry

While 1910.1030 does not apply to the construction industry, employees in construction are not free from bloodborne pathogen hazards. Therefore, appropriate regulated waste containers must be provided when needed by employees responsible for giving first aid or medical assistance at a construction site, per 1926.25.

Research labs and production facilities

Employers will want to note that human immunodeficiency virus (HIV) and hepatitis B virus (HBV) research labs and production facilities may have more stringent waste disposal requirements under 1910.1030(e).

Contaminated laundry practices

• Laundry that’s soiled with blood or OPIM or may contain sharps should be handled as little as possible, promptly bagged, and clearly labeled.
• Employees can’t wash contaminated laundry at home, but laundry can be part of their job duties at work if appropriate safety measures are taken.

Contaminated laundry is laundry that is soiled with blood or other potentially infectious materials (OPIM) or may contain contaminated sharps.

Handling contaminated laundry

Laundry that has been contaminated with blood or OPIM should be handled as little as possible with a minimum of agitation. Employees who handle these materials must wear protective gloves and other appropriate personal protective equipment (PPE).

Employees should bag or containerize contaminated laundry as soon as possible at the location it was used. They shouldn’t sort or rinse the laundry first.

If the contaminated laundry is wet and seems reasonably likely to soak through or leak, the material for the bags or containers used in laundry collection must prevent fluids from reaching the outside of the bags or containers.

Laundry should only be sorted in a designated laundry area, not at the location of use.

Contaminated laundry must be easily identifiable. The employer has two choices:

• Laundry bags or containers can be identified according to the requirements of 1910.1030(g)(1)(i) — either given fluorescent orange or orange-red labels with the biohazard symbol, or color-coded red.
• When universal precautions are used for all soiled laundry (considering all laundry to be contaminated), the employer may use an alternative color or label for the bags/containers, as long as all employees are trained to recognize them as containing soiled laundry that requires the use of universal precautions.

Washing contaminated laundry

The Occupational Safety and Health Administration (OSHA) regulations stop short of giving instructions for actually cleaning and disinfecting contaminated laundry. Instead, an OSHA directive and interpretation say that clothing manufacturer’s instructions should be met, and Centers for Disease Control and Prevention (CDC) guidelines are available. The CDC guidelines offer two choices:

• Use detergent in water above 160°F for a cycle greater than 25 minutes, and
• Use a “suitable chemical” and concentration if the water is below 160°F.

Who can wash contaminated laundry?

Employees aren’t allowed to take laundry home, both because the employer cannot ensure proper handling or laundering procedures and because contamination could migrate to the homes of employees.

It is the employer’s responsibility to launder, repair, replace, and dispose of contaminated PPE.

If uniforms are intended to protect workers from blood or OPIM (or if uniforms are contaminated), then the employer is responsible for laundering them.

Employers can have employees wash contaminated laundry onsite as long as proper safety procedures such as providing PPE are followed. Laundry can also be contracted out.

When a facility that uses universal precautions in handling laundry ships it out to a second facility that does not, the first facility must place the laundry in bags or containers labeled or color-coded in accordance with 1910.1030(g)(1)(i) so that workers at the second facility can easily identify contaminated laundry.

Labels, tags, signs, and colors

• Employees must receive sufficient warning through labels, signs, and training to eliminate or minimize their exposure to bloodborne pathogens.
• Labels must be fluorescent orange or orange-red, with lettering and symbols in a contrasting color. However, red bags and containers can be used instead of labels.
• Biohazard markings are regulated not only at 1910.1030 but also at 1910.145.

Employees must receive sufficient visual warning to eliminate or minimize their exposure to bloodborne pathogens.

When employees aren’t routinely required to deal with blood or other potentially infectious materials (OPIM), they can easily become complacent about the hazards. Employers must provide appropriate signs, tags, labels, and color-coded containers to clearly mark biohazards, and make sure that employees are thoroughly trained in recognizing, using, and complying with them.

Biohazard warning signs, labels, tags, and color-coding signify the actual or potential presence of a biohazard. They’re used to identify equipment, containers, or work areas that contain, or are contaminated with, blood or OPIM.

In general industry, the Occupational Safety and Health Administration (OSHA) regulates biohazard markings not only at 1910.1030 but also at 1910.145. Employers should review and follow the marking requirements for both regulations. Note that for the shipyard industry, 1915.1030 says its requirements are identical to 1910.1030.

Likewise, 1915.91 says its requirements are identical to 1910.145. The construction industry, on the other hand, has its own signs and tags provisions at 1926.200.

When labels are required

If 1910.1030 applies, then labels must be provided on the following:

• Containers of regulated waste;
• Containers of contaminated sharps;
• Refrigerators and freezers that are used to store blood or OPIM;
• Containers used to store, transport, or ship blood or OPIM;
• Contaminated equipment that is being shipped or serviced; and
• Bags or containers of contaminated laundry, except as provided in 1910.1030.

