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Workers exposed to regulated substances in the workplace (e.g., lead, silica, asbestos) have an elevated risk for occupational diseases. OSHA requires employers to screen these workers for potential exposures with a focus on early detection of illness.
Medical surveillance is a systematic, complex process that looks for problems in the workplace identified by looking at abnormal screening results. Medical screening is one component of medical surveillance that assists with analyzing work group trends.
OSHA’s requirements rely on clinical reviews of an employee’s work history, medical history, physical assessment, and biological testing. Employers must provide medical examinations under the supervision of a licensed physician, without cost to employees, without loss of pay, and at a reasonable time and place. Records must be maintained in the strictest confidence to protect individual employee privacy.
This table summarizes OSHA’s general industry regulations that contain medical surveillance requirements; it does not cover EPA or other agency requirements.
1910.95 Occupational noise exposure | |
Who: | Employees whose occupational noise exposure equals or exceeds 85 decibels over an 8-hour time-weighted average (TWA). |
Frequency: | Audiograms.
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Records: | Audiometric test records. Must be kept for the duration of the affected employee’s employment, and include:
Noise exposure measurement records. Must be kept for 2 years. |
1910.120 Hazardous Waste Operations and Emergency Response (HAZWOPER) | |
Who: |
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Frequency: | For employees covered under paragraphs (f)(2)(i), (f)(2)(ii), and (f)(2)(iv) [see above entry], medical examinations and consultations must be made available:
For employees covered under 1910.120(f)(2)(iii) [see above entry] and for all employees including those of employers covered by 1910.120(a)(1)(v) who may have been injured, received a health impairment, developed signs or symptoms which may have resulted from exposure to hazardous substances resulting from an emergency incident, or exposed during an emergency incident to hazardous substances at concentrations above the permissible exposure limits or the published exposure levels without the necessary personal protective equipment being used:
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Records: | Medical surveillance records. Must be kept for at least the duration of employment plus 30 years, and include:
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1910.134 Respiratory protection | |
Who: | Employees required to use a respirator in the workplace. |
Frequency: | Medical evaluation. Must be provided before an employee is fit tested or required to use a respirator in the workplace, to determine employee’s ability to wear a respirator. Additional medical evaluations. Must be provided if:
Medical evaluations may be discontinued when the employee is no longer required to use a respirator. |
Records: | Medical evaluation records. Must be kept for at least the duration of employment plus 30 years. |
1910.1001 Asbestos | |
Who: | Employees who are or will be exposed to airborne concentrations of fibers of asbestos at or above the time-weighted average (TWA) and/or excursion limit. TWA. Airborne concentration of asbestos in excess of 0.1 fiber per cubic centimeter of air as an 8-hour TWA. Excursion limit. Airborne concentration of asbestos in excess of 1.0 fiber per cubic centimeter of air (1 f/cc) as averaged over a sampling period of 30 minutes. |
Frequency: | Pre-placement examinations. Must be provided or made available before an employee is assigned to an occupation exposed to airborne concentrations of asbestos fibers at or above the TWA and/or excursion limit. Periodic examinations. Must be made available annually. Termination of employment examinations. Must be provided or made available and given within 30 calendar days before or after the date of termination of employment. Recent examinations. No medical examination is required of any employee, if adequate records show that the employee has been examined in accordance with pre-placement, periodic, or termination examination requirements within the past 1-year period. A pre-employment medical examination which was required as a condition of employment by the employer, may not be used to meet the requirements of a recent examination, unless the cost of that examination is borne by the employer. |
Records: | Exposure measurements. Must be kept for at least 30 years and include:
Medical surveillance records. Must be kept for the duration of employment plus 30 years and include:
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1910.1003 13 Carcinogens (1910.1003 through 1910.1016) | |
Who: | Employees considered for assignment to enter regulated areas, and for authorized employees. Regulated area. An area where entry and exit are restricted and controlled. Authorized employees. Employees whose duties require them to be in the regulated area and who have been specifically assigned by the employer. |
Frequency: | Pre-assignment physical evaluation. Must be provided before an employee is assigned to enter a regulated area. Periodic physical examination. Must be provided at least annually following the pre-assignment examination. |
