Document 5MokRZ16Vq6ayxmORK6VeV55

TOXIC SUBSTANCES AY 1 IE4itar'i k u The Occupational Sa/ety end Health Administration promulgated the permaoeot standard for occupational exppwr* to lead on November IS, 1978 (13 FR 52952, November H. 1978). Tbe-U.S. Supreme Court June 29, 1981 denied a writ of certiorari to the U S Court of Appeals for the District of Columbia Circuit thereby allowing that court's decision (8 OSHC 1810), which sub stantially upheld the lead standard, to go un reviewed. The D C circuit ordered further ad ministrative proceedings as to the applicabili- S-f oi the lead standard to non-ferrous founries: pigment manufacture: shipbuilding: auto manufacturing: solder manufacture: wire patenting; pottery: brick manufacture; agricultural pesticides manufacture; leather manufacture, pipe galvanizing; gasoline ad ditives manufacture: linoleumrubber-plastics manufacture; paint spraying; ammunition manufacture; smelting and refin ing of zinc, silver, gold, platinum, rapper and aluminum; machining; lead burning; glass manufacture; textile manufacture; book bind ing; steel alloy manufacture: terne metal manufacturing; glass polishing and spinning; cutlery manufacture: diamond processing; plumbing; jewelry manufacture; pearl processing; casting; cable coating; elec troplating; explosive manufacture; lamp manufacture; sheet metal manufacture: tin rolling, telecommunications: and independent collecting and processing of scrap lead (ex cluding collecting and processing that is part of a secondary smelting operation).) $1910.1025 Dead. (a) Scope and application. (1) This section applies to ail occupational ex posure to lead, except as provided in paragraph (a)(2). (2) This section does not apply to the construction industry or to agricultural operations covered by 29 CFR Part 1928. [Section 1910.1025(a)(2) amended at 44 FR 50338. August 28. 1979, effective im mediately) (b> Definitions. "Action level" means employee exposure, without regard to the use of respirators, to an airborne concentration of lead of 30 micro grams per cubic meter of air (30 pg/ mb averaged over an 8-hour period. "Assistant Secretary" means the As sistant Secretary of Labor for Occupa tional Safety and Health. U.S. Depart ment of Labor, or designee. "Director" means the Director. Na tional Institute for Occupational Safety and Health .CNIOSH). U.S. De partment ofHealth, Education, and Welfare, or desigiMte"Lead" means i^ETailic lead, all inor ganic lead competmds. and organic lead soaps. Excluded from this defini tion are all other-"organic lead com pounds. (c) Permissible exposure limit (PEL). (1) The employer shall assure that no employee is exposed to lead at concen trations greater than fifty micrograms per cubic meter of air (50 pg/m1) aver aged over an 8-hour period. (2) If an employee is exposed to lead for more than 8 hours in any work day. the permissible exposure limit, as a time weighted average (TWA) for that day, shall be reduced according to the following formula: Maximum permissible limit (In pg/ m'l - MWbumi worked ia the day ISectioo 1910.1825(c)(2) corrected at 44 FR 244*l79?"ry ** 1*78' eff*Cjft3(<F*bn"ry (3) When respirators are used to^upS .plement engineering and work practice controls to comply with the PEL and ail the requirements of paragraph (f) have been met. employee exposure, for the purpose of determining whether the employer has complied with the PEL. may be considered to be at th< level provided by the protection factor of the respirator for those periods the respirator is worn. Tnose periodi'may" be averaged with exposure levels during periods when respirators are not worn to determine the employee's dally TWA exposure. (d) Exposure monitoring. (1) Gener al. (i) For the purposes of paragraph (d), employee exposure is that expo sure which would occur if the employ ee were not using s respirator. (ii) With the exception of monitor ing under paragraph (dxS>, the em ployer shall collect Tti(H ahift (tor at least 7 continuous hoursT personal samples Including at least one sample for each shift for each job classifica tion in each work area. (iii) Full shift personal samples shall be representative of the monitored employee's regular, daily exposure to lead. (2) Initial determination. Each em ployer who has a workplace or work operation covered by this standard shall determine if any exployee may be exposed to lead at or above the action level. (3) .Basis of initial determination, (i) The employer shall monitor employee exposures and shall base initial deter minations on the employee exposure monitoring results and any of the fol lowing. relevant considerations: (A) Any information, observations, or calculations which would indicate employee exposure to lead; (B) Any previous measurements of air borne lead: and <C> Any employee complaints of symptoms which