The label must:

• Be fluorescent orange or orange-red in color or predominantly so, with lettering and symbols in a contrasting color;
• Have a legend with the biohazard symbol (see “Symbols” below) followed by the word “BIOHAZARD”; and
• Be attached with string, wire, adhesive, or another method to prevent loss or unintentional removal.

As an alternative to a label, red bags or red containers can be used.

For contaminated equipment being serviced or shipped, the label must state which parts of the equipment are contaminated. This requirement alerts employees to possible exposure, since the nature of the material or contents will not always be readily identifiable as blood or OPIM.

The labeling requirements do not preempt either the U.S. Postal Service labeling requirements (39 CFR and 18 U.S. Code Section 1691 to 1738) or the Department of Transportation’s (DOT) Hazardous Materials Regulations (49 CFR 171 to 180).

DOT labeling is required on transport containers that contain “known infectious substances.” It is not required on all containers for which 1910.1030 requires the biohazard label. Where there is an overlap between the OSHA-mandated label and the DOT-required label, the DOT label will be considered acceptable on the outside of the transport container, provided that the OSHA-mandated label (or red color-coding) appears on any internal containers that are present.

Containers serving as collection receptacles within a facility are not covered by the DOT requirements, so these must have the OSHA label.

When labels are not required

Biohazard labels are not required:

• When red bags or red containers are used instead;
• On individual containers of blood, blood components, or blood products that:
  • Are clearly marked as specified by the Food and Drug Administration (FDA),
  • Have been screened for hepatitis B virus (HBV) and human immunodeficiency virus (HIV), and
  • Have been released for transfusion or other clinical use;
• On individual containers of blood or OPIM that are placed in a labeled container (e.g., a test tube rack) during storage, transport, shipment, or disposal; and
• On regulated waste that has been decontaminated by incineration, autoclaving, or chemical means prior to disposal.

If universal precautions are used for handling all soiled laundry, the employer may use an alternative color or label for the containers, as long as all employees are trained to recognize them.

Tags

Biohazard tags made of card, paper, pasteboard, plastic, or other material are affixed as close as safely possible to a biohazard by string, wire, or adhesive that prevents the tags’ loss or unintentional removal. Biohazard tags are intended to:

• Identify the actual or potential presence of a biological hazard;
• Identify equipment, containers, or experimental animals that contain or are contaminated with hazardous biological agents; and
• Communicate biohazards that are out of the ordinary, unexpected, or not readily apparent.

Paragraph 1910.145(f) explains that the tag must use a signal word, DANGER,” “CAUTION,” “BIOHAZARD,” “Biological Hazard,” or the biological hazard symbol itself, shown in the regulation. The OSHA-recommended color scheme is fluorescent orange or orange-red, or predominantly so, with lettering or symbols in a contrasting color.

Tags need not be used where signs are posted to communicate a biohazard.

For construction, paragraph 1926.200(h) and (i) offer both:

• Modern “DANGER,” “WARNING,” or “CAUTION” tag options and color schemes; and
• Old “DANGER,” “CAUTION,” or “BIOHAZARD” tag options and color schemes.

The old BIOHAZARD tag is white with a fluorescent-orange or orange-red panel with black letters. The biohazard symbol is fluorescent-orange or orange-red against the white background.

Signs

In HIV and HBV research laboratories and production facilities, signs must be posted at all access doors when OPIM or infected animals are present in the work area or containment module. According to 1910.1030, these signs must be fluorescent orange-red or predominantly so, with lettering and symbols in a contrasting color. They must also contain the following information:

• The name of the infectious agent,
• Special requirements for entering the area, and
• The name and telephone number of the laboratory director or other responsible person.

Other general industry and shipyard workplaces should follow 1910.145 for biological hazard signs, which have a biological hazard warning to signify the actual or potential presence of a biohazard and to identify things that contain, or are contaminated with, viable hazardous agents. Section 1910.145 doesn’t specify the text, symbol, color, or format of biological hazard signs, giving the employer flexibility.

For construction, 1926.200 calls for employers to follow either:

• Modern “DANGER,” “WARNING,” “CAUTION,” or “SAFETY INSTRUCTION” sign options and color schemes; or
• Old “DANGER,” “CAUTION,” “SAFETY INSTRUCTION,” or “BIOHAZARD” sign options and color schemes.

The old BIOHAZARD sign does not have a color scheme for the signal word or message but does call for a biohazard symbol that is fluorescent orange or orange-red on contrasting background.

Symbols

Below is the universal biohazard symbol legend as it appears in 1910.1030, as well as a diagram of the symbol that appeared in the Federal Register in 1974, complete with dimensions:

According to 1910.145, the symbol design for biological hazard tags must conform to the design below:

Responding to an exposure incident

• After an exposure incident, an exposed employee should wash exposed areas, seek medical attention, and report the incident.
• Employees who witness incidents should call for help and not assist unless they’re trained responders.

The appropriate course of action after an exposure incident depends on the person’s relationship to the incident and level of training.