Records: | Medical examination records. Must be complete and accurate and kept for the duration of the employee’s employment. |
1910.1017 Vinyl chloride | |
Who: | Each employee exposed, without regard to the use of respirators, to vinyl chloride in excess of the action level. Action level. A concentration of vinyl chloride of 0.5 ppm averaged over an 8-hour work day. |
Frequency: | Medical examinations. Must be provided:
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Records: | Monitoring and measuring records. Must:
Medical records. Must be kept for the duration of the employment of each employee plus 20 years, or 30 years, whichever is longer. All records. Must include the name of each employee where relevant and be kept for not less than 30 years. |
1910.1018 Inorganic arsenic | |
Who: |
Action level. A concentration of inorganic arsenic of 5 micrograms per cubic meter of air (5 µg/m3) averaged over any 8-hour period. |
Frequency: | Initial examination. At the time of initial assignment to an area where the employee is likely to be exposed over the action level at least 30 days per year. Periodic examination. Must be provided at least annually. Termination examination. Whenever a covered employee has not taken a periodic examination within 6 months preceding the termination of employment, the employer must provide such examination to the employee upon termination of employment. Additional examination. If the employee develops signs or symptoms commonly associated with exposure to inorganic arsenic the employer must provide an appropriate examination and emergency medical treatment. |
Records: | Exposure monitoring records. Must be kept for at least 40 years or for the duration of employment plus 20 years, whichever is longer, and include:
Medical surveillance records. Must be kept for at least 40 years or for the duration of employment plus 20 years, whichever is longer, and include:
Additional records. The employer must keep (or assure the examining physician keeps) the following medical records for at least 40 years, or for the duration of employment plus 20 years, whichever is longer:
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1910.1024 Beryllium | |
Who: | Employees who:
Action level. A concentration of airborne beryllium of 0.1 micrograms per cubic meter of air (μg/m3) calculated as an 8-hour time-weighted average (TWA). Permissible Exposure Limits (PELs): Time-weighted average (TWA) PEL. An airborne concentration of beryllium in excess of 0.2 μg/m3 calculated as an 8-hour TWA. Short-term exposure limit (STEL). An airborne concentration of beryllium in excess of 2.0 μg/m3 as determined over a sampling period of 15 minutes. |
Frequency: | Medical examinations. Must be provided within 30 days and at least every 2 years thereafter. |
Records: | Air monitoring data. Employers must make and maintain a record of all exposure measurements taken to assess airborne exposure and maintain them for at least 30 years. The records must include at least:
Medical surveillance records. Must be kept for at least 30 years and include:
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1910.1025 Lead | |
Who: | Employees who are or may be exposed at or above the action level for more than 30 days per year. Action level. Employee exposure, without regard to the use of respirators, to an airborne concentration of lead of 30 micrograms per cubic meter of air (30 µg/m3) averaged over an 8-hour period. |
Frequency: | Biological monitoring. Blood lead and zinc protoporphyrin (ZPP) level sampling and analysis must be made available:
Follow-up blood sampling tests. Whenever the results of a blood lead level test indicate that an employee’s blood lead level is at or above the numerical criterion for medical removal under paragraph (k)(1)(i)(A) of 1910.1025, the employer must provide a second (follow-up) blood sampling test within 2 weeks after the employer receives the results of the first blood sampling test. Medical examinations and consultations. Must be made available:
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Records: | Exposure monitoring records. Must be kept for at least 40 years or for the duration of employment plus 20 years, whichever is longer, and include:
Medical surveillance. Must be kept for the duration of employment plus 30 years and include:
Medical records. Must be kept by the employer or the examining physician for at least 40 years, or for the duration of employment plus 20 years, whichever is longer, and include:
Medical removal records for employees removed from current exposure to lead. Must be kept for at least the duration of an employee’s employment and include:
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1910.1026 Chromium (VI) | |
Who: | Employees who:
Action level. A concentration of airborne chromium (VI) of 2.5 micrograms per cubic meter of air (2.5 µgm/m3) calculated as an 8-hour time-weighted average (TWA). Permissible exposure limit (PEL). An airborne concentration of chromium (VI) in excess of 5 micrograms per cubic meter of air (5 µgm/m3), calculated as an 8-hour time-weighted average (TWA). |
Frequency: | Medical examinations. Must be provided:
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Records: | Air monitoring data. Must be kept for at least 30 years and include:
Historical monitoring data. Where the employer has relied on historical monitoring data to determine exposure to chromium (VI), these records must be kept for at least 30 years and include:
Objective data. An accurate record of all objective data relied upon to comply with the requirements of 1910.1026 must be kept for 30 years and include:
Medical surveillance records. Must be kept for 30 years and include:
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1910.1027 Cadmium | |
Who: |
Action level. An airborne concentration of cadmium of 2.5 micrograms per cubic meter of air (2.5 µg/m3), calculated as an 8-hour time-weighted average (TWA). |
Frequency: | Initial (preplacement) examinations. Must be provided within 30 days after initial assignment to a job with exposure to cadmium. Recent examinations. An initial examination is not required to be provided if adequate records show that the employee was examined in accordance with the requirements of paragraph (l)(2)(ii) of 1910.1027 within the past 12 months. In that case, such records must be maintained as part of the employee’s medical record and the prior exam must be treated as if it were an initial examination for the purposes of paragraphs (l)(3) and (4) of 1910.1027. Periodic medical surveillance. Must be provided within 1 year after the initial examination and thereafter at least biennially. Biological sampling must be provided at least annually, either as part of a periodic medical examination or separately as periodic biological monitoring. Examination for respirator use. Must be provided prior to the employee’s being assigned to a job that requires the use of a respirator, to any employee without a medical examination within the preceding 12 months that satisfies the requirements of 1910.1027(l)(6)(i). Emergency examinations. Must be provided as soon as possible to any employee who may have been acutely exposed to cadmium because of an emergency. Termination of employment examinations. At termination of employment, the employer must provide a medical examination in accordance with paragraph (l)(4)(ii) of 1910.1027, to any employee to whom at any prior time the employer was required to provide medical surveillance. If the last examination satisfied the requirements of paragraph (l)(4)(ii) and was less than 6 months prior to the date of termination, no further examination is required unless otherwise specified in paragraphs (l)(3) or (l)(5). If the employer has discontinued all periodic medical surveillance under paragraph 1910.1027(l)(4)(v), no termination of employment medical examination is required. |
Records: | Medical surveillance records. Must be kept for the duration of employment plus 30 years, and include:
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1910.1028 Benzene | |
Who: | Employees who:
Action level. An airborne concentration of benzene of 0.5 ppm calculated as an 8-hour time-weighted average (TWA). PELs: Time-weighted average limit (TWA). An airborne concentration of benzene in excess of one part of benzene per million parts of air (1 ppm) as an 8-hour TWA. Short-term exposure limit (STEL). An airborne concentration of benzene in excess of 5 ppm as averaged over any 15-minute period. |
Frequency: | Initial examinations. Before the time of initial assignment. Periodic examinations. At least annually following the initial examination. Emergency examinations. If an employee is exposed to benzene in an emergency situation, the employer must have the employee provide a urine sample at the end of the employee’s shift and have a urinary phenol test performed on the sample within 72 hours. |
Records: | Exposure measurements. Must be kept for at least 30 years and include:
Medical surveillance records. Must be kept for the duration of employment plus 30 years, and include:
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1910.1029 Coke oven emissions | |
Who: | Employees who are employed in a regulated area at least 30 days per year. Regulated area. An area defined at 1910.1029(d) with access limited to authorized persons. Permissible exposure limit. Employees in the regulated area must not be exposed to coke oven emissions at concentrations greater than 150 micrograms per cubic meter of air (150 µg/m3), averaged over any 8-hour period. |
Frequency: | Initial examinations. Must be provided at the time of initial assignment to a regulated area or upon the institution of the medical surveillance program. Periodic examinations. Must be provided at least annually. |
Records: | Medical surveillance records. Must include:
Medical records. The employer must keep, or assure that the examining physician keeps:
All medical records and medical surveillance records. Must be kept for at least 40 years, or for the duration of employment plus 20 years, whichever is longer. |
1910.1030 Bloodborne pathogens | |
Who: | Employees with occupational exposure to bloodborne pathogens, as defined at 1910.1030(b). |
Frequency: | Hepatitis B vaccine and vaccination series. Must be offered to all employees with occupational exposure. Post-exposure evaluation and follow-up. Must be made immediately available to all employees who have had an exposure incident. |
Records: | Medical records. Must be kept for the duration of employment plus 30 years and include:
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1910.1043 Cotton dust | |
Who: | Employees exposed to cotton dust. Action levels: Yarn manufacturing and cotton washing operations: Airborne concentration of lint-free respirable cotton dust of 100 µg/m3 mean concentration, averaged over an 8-hour period, as measured by a vertical elutriator or an equivalent instrument. Waste houses for textile operations: Airborne concentration of lint-free respirable cotton dust of 250 µg/m3 mean concentration, averaged over an 8-hour period, as measured by a vertical elutriator or an equivalent instrument. Textile processes known as slashing and weaving: Airborne concentration of lint-free respirable cotton dust of 375 µg/m3 mean concentration, averaged over an 8-hour period, as measured by a vertical elutriator or an equivalent instrument. |
Frequency: | Initial examinations. Must be provided to each employee who is or may be exposed to cotton dust. New employees must be provided an examination prior to initial assignment. Periodic examinations. Must be provided:
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Records: | Medical records. Must be kept for at least 20 years and include:
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1910.1044 – 1,2-dibromo-3-chloropropane | |
Who: | Employees who work in regulated areas and those who are subjected to DBCP exposures in an emergency situation. Regulated areas are those where DBCP concentrations are in excess of the permissible exposure limit (PEL). PEL: Inhalation. Airborne concentration of DBCP in excess of 1 part DBCP per billion parts of air (ppb) as an 8-hour time-weighted average (TWA). Dermal and eye exposure. No employee must be exposed to skin or eye contact with DBCP. |
Frequency: | Medical examinations. Must be provided at the time of initial assignment and annually thereafter. |
Records: | Medical records. Must be kept for at least 40 years or the duration of employment plus 20 years, whichever is longer, and include:
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1910.1045 Acrylonitrile | |
Who: | Employees who are or will be exposed to AN at or above the action level, without regard to the use of respirators. Action level. A concentration of AN of 1 ppm as an 8-hour time-weighted average (TWA). |
Frequency: | Initial examinations. Must be provided at the time of initial assignment or upon institution of the medical surveillance program. Periodic examinations. Must be provided at least annually. If an employee has not had the initial examination within 6 months preceding termination of employment, the employer must make such examination available to the employee prior to termination. Additional examinations. Must be provided to employees who develop signs or symptoms which may be associated with exposure to AN. |
Records: | Medical records. Must be kept for at least 40 years, or for the duration of employment plus 20 years, whichever is longer, and include:
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1910.1047 Ethylene oxide | |
Who: | All employees who are or may be exposed to EtO at or above the action level, without regard to the use of respirators, for at least 30 days a year, and all employees who have been exposed to EtO in an emergency situation. Action level. A concentration of airborne EtO of 0.5 ppm calculated as an 8-hour time-weighted average (TWA). |
Frequency: | Medical examinations. Must be provided:
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Records: | Medical records. Must be kept for the duration of employment plus 30 years and include:
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1910.1048 Formaldehyde | |
Who: |
Action level. A concentration of 0.5 part formaldehyde per million parts of air (0.5 ppm) calculated as an 8-hour time-weighted average (TWA) concentration. Short-term exposure limit (STEL). An airborne concentration of formaldehyde which exceeds two parts formaldehyde per million parts of air (2 ppm) as a 15-minute STEL. |
Frequency: | Medical examinations. Must be given:
Emergency medical examinations. Must be made available as soon as possible to all employees who have been exposed to formaldehyde in an emergency. |
Records: | Medical records. Must be kept for the duration of employment plus 30 years and include:
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1910.1050 Methylenedianiline | |
Who: |
Action level. A concentration of airborne MDA of 5 ppb as an 8-hour time-weighted average (TWA). Dermal exposure to MDA. Occurs where employees are engaged in the handling, application, or use of mixtures or materials containing MDA, with any of the following non-airborne forms of MDA:
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Frequency: | Initial examinations. Before the time of initial assignment. Periodic examinations. At least annually following the initial examination. Emergency examinations. If the employer determines that the employee has been exposed to a potentially hazardous amount of MDA in an emergency situation. Additional examinations. Where the employee develops signs and symptoms associated with exposure to MDA. |
Records: | Medical surveillance records. Must be kept for at least the duration of employment plus 30 years and include:
Medical records. The employer must keep, or assure that the examining physician keeps, for at least the duration of employment plus 30 years, the following medical records:
Medical removal records. Records for employees removed from current exposure to MDA must be kept for at least the duration of an employee’s employment plus 30 years, and include:
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1910.1051 1,3-Butadiene | |
Who |
Action level. A concentration of airborne BD of 0.5 ppm calculated as an 8-hour time-weighted average (TWA). Permissible exposure limits (PELs): Time-weighted average (TWA) limit. No employee must be exposed to an airborne concentration of BD in excess of 1 part BD per million parts of air (ppm) measured as an 8-hour time-weighted average. Short-term exposure limit (STEL). No employee must be exposed to an airborne concentration of BD in excess of 5 parts of BD per million parts of air (5 ppm) as determined over a sampling period of 15 minutes. |
Frequency: | Health questionnaire and complete blood count with differential and platelet count (CBC). Annually. Initial physical examination. Must be given:
Emergency medical screening. Must be conducted as quickly as possible but not later than 48 hours after the exposure. Respirator fit test. For each employee who must wear a respirator, physical ability to perform the work and use the respirator must be determined as required by 1910.134. |
Records: | Exposure measurements. Records must be kept for at least 30 years and include:
Medical screening and surveillance records. Must kept for the duration of employment plus 30 years and include:
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1910.1052 Methylene chloride | |
Who: | Employees who are or may be exposed to MC:
Action level. A concentration of airborne MC of 12.5 parts per million (ppm) calculated as an 8-hour time-weighted average (TWA). Eight-hour time-weighted average (TWA) PEL. Airborne concentration of MC in excess of 25 parts of MC per million parts of air (25 ppm) as an 8-hour TWA. Short-term exposure limit (STEL). An airborne concentration of MC in excess of 125 parts of MC per million parts of air (125 ppm) as determined over a sampling period of 15 minutes. |
Frequency: | Medical evaluation. Before having an employee use a supplied-air respirator in the negative-pressure mode, or a gas mask with an organic-vapor canister for emergency escape, the employer must:
Medical surveillance. Must be made available:
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Records: | Medical surveillance records. Must be kept for the duration of employment plus 30 years, and include:
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1910.1053 Respirable crystalline silica | |
Who: | Employees who will be occupationally exposed to respirable crystalline silica at or above the action level for 30 or more days per year. Action level. A concentration of airborne respirable crystalline silica of 25 μg/m3, calculated as an 8-hour time-weighted average (TWA). |
Frequency: | Initial examinations. An initial (baseline) examination must be made available within 30 days after initial assignment, unless the employee has received a medical examination that meets the requirements of 1910.1053 within the last 3 years. Periodic examinations. At least every 3 years, or more frequently if recommended by the physician or other licensed healthcare professional (PLHCP). Additional examinations. If the PLHCP’s written medical opinion indicates that an employee should be examined by a specialist, the employer must make available a medical examination by a specialist within 30 days after receiving the PLHCP’s written opinion. |
Records: | Medical surveillance records. Must be kept for the duration of employment plus 30 years, and include:
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1910.1450 Occupational exposure to hazardous chemicals in laboratories | |
Who: | Employees exposed above the action level or the permissible exposure limit (PEL) for an OSHA-regulated substance for which there are exposure monitoring and medical surveillance requirements. |
Frequency: | Medical examinations. Whenever employees develop signs or symptoms associated with a hazardous chemical to which they may have been exposed in the laboratory, they must be provided an opportunity to receive an appropriate medical examination. Medical surveillance. Where exposure monitoring reveals an exposure level routinely above the action level (or in the absence of an action level, the permissible exposure limit (PEL)) for an OSHA-regulated substance for which there are exposure monitoring and medical surveillance requirements, medical surveillance must be established for the affected employee as prescribed by the particular standard. Medical consultations. Whenever an event takes place in the work area such as a spill, leak, explosion, or other occurrence resulting in the likelihood of a hazardous exposure, the affected employee must be provided an opportunity for a medical consultation. The consultation must be for the purpose of determining the need for a medical examination. |
Records: | Medical and monitoring records. The following records must be kept for at least the duration of employment plus 30 years:
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