may be attributable to exposure to lead. (ii) Monitoring for the initial deter mination may be limited to a repre sentative sample of the exposed em ployees who the employer reasonably believes are exposed to the greatest airborne concentrations of lead in the workplace. (iii) Measurements of airborne lead made in the preceding 12 months may be used to satisfy the requirement to monitor under paragraph (d)(3)(i) if the sampling and analytical methods used meet the accuracy and confidence levels of paragraph (d)(9) of this section. (4) Positive initial determination and initial momtorinp. (i 1 Where a determina tion conducted under paragraphsid)(2) and (d)(3) of this section shows the possibility of any employee exposure at or above the ac tion level, the employer shall conduct moni toring which is representative of the exposure for' etch employee in the workplace who la expoaed to lead. (it) Measurements of airborne lead made in tlie preceding 12 month* may be uaed to satisfy the requirement if the sampling and SnfheicaJ methods uaed meet the accuracy aflfP'wonfklence levels of paragraph (d)(9) of this section. (5) Negative initial determination. Where a determination, conducted under paragraphs (d)(2) and (d)(3) of this section Is made that no employee is exposed to airborne concentrations of lead at or above the action level, the employer shall make a written record of such determination. The reeor'* shall include at least the infor mation specified in paragraph (d)(3) of this section and shall also include the date of determination, location within the worksite, and the name and social security'number of each employee monitored. (8) Frequency, (i) If the Initial reonitertag,reveals employee exposure to be beldw the action level the measure ments need not be repeated except as otherwise provided In paragraph (dX7) of this section. (ii) If the initial determination or subsequent monitoring rcveaU em ployee exposure to be at or abfte the action level but below the permissible exposure limit the employer shall repeat monitoring in accordant with this paragraph at least ejgry* 6 months. The employer shall continue monitoring at the required frequency until at least two consecutive measure ments. taken at least 7 days apart, are below the action level at which time the employer may discontinue moni toring for that employee except as otherwise provided in paragraph (d)(7) of this section. (iii! If the initial monitoring reveals that employee exposure is above the permissible exposure limit the employ er shall repeat monitoring quarterly. The employer shall continue monitor ing at the required frequency until at least two consecutive measurements, taken at least 7 days apart, are below the PEL but at or above the action level at which time the employer shall repeat monitoring for that employee at the frequency specified in para graph (d)(6)(ii). except as otherwise provided in paragraph (d)(7) of this section. (7) Additional monitoring. When ever there has been a production, process, control or personnel change which may result in new or additional exposure to lead, or whenever the em ployer has any other reason tc suspect a change which may result in new or additional exposures to lead, addition al monitoring In accordance with this paragraph shall be conducted. 18) Employee notification. <>) Within 5 working days after the receipt of monitoring results, the employer shall notify earii employee in writing of the (Sec. 1910.10251dH8K>] 12-23-82 Pubusned by THE BUREAU OF NATIONAL AFFAIRS >NC VNASh iNGTON DC 20C3? 13 CYWI 3-001191 31:8422 REFERENCE FILE results which represent that employ ee's exposure. <ii) Whenever the results Indicate that the representative employee ex posure. without regard to respirators, exceeds the permissible exposure limit, the employer shall incude in the written notice a statement that the permissible exposure limit was exceed ed and a description of the corrective action taken or to be taken to reduce exposure to or below the permissible exposure limit. (9) Accuracy of measurement The employer shall use a method of moni toring and analysis which has an accu racy (to a confidence level of 95%) of not less than plus or minus 20 percent for airborne concentrations of lead equal to or greater than 30 jig/m\ (e) Methods of compliance.