An exposed person

An employee who suffers an exposure incident should take the following actions:

• Remove any clothing or shoes contaminated with blood or other potentially infectious materials (OPIM) and place them in a biohazard bag or container;
• Minimize the exposure by immediately flooding the exposed area — most likely the hands — with water, then thoroughly washing affected skin with soap and water;
• Flush any splashes to the nose and mouth with water;
• Irrigate the eyes with water or saline if they were exposed to blood or OPIM;
• Seek medical attention as soon as possible; and
• Report the incident to a supervisor.

Immediately reporting exposure incidents allows for timely medical evaluation and follow-up, testing of the source person’s blood, and exploring measures to prevent similar incidents in the future. Employers must treat reports in the strictest confidence.

A witness to the incident

An employee who witnesses an exposure incident should take the following actions:

• Use universal precautions and treat all blood and OPIM as if it’s known to be infectious.
• Call for help. Employees should have ready access to information about which employees are trained and equipped to respond properly, and/or how to contact services outside the company.
• Resist offering assistance without the proper training and personal protective equipment (PPE), and discourage coworkers from doing so.

A trained responder

An employee who is a designated and trained responder or cleanup person should take the following actions:

• Use appropriate PPE;
• Follow safe work practices;
• Use proper cleanup, disposal, and labeling procedures; and
• Recognize biohazard markings.

Post-exposure evaluation and follow-up

• After an exposure incident, employers must provide a confidential medical evaluation and follow-up to any worker with occupational exposure.
• The evaluation includes documentation, testing of the exposed employee and source individual, counseling, and prophylaxis such as vaccination.
• Employees who decline having their post-incident blood samples tested for HIV have 90 days to change their minds.

After any worker with occupational exposure experiences an exposure incident, the employer must make a confidential medical evaluation and follow-up available to the worker immediately. This evaluation and follow-up must be at no cost to the worker.

An exposure incident is a specific eye, mouth, other mucous membrane, non-intact skin, or parenteral (under the skin) contact with blood or other potentially infectious materials (OPIM). The exposed employee is the one who suffers the exposure incident. The source individual is a person, living or dead, whose blood or OPIM may be a source of exposure to the employee.

It’s the employer’s responsibility to establish procedures for evaluating exposure incidents. Thorough assessment and confidentiality are critical issues. The medical evaluation and follow-up must at the very least:

• Document the routes of exposure and how exposure occurred.
• Identify and document the source individual, if feasible and not prohibited by law.
• Obtain consent and test the source individual’s blood as soon as possible to determine infectivity and document the source’s blood test results. (If the source is known to be infectious for hepatitis B virus (HBV) or human immunodeficiency virus (HIV), testing need not be repeated to determine the known infectivity.)
• Provide the exposed employee with the test results and information about applicable disclosure laws and regulations concerning the source identity and infection status.
• Obtain consent and collect and test the exposed employee’s blood as soon as possible.
• Provide post-exposure prophylaxis (preventive treatment, including any needed vaccination), when medically indicated, as recommended by the U.S. Public Health Service (or Centers for Disease Control and Prevention (CDC));
• Make counseling immediately available concerning infection status, test results, and interpretation, which will help the exposed employee understand the potential risk of infection and make decisions regarding the protection of personal contacts.
• Include evaluation of any reported illnesses.

If an employee who does not have occupational exposure suffers an exposure incident (e.g., a Good Samaritan), medical evaluation and follow-up are not required. However, the Occupational Safety and Health Administration (OSHA) does recommend that employers make them available.

Timing

The word “immediately” is used in the Bloodborne Pathogens Standard to emphasize the importance of prompt medical evaluation and prophylaxis. An exact time is not given, but OSHA requires them to be given as soon as possible after exposure. An OSHA inspector who believes that access to care was delayed is recommended to investigate.

Tools made available to OSHA trainers suggest that treatment should begin preferably within 24 hours, and no later than seven days. However, this suggestion is not in the regulation.

The hepatitis B vaccine is most effective when given within 24 hours of exposure, so if the employee hasn’t received this vaccine previously, there’s no time to waste.

Construction industry

While 1910.1030 does not apply to the construction industry, employees in construction are not free from bloodborne pathogens hazards. Therefore, OSHA has indicated that employees responsible for providing first aid or medical assistance at a construction site are expected to be offered vaccination and follow-up in the event of an exposure incident.

Healthcare professional communications

• After an exposure incident, the healthcare professional who evaluates the exposed employee must be provided with information about the incident and the people and regulations involved.
• The healthcare professional must follow up with a written opinion to the employer that communicates very limited information to the employer and keeps the rest confidential.

At the time of an exposure incident, the exposed employee must be directed to a healthcare professional. The employer must ensure that the healthcare professional evaluating the employee is provided with the following information:

• A copy of the Bloodborne Pathogens Standard at 1910.1030;
• A description of the exposed employee’s job duties as they relate to the incident;
• An accident report of the specific exposure, including route of exposure;
• Results of the source individual’s blood testing, if available; and
• All relevant employee medical records that the employer is responsible for maintaining, including hepatitis B vaccination status.

The employer does not have a right to know the results of the source individual’s blood testing, but must ensure that the information is provided to the evaluating healthcare professional. If the evaluating healthcare professional is also the employer, the information that must go to the healthcare professional must still be in the exposed employee’s record and made available at the time of a post-exposure incident. All applicable laws and standards of confidentiality apply.

If the employee requires hepatitis B vaccination, the employer must ensure that the healthcare professional giving the vaccination is provided with a copy of the Bloodborne Pathogens Standard.

Written opinion

Following the post-exposure evaluation, the healthcare professional must provide a written opinion to the employer. The employer must provide a copy of this written opinion to the employee within 15 days of the evaluation.

The written opinion for hepatitis B vaccination shall be limited to the following information:

• Whether the vaccination is indicated for the employee, and
• Whether the employee has received it.

The healthcare professional’s written opinion for post-exposure evaluation and follow-up shall be limited to the following information:

• That the employee has been informed of the results of the evaluation, and
• That the employee has been told about any medical conditions resulting from exposure to blood or other potentially infectious materials (OPIM) that require further evaluation or treatment.

The employer is allowed access only to this limited information. All other findings or diagnoses must remain confidential and not be included in the written report. Any information regarding the results of the employee’s evaluation or medical conditions must be conveyed by the healthcare professional to the employee alone.

Written exposure control plan

• Employers covered by 1910.1030 must have a written exposure control plan that identifies employees with occupational exposure, lays out a timetable for compliance with the standard, and addresses other elements of the standard as applicable to the workplace.

Employers covered by 1910.1030 need to develop a written plan. This plan is referred to as the “exposure control plan.” It’s basically designed to eliminate or minimize employee exposure to blood and other potentially infectious materials (OPIM).

The primary purpose of the exposure control plan is to identify employees who have occupational exposure and to commit the employer to a timetable for implementing the standard’s requirements. However, the plan must also address paragraphs (d)-(h) of the standard in a way that’s appropriate to the circumstances of the particular workplace.

Broadly, these paragraphs cover

• Methods of compliance for employers with employees with occupational exposure,
• Regulations applying to certain facilities producing or performing laboratory study of human immunodeficiency virus (HIV) or hepatitis B virus (HBV),
• Hepatitis B vaccination and post-exposure evaluation and follow-up,
• Employee training and communication, and
• Recordkeeping.

For small facilities, an annotated copy of 1910.1030 may be adequate to address paragraphs (d)-(h). Larger facilities could develop a broad facility-wide program that incorporates provisions from the standard that apply to them.

Medical records

• Employers must maintain a confidential medical record for each employee who has occupational exposure.
• These records should be kept for 30 years after the employee’s term of employment ends, unless that term is less than a year.

Employers must maintain a confidential medical record for each employee with potential for exposure, according to the Occupational Safety and Health Administration (OSHA) standard governing access to employee exposure and medical records at 1910.1020.

This record shall include:

• The name of the employee;
• A copy of the employee’s hepatitis B vaccination status, including:
  • Dates of all hepatitis B vaccinations,
  • Any medical records related to the employee’s ability to receive vaccination, and
  • Documentation of any claim of vaccination exemption;
• A copy of all results of examinations, medical testing, and follow-up procedures; The employer’s copy of the healthcare professional’s written opinion; and
• A copy of the information provided to the healthcare professional.

Records storage

The employer shall maintain the required records for at least the duration of the employee’s employment plus 30 years. The requirements of 1910.1020, the Access to Employee Exposure and Medical Records Standard, apply.

The medical records of employees who have worked for less than one year don’t need to be retained beyond the term of employment if they are provided to the employee at the end of employment.

If an employer contracts for the services of a healthcare provider, the medical records may be kept at the provider’s worksite.

Confidentiality and availability

The employer shall ensure that the required employee medical records are:

• Kept confidential; and
• Not disclosed or reported without the employee’s express written consent to any person within or outside the workplace, except as required by 1910.1030 or by law.

Medical records should be kept confidential in accordance with 1910.1020. If recordkeeping is carried out by another party on the employer’s behalf, the employer is responsible for exercising reasonable diligence to make sure that party fulfills the preservation and access requirements.

All medical records required to be kept under the Bloodborne Pathogens Standard must be made available to OSHA.

Training records

• Employers must keep accurate records of employee training in bloodborne pathogen hazards.

The Bloodborne Pathogens Standard requires employers to maintain and keep accurate training records. These records help to:

• Track the relationship between exposure incidents (e.g., needlesticks) and various jobs and the corresponding level of training, and
• Determine whether a workplace’s training program adequately addresses the risks involved in each job.

Employee training records must include the following:

• Training dates,
• Content or a summary of the training,
• Names and qualifications of trainer(s), and
• Names and job titles of trainees.

Unlike medical records, training records are not considered to be confidential. Training records may be stored onsite where the actual documents are readily accessible, and they must be retained for three years from the training date. Upon request, employees and their representatives have a right to examine and copy employee training records.