--(1) Engineering and work practice controls. (i) Where any employee is exposed to lead above the permissible exposure limit for more than 30 days per year, the employer shall implement engineering and work practice controls (including administrative controls) to reduce and maintain employee exposure to lead in accordance with the implementation schedule in Table I below, except to the extent that the employer can demonstrate that such controls are not feasible. Wherever the engineering and work practice controls which can be instituted are not sufficient to reduce employee exposure to or below the permissible exposure limit, the employer shall nonetheless use them to reduce exposures to the lowest feasible level and shall supplement them by the use of respiratory protection which complies with the requirements of paragraph (f) of this section, (ii) Where any employee is exposed to lead above the permissible exposure limit but for 30 days or less per year, the employer shall implement engineering controls to reduce exposures to 200 Mg/m1, but thereafter may implement any combination of engineering, work practice (including administrative controls), and respiratory controls to reduce and maintain , employee exposure to lead to 1 50 fig/m'. Ta bl e I--imp l eme n t a t io n Sc h e d u l e^ Industry* Compkanea dataa* 200 not 100 f m* m* m* PriRWy load production..... Secondary load production.... Load add baitary manufac* turn--------- ---................ AmomoMa manufacture/ toidor grindtag Bmwct, gray iron found1 nas. Mt manufactura. pamta and coating* man ufacture, wal papar man* ufactura, can manufactura, and pnnting.________ <31 3 13) 3 (3) 2 13) N/A 13) N/A to 5 6 7 1 Ta bl e I--Imp l e me n t a t io n Sc h e o u l e -- Continued ; Compkanea dates * 200 g/ too nq/ . 50 m rn* ! Lead manufacture, nonterrous tounpnea. leaped steel manufacture, lead cnemicat manufao> bxe. smpbgtiding and amp rape*, battery breaking * the codacton ana proc- j esamg of scrap (exstudmg of scrap wtweh pan of I a seconoary smeftng op- eraaon). secondary lead | smarting of copper, and I leadcasong...................... j o)! N/A AS other mdustnee....... .......* 2 3 * *0*)*i* * * (iNi)/A ) N/A 2* * mcfudea'anciNvy actMbas located on die same worksite. `Erpreased as the number of years from the effects* date by which compkanct with the grven aetom# expoeure level as an A-nour TWA muat be achieved. * On affective date. This continues an obligation from Table Z-2 of 29 CFR 1910.1000: which had bean in affect since 1971 but which was delated upon the effectiveness of this section. [Section 1910.1025 (e)(1) table amended by 46 FR 6226. January 21. 1961) [Editor's note: The effective dale of Section 1910.1025 (e)(1) table was extended from February 20, 1981. to March 30, 1981. in the February 6. 1981 Federal Register, in accor dance with President Reagan's Directive.) [Section 1910.1025(e)(1) and Table I revised by 46 FR 60775, December II, 1981) (2) Respiratory protection. Where engineering and work practice controls do not reduce employee exposure to or below the 50 |ig/m* permissible expo sure limit, the employer shall supple ment these controls with respirators in accordance with paragraph (f). (Editor's note: The Occupational Safety and Health Administration December 3, 1982 (47 FR 54433) stayed Sections 1910.1025(e)(3)(ii)(B) and (E) for prima ry and secondary smelters and. battery manufacturers, pending completion of an overall review of the entire standard. Em ployers in the three affected industries still must meet the required compliance level of 50 micrograms of lead per cubic meter of air and are subject to requirements in other subparagraphs of 1910.1025 (e) (3) (ii)-for development of more general com pliance plans.) (3) Compliance program. (i) Each employer shall establish and implement a written compliance program to reduce exposures to or below the permissible exposure limit, and interim levels if applicable, solely by means of engineering and work practice controls in accordance with the implementation schedule in paragraph (e)(1). (ii) Written plana for these compli ance programs shall include at least the following: (A)A description of each operation in which lead is emitted: e.g. machin ery used, material processed, controls Occupotionol Safely 6. Health Reporter in place, crew size, employee job re sponsibilities. operating procedures and maintenance practices: (B> A description of the specific means that will be employed to achieve compliance, including engi neering plans and studies used to de termine methods selected for control ling exposure to lead; (C) A report of the technology con sidered in meeting the permissible ex posure limit; (D) Air monitoring data which docu ments the source of lead emissions; c El) A detailed schedule for imple mentation of the program, including documentation such as copies of pur chase orders for equipment, construc tion contracts, etc.; <F) A work practice program whichincludes items required under para graphs (g). (h) and (i) of this regula tion; (O) An administrative control sched ule required by paragraph (e)(8), If ap plicable; (H) Other relevant information. (iti) Written programs shall be sub mitted upon request to the Assistant Secretary and the Director, and shall be available at the worksite for exami nation and