Injury and illness logs

• Work-related bloodborne pathogen exposure incidents must be recorded on logs under certain circumstances and with attention to privacy concerns.

The information kept on injury and illness and sharps injury logs help covered employers evaluate the safety of the workplace, understand bloodborne pathogens and other hazards in the workplace, and implement employee protections to reduce or eliminate those hazards. The idea is to prevent future workplace injuries and illnesses, including those related to bloodborne pathogens.

OSHA recordkeeping

OSHA lists “partially exempted industries” at Appendix A to Subpart B of 29 CFR 1904. Employers who are not in a partially exempted industry must keep injury and illness logs under Part 1904.

Section 1904.8 requires all work-related needlesticks and cuts from sharp objects that are contaminated with another person’s blood or other potentially infectious material (OPIM) to be first recorded on the OSHA 300 Log as an “injury.” Later, if the employee is diagnosed with an infectious bloodborne disease, the identity of the disease must be entered and the classification must be changed to an “illness.”

On the other hand, if an employee is splashed or exposed to blood or OPIM without being cut or punctured, the incident must be recorded on the OSHA 300 only if it results in the diagnosis of a bloodborne illness or it meets one or more of the recording criteria of 1904.7.

To protect privacy, the employee’s name must not to be entered on the 300 Log. See the requirements for privacy cases in subparagraphs 1904.29(b)(6) through (b)(10). Employers must keep a separate, confidential list of case numbers and employee names so they can update the cases and provide them if asked by the government.

For more information, see 29 CFR 1904 under Other related regulations.

Sharps injury log

Employers not in partially exempted industries and having employees with occupational exposure to bloodborne pathogens must also establish and maintain a sharps injury log for the recording of percutaneous (through the skin) injuries from contaminated sharps. The information in the log has to be recorded and maintained in such a manner as to protect the confidentiality of the injured employee.

This applies to any employer who is required to maintain a log of occupational injuries and illnesses under the Occupational Safety and Health Administration (OSHA) injury and illness recordkeeping standard, Part 1904. The sharps injury log is separate from the log of injuries and illnesses kept under the Part 1904 recordkeeping rule.

The purpose of the log is to aid in the evaluation of devices being used and to quickly identify problem areas in the facility. Thus, it should be reviewed regularly and during the annual review and update of the written exposure control plan.

The sharps injury log needs to contain, at a minimum:

• The type and brand of device involved in the incident,
• The department or work area where the incident occurred, and
• An explanation of how the incident occurred.

If determining the type and brand of the device would increase the potential for additional exposure (e.g., a housekeeper suffer a needlestick injury through a trash bag), the type/brand may be recorded as “Unknown.”

More information may be included in the log. However, the confidentiality of the injured employee must be maintained throughout the process. If the data are made available to other parties (e.g., supervisors, safety committees, employees, or employee representatives), any information that identifies or could reasonably be used to identify the employee must be withheld.

The employer can determine the format in which to maintain the log (e.g., paper or electronic). Many employers already compile reports of percutaneous injuries to comply with 1910.1030(f)(3). Existing mechanisms for collecting these reports could be sufficient, provided that the information meets the minimum requirements of the Bloodborne Pathogens Standard and protects employee confidentiality.

Employers may use the OSHA 300 log and 301 incident report to meet the sharps injury log requirements. To use these recordkeeping forms, the type and brand of the device have to be entered on either the 300 or 301 form, and the records must be maintained in a way that segregates sharps injuries from other types of work injuries.

Logs must be saved for at least five years following the end of the calendar year that they cover.

Employers partially exempt from recordkeeping requirements under Part 1904 are not required to maintain a sharps injury log, but are encouraged to do so.

However, all employers must comply with the post-exposure documentation requirements of 1910.1030(f)(3) and the annual review documentation requirements of 1910.1030(c)(1)(iv), even when a sharps log is not required.

Records access

• Employers must make their exposure control plan available to workers in a location and format they can access, as well as to NIOSH and OSHA officials upon request.
• Training records must be available to NIOSH and OSHA officials, the employee, and employee representatives.
• Medical records must be available to NIOSH and OSHA officials, the employee, and anyone having the employee’s written consent.

Records must be available to the employees they concern, to representatives of those employees in certain circumstances, and to officials of the Occupational Safety and Health Administration (OSHA) and National Institute for Occupational Safety and Health (NIOSH) upon request.

Exposure control plan

Employers must make their written exposure control plan accessible to employees. The location and format of the plan may be adapted to a workplace’s circumstances, provided that workers can access a copy at the workplace during their shift. OSHA allows a written program to be in either paper or electronic format, as long as the program meets all other requirements of the Bloodborne Pathogens Standard.

The employer must ensure that employees know how to access the document and that there are no barriers to employee access. So if a plan is maintained solely on computer, workers must be trained to operate the computer.

The plan may be part of a larger document (such as one addressing all health and safety hazards in the workplace). However, to be accessible to employees, it must be cohesive by itself, or there must be a guiding document that states the overall policy goals and references the elements of existing separate policies that make up the plan.

If employees request a hard copy of the plan, employers must make it available to them within 15 working days of that request. Upon request, employers must also make the plan available to OSHA and the National Institute for Occupational Safety and Health (NIOSH), or their designated representatives, for examination and copying.

Training and medical records

Upon request, both medical and training records must be made available to both NIOSH and OSHA officials. Training records must be available to employees or employee representatives upon request. Medical records can be obtained only by the employee, OSHA, NIOSH, or anyone having the employee’s written consent, in accordance with 1910.1020.

The employer must comply with the requirements involving transfer of records set forth in 1910.1020(h).

Requirements for both research laboratories and production facilities

• Under the Bloodborne Pathogens Standard, additional requirements apply to HIV and HBV research labs and production facilities.
• These requirements concern elements of these workplaces that include decontamination, access, containment equipment, and ventilation.

Paragraph 1910.1030(e) applies to research laboratories and production facilities engaged in the culture, production, concentration, experimentation, and manipulation of human immunodeficiency virus (HIV) and hepatitis B virus (HBV). They are in addition to the other requirements of the standard. They don’t apply to clinical or diagnostic laboratories engaged solely in the analysis of blood, tissues, or organs.

The following practices are required of both research laboratories and production facilities.

Standard microbiological practices

• All regulated waste must either be incinerated or decontaminated by a method such as autoclaving that’s known to effectively destroy bloodborne pathogens.

Special practices

• Laboratory doors shall be kept closed when work involving HIV or HBV is in progress.
• Contaminated materials that are to be decontaminated at a site away from the work area shall be placed in a durable, leakproof, labeled or color-coded container that is closed before being removed from the work area.
• Access to the work area shall be limited to authorized people.
  • Written policies and procedures shall be established under which only people who have been advised of the potential biohazard, meet entry requirements, and comply with all entry and exit procedures are allowed to enter the work areas and animal rooms.
• When other potentially infectious materials (OPIM) or infected animals are present in the work area or containment module, a hazard warning sign complying with 1910.1030(g)(1)(ii) and incorporating the universal biohazard symbol shall be posted on all access doors.
• All activities involving OPIM shall be conducted in biological safety cabinets or other physical containment devices within the containment module, never on the open bench.
• Laboratory coats, gowns, smocks, uniforms, or other appropriate protective clothing shall be used in the work area and animal rooms. Protective clothing shall not be worn outside the work area and shall be decontaminated before being laundered.
• Special care shall be taken to avoid skin contact with OPIM. Gloves shall be worn when handling infected animals and for unavoidable hand contact with OPIM.
• Before disposal, all waste from work areas and animal rooms shall either be incinerated or decontaminated by a method such as autoclaving known to effectively destroy bloodborne pathogens.
• Vacuum lines shall be protected with liquid disinfectant traps and high-efficiency particulate air (HEPA) filters or filters of equivalent or superior efficiency.
  • Traps and filters must be checked routinely and maintained or replaced as necessary.
  • In humid atmospheres, HEPA filters may be ineffective, so an alternative may be preferable.
• Hypodermic needles and syringes shall be used only for parenteral (under the skin) injection and aspiration of fluids from laboratory animals and diaphragm bottles.
  • Only needle-locking syringes or disposable syringe-needle units (in which the needle is integral to the syringe) shall be used with OPIM.
  • Extreme caution shall be used when handling needles and syringes.
  • A needle shall not be bent, sheared, replaced in the sheath or guard, or removed from the syringe following use.
  • The used needle and syringe shall be promptly placed in a puncture-resistant container and autoclaved or decontaminated before reuse or disposal.
• All spills shall be immediately contained and cleaned up by appropriate professional staff or others properly trained and equipped to work with potentially concentrated infectious materials.
• A spill or accident that results in an exposure incident shall be immediately reported to the laboratory director or other responsible person.
• A biosafety manual shall be prepared or adopted and periodically reviewed and updated at least annually or more often if necessary.
  • Workers must be informed of potential hazards and required to read and follow instructions on practices and procedures.
  • During review and update of the manual, any additional procedures shall be developed that are necessary to protect employees in situations unique to a research/production facility.

Containment equipment

• Certified biological safety cabinets (BSC) (Class I, II, or III) or other appropriate combinations of personal protection or physical containment devices shall be used for all activities that may involve exposure to OPIM droplets, splashes, spills, or aerosols.
  • Examples of alternatives to BSC include special protective clothing, respirators, centrifuge safety cups, sealed centrifuge rotors, and containment caging for animals.
• BSC shall be certified when installed, whenever they are moved, and at least annually.
  • A dated tag indicating who performed the certification should be affixed to the BSC.
  • Alternatively, a certification report attesting to a minimum inward face velocity of at least 75 linear feet per minute and the integrity of the HEPA filters should be available to the compliance officer.
  • This report must be dated and signed by the trained technician performing the measurements and integrity tests.

Additional training requirements for employees in HIV and HBV research laboratories and HIV and HBV production facilities are specified in 1910.1030(g)(2)(ix).

Other requirements for research laboratories only

• Under the Bloodborne Pathogens Standard, some additional requirements apply only to HIV and HBV research labs.
• These requirements concern safety and decontamination equipment.

In addition to the requirements that apply to both research laboratories and production facilities, human immunodeficiency virus (HIV) and hepatitis B virus (HBV) research laboratories shall meet the following criteria:

• Each laboratory shall contain a facility for handwashing that is readily available within the work area.
  • The handwashing facility must be supplied with at least tepid water, soap, and hand towels.
• The laboratory shall also provide an eyewash facility.
  • The eyewash must supply a sufficient quantity of water to completely flush the eyes. A 15-minute supply of continuous free-flowing water is acceptable.
  • The employee’s hands must be free to hold the eyelids open to aid in the complete flushing of the eyes.
• Portable handwashing and eyewash facilities are acceptable only if they meet these requirements.
• An autoclave for decontamination of regulated waste shall be available.

Other requirements for production facilities only

• Under the Bloodborne Pathogens Standard, some additional requirements apply only to HIV and HBV production facilities.
• These requirements concern work area access, safety and decontamination equipment, and ventilation.

In addition to the requirements that apply to both research laboratories and production facilities, human immunodeficiency virus (HIV) and hepatitis B virus (HBV) production facilities shall meet the following criteria:

• The work areas shall be separated from areas that are open to unrestricted traffic flow within the building.
  • Entering the work area from access corridors or other adjoining areas must require passage through two sets of doors.
  • Physical separation of the high-containment work area from access corridors or other areas or activities may also be provided by a clothes-change room (showers may be included), airlock, or other access facility that requires passing through two sets of doors before entering the work area.
• The surfaces of doors, walls, floors, and ceilings in the work area shall be water-resistant so that they can be easily cleaned. Penetrations in these surfaces shall be sealed or capable of being sealed so they can be decontaminated.
• Each work area shall contain a sink for washing hands.
  • The sink shall be foot, elbow, or automatically operated and near the exit door of the work area.
  • The handwashing facility must be supplied with at least tepid water, soap, and hand towels.
• Each work area must also have a readily available eyewash facility.
  • The eyewash must supply a sufficient quantity of water to completely flush the eyes. A 15-minute supply of continuous free-flowing water is acceptable.
  • The employee’s hands must be free to hold the eyelids open to aid in the complete flushing of the eyes.
• Portable handwashing and eyewash facilities are acceptable only if they meet these requirements.
• Access doors to the work area or containment module shall be self-closing.
• An autoclave for decontamination of regulated waste shall be available within or as near as possible to the work area.
  • This minimizes the potential for accidental exposure of other employees from the transport of culture fluids, plasticware, and other contaminated equipment.
• A ducted exhaust-air ventilation system shall be provided.
  • This system shall create directional airflow that draws air into the work area through the entry area.
  • Exhaust air shall not be recirculated to any other area of the building.
  • Exhaust air shall be discharged outside, away from occupied areas and air intakes.
  • The proper direction of the airflow shall be verified (i.e., into the work area).

Who trains contract and temporary employees?

• Bloodborne pathogens training for contract and temporary employees is a shared responsibility between the contractor/staffing agency and the client/host employer.
• Generally, the contractor/agency handles generic bloodborne pathogen information and training, and the client/host employer handles site-specific bloodborne pathogen information and training.

In contract situations, both the contractor and client employer share responsibility for ensuring that contract employees are protected. Likewise, for temporary employees, the staffing agency and host employer are considered joint employers. In either scenario, it is in the interest of both employers to ensure that required training has been provided:

• Contract employees: The contractor maintains a continuing relationship with its employees, but the client employer often creates and controls the hazards. The Occupational Safety and Health Administration (OSHA) explains that the contractor employer is expected to provide generic training in universal precautions, the concept of treating all human blood and other potentially infectious materials (OPIM) as if known to be infectious. Client employers, on the other hand, normally provide site-specific bloodborne pathogens training.
• Temporary employees: As joint employers, both the staffing agency and the host employer are responsible for ensuring that the temporary employee is properly trained. However, the two may decide that a division of the training responsibility may be appropriate. Generally, the staffing agency is responsible for providing generic bloodborne pathogen information and training, while the host employer is typically responsible for providing site-specific bloodborne pathogens training.

Diseases to cover

• HIV, HBV, and HCV should be covered during training.
• Less common bloodborne diseases should be acknowledged but not covered in depth unless relevant to the specific workplace.

Human immunodeficiency virus (HIV) and hepatitis B must be covered in bloodborne pathogen training, but other bloodborne pathogens and bloodborne diseases also exist, such as hepatitis C virus (HCV) and syphilis. Training should acknowledge other diseases while focusing on the ones that are most relevant to the workplace. Uncommon diseases such as Creutzfeldt-Jakob disease don’t need to be covered unless, for example, employees are working in a research facility with that particular virus.