copying by the Assistant Secretary, Director, any affected em ployee or authorized employee repre sentatives. (iv) Written programs shall be re vised and updated at least every 6 months to reflect the current status of the program. (4) Bypass of interim level. Where an employer's compliance plan pro, vides for a reduction of employee ex posures to or below the PEL solely by means of engineering and work prac tice controls in accordance with the implementation schedule in table I, and the employer has determined that compliance with the 100 Mg/m1 interim level would divert resources to the extent that it clearly precludes compli ance, otherwise attainable, with the PEL by the required time, the employ er may proceed with the plan to comply with the PEL In lieu of compli ance with the interim level if: (t) The compliance plan clearly doc uments the basts of the determination; (ii) The employer takes all feasible steps to provide maximum protection for employees until the PEL is met; and (iii) The employer notifies tne OSHA Area Director nearest the af fected workplace In writing within 10 working days of the completion or re vision of the compliance plan reflect ing the determination. (5) Mechanical ventilation. (1) When ventilation is used to control exposure, measurements which demonstrate the effectiveness of the system in control ling exposure, such as capture veloc ity, duct velocity, or static pressure shail be made at least every 3 months. Measurements of the system's effec tiveness in controlling exposure shall [Sac. 1910.1025 (a)<5> (i) i 14 t 1 zJ CYWI 3-001192 TOXIC SUBSTANCES S- 184 31.8423 be made within 5 days of any change in production, process, or control which might result in a change in em ployee exposure to lead. <u) Recirculation of air. If air from exhaust ventilation is recirculated into the workplace, the" employer shall assure that <A) the system has a high efficiency filter with reliable back-up filter; and <B) controls to monitor the concentration of lead in the return air and to bypass the recirculation system automatically if it fails are installed, operating, and maintained. (6) Administrative controls. If ad ministrative controls are used as a means of reducing employees' TWA exposure to lead, the employer shall estabish and implement a job rotation schedule which includes: (i) Name or identification number of each affected employee; (ii) Duration and exposure levels at each job or work station where each affected employee is located: and (iii) Any other information which may be useful in assessing the reliabil ity of administrative controls to reduce exposure to lead. (f) Respiratory protection. (1) General Where the use of respi rators is required under this section, the employer shall provide, at no cost to the employee, and assure the use of respirators which comply with the re quirements of this paragraph. Respira tors shall be used in the'following cir cumstances: <i) During the time period necessary to Install or implement engineering or work practice controls, except that after the dates for compliance with' the interim levels In table I, no em ployer shall require an employee to wear a negative pressure respirator longer than 4.4 hours per day; (ii) In work situations in which engi neering and work practice controls are not sufficient to reduce exposures to or below the permissible exposure limit; and (iii) Whenever an employee requests a respirator. (2) Respirator selection. (i) Where respirators are required un der this section the employer shall select the appropriate respirator_or combination of respirators from--table.11 below.. -- " Ta b u II.--Respiratory rejection for lead Aerosol* Airborne concentration of -- ' lead or condition of use Required respin.tor' Not in excess ot 0.5 Half-mask, alr-purlfrin* mg/m 110X PEL), respirator equipped a-ith high efficiency filters.1 * Net In excess of 2.5 pull facepiece, air-purifying mg/me50X PEL), respirator with high eificiency filters.* Not in excess of SO (1) Any powered. air-p>irlfytn* mg/m *t 1000X respirator wit h high PEL). efficiency filters*: or (21 Half- mask supplied air respirator Ta b u II --Respiratory Protection for Lead Aerosols Airborne concentration of lead or condition of use Required respirator' operated in positive-pressure mode.' Not in excess of 100 Supplied-air respirators with mg, m* c200X PELi full facepiece, hood, helmet, or suit, operated in positive pressure mode. Greater than 100 Full facepiece, self-contained mg/m'. unknown breathing apparatus concentration or operated in positive-pressure fire fighting. mode.* * 3 4 'Respirators specified for high . concentrations can be used at lower concentrations of lead. 'Full facepiece ts required if the lead aerosols cause eye or skin irritation at the use concentra tions. *A high efficiency particulate fitter means 00 97 percent efficient against 0.3 micron si2< particles. (ii) The employer shall provide a powered, air-purifying respirator In lieu of the respirator specified In Table II whenever: (A) An employee chooses to use this type of respirator: and (B) This respirator will provide ade quate protection to the employee. (iii) The employer shall select respira tors from among those approved for pro tection against lead dust, fume, and mist by the Mine Safety and Health Administration and the Na tional Institute for Occupational Safety and Health (NIOSH) under the provisions of 30 CFR Part 11. (3) Respirator usage. > (i) The employer shall assure that the respirator issued to the employee exhibits minimum facepiece leakage and that the respirator is fitted prop erly. (ii) Employers shall perform either quantitative or qualitative face fit tests at the time of initial fitting and at least every six months thereafter for each employee wearing negative pressure respirators. The qualitative fit tests may be used only for testing the fit of half mask respirators where they are permitted to be worn, and shall be conducted in accordance with Appendix D. The tests shall be used to select facepieces that provide the required protection as prescribed in table II. (Section 1910.1025 (f)(3)(H) revised by 47 FR 51117, November 12. 1982] (lli) If an employee exhibits difficul ty in breathing during the fitting test or during use, the employer shall make available to the employee an ex amination in accordance with para graph (J)(3)(i>(C) of this section to de termine whether the employee can wear a respirator while performing the required duty. (4) Respirator program, (i) The em ployer shall institute a respiratory protection program In accordance wtth 29 CFR 1910.134 (b), (d>. (e) and (f). (ii) The employer shall permit each employee who uses a filter respirator to change the filter elements when ever an increase in breathing resis tance is detected and shall maintain an adequate supply of filter elements for this purpose. ... (iii) Employees who wear respirators shall be permitted to leave work areas to wash their face and respirator facepiece whenever necessary to prevent skin irrita tion associated with respirator use. (g) Protective icork clothing and equipment. (T) Provision and use. It an employ ee is exposed to lead above the FEU without regard to the use of respira tors or where the possibility of skin or eye irritation exists, the employer shall provide at no cost to the employ ee and assure that the employee uses appropriate protective work clothing and equipment such as, but not limit ed to: (1) Coveralls or similar full-body work clothing; (ii) Gloves, hats, and shoes or dispos able shoe coverlets; and (iii) Face shields, vented goggles, or other appropriate protective equip ment which complies with 1911133 of this Part. f. (2) Cleaning and replacement (l) The employer shall provide the pro tective clothing required in paragfiph (gxi) of this section in a clean and dry condition at least weekly, and daily to employees whose exposure levels with out regard to a respirator are over 200 pg/m* of lead as an 8-hour TWA. (ii) The employer shall provide for the cleaning, laundering, or disposal of protective clothing and equipment re quired by paragraph (g)(1) of this sec tion. (ill) The employer shall repair or re place required protective clothing and equipment as needed to maintain their effectiveness. (iv) The employer shall assure that all protective clothing is removed at the completion of a work shift only in change rooms provided for that pur pose as prescribed in paragraph (i)(2) of this section. <v> The employer snail assure that contaminated protective clothing which is to be cleaned, laundered, or disposed of. is placed in a closed con* tainer in the change-rocm which pre vents dispersion of lead outside the container. (vi) The employer shall inform in writing any person who cleans or laun ders protective clothing or equipment of the potentially harmful effects of exposure to lead. (vii) The employer shall assure that the containers of contaminated protec tive clothing and equipment required by paragraph (g)(2)(v) are labelled as follows: CAUTION: CLOTHING CON TAMINATED WITH LEAD. DO NOT REMOVE DUST BY BLOWING OR SHAKING. DISPOSE OF LEAD [Sec. 1910.1025(j)(2)(vii)] 12-23-82 Published by THE BUREAU OF NATIONAL AFFAIRS. INC.. WASHINGTON DC. 20037 15 CYWI 3-001193 31:8424 REFERENCE FILE CONTAMINATED WASH WATER (iii) The employer shall assure that tinue until two consecutive blood sam IN ACCORDANCE WITH APPLICA employees who are required to shower ples and analyses indicate a blood lem' BLE LOCAL, STATE, OR FEDERAL pursuant to paragraph <i)(3)(t) do not level below 40 jig/100 g of whole blood: REGULATIONS. leave the workplace wearing any cloth and