HCV is the most common chronic bloodborne infection in the United States, so the Occupational Safety and Health Administration (OSHA) says it is important that training include information on its transmission and symptoms. People who are chronically infected with HCV may not be aware of their infection because they may not be clinically ill. The infection may lead to chronic liver disease that develops slowly, often taking two or more decades before it is recognized.

For comprehensive information about basic symptoms and modes of transmission of bloodborne diseases, see the Centers for Disease Control and Prevention website at www.cdc.gov.

HIV/HBV labs and production facilities

• Employees in HIV and HBV research laboratories and production facilities must receive additional bloodborne pathogens training.
• Employers must verify and document employees’ proficiency in handling bloodborne pathogens, and provide training to move them up to proficiency as needed, before employees do any work with bloodborne pathogens.

Subparagraph 1910.1030(g)(2)(ix) lists additional training elements for employees in human immunodeficiency virus (HIV) and hepatitis B virus (HBV) laboratories and production facilities. Research laboratories produce or use research-laboratory-scale amounts of HIV or HBV, while production facilities engage in industrial-scale, large-volume, or high-concentration production of HIV or HBV.

In addition to the general training requirements at 1910.1030(g)(2)(vii), employers in HIV or HBV research laboratories and HIV or HBV production facilities must do the following as part of initial training:

• Verify that employees demonstrate proficiency in standard microbiological practices and techniques (as outlined in the Centers for Disease Control and Prevention’s (CDC’s) “Biosafety in Microbiological and Biomedical Laboratories”) and in the practices and operations specific to the facility before being allowed to work with HIV or HBV. Proficiency can be established with prior work experience and/or relevant education, such as a graduate degree in the study of viral diseases or another closely related subject area with a period of related laboratory research experience.
• Confirm that employees have prior experience in the handling of human pathogens or tissue cultures before they work with HIV or HBV.
• Provide a training program to employees who have no prior experience in handling human pathogens that helps them to progress through work activities to learn techniques and develop proficiency. Employees must demonstrate proficiency before doing anything that involves infectious agents.

Consent and hepatitis B vaccination

• Employers can’t force workers to undergo screening for antibodies or vaccination, or to allow the employer access to their test results.
• Workers can decline hepatitis B vaccination but must be given appropriate training about it and sign OSHA’s statement of declination.

Worker consent and confidentiality in regard to hepatitis B vaccination are crucial. Employees cannot be required to be screened for HBV antibodies before or after vaccination, or to release test results to their employers. They can choose not to receive the hepatitis B vaccine.

Consent forms and waivers

Section 1910.1030 does not refer to consent forms for employees accepting the vaccine, so they’re not required. According to the Occupational Safety and Health Administration (OSHA), medical informed consent forms are acceptable, unless they require employees to release test results to their employers or they exaggerate the hazards of the vaccine. Any waiver of liability for any harm caused by the vaccine also violates the regulation.

Pre- and post-vaccination testing

According to OSHA, an employer cannot require an employee to be pre-screened for hepatitis B virus antibodies. However, pre-screening can be made available at no cost to the employee. If the antibody testing reveals that the employee is immune, the employer doesn’t have to provide vaccination to that employee. If an employee declines the pre-screening, then the employer must make the vaccination available.

An employer also cannot require post-vaccination testing unless the Centers for Disease Control and Prevention (CDC) call for it. CDC guidelines do call for a post-vaccination titer for certain employees who have ongoing contact with patients or blood and who are at ongoing risk of percutaneous (through the skin) injuries.

All laboratory tests must be free of charge to the employee and conducted by an accredited lab. The healthcare professional must provide a written opinion to the employer as to whether hepatitis B vaccination is needed and if the employee has received it.

Vaccination declination statement

Any employee with occupational exposure who chooses not to receive the hepatitis B vaccine must sign OSHA’s statement of declination of hepatitis B vaccination. Before signing, the employee must be given appropriate training regarding the following:

• Hepatitis B epidemiology, symptoms, and modes of transmission;
• Hepatitis B vaccination, including the effectiveness, safety, method of administration, and benefits of being vaccinated; and
• The availability of the hepatitis B vaccine and vaccination free of charge to the employee with occupational exposure.

The statement is not a waiver; employees can request and receive the hepatitis B vaccination at a later date, provided they still have occupational exposure.

Signing the statement of declination confirms that the employee is aware of the risk of hepatitis B and was given the chance to be vaccinated, but is declining it with the understanding that a free vaccination will be available at a later date if the employee still has occupational exposure.

Employers must use the declination form as provided by OSHA. Any additions to the form language should be made for the sole purpose of improving employee comprehension. Using a form that conveys the same information, but with different words, may be considered a de minimis (no penalty) violation. Employers must not add language that would discourage employee acceptance of the vaccine or add liability concerns. If an employer adds information that requires the employee to provide confidential medical information, either on the declination form or on a separate form, an OSHA citation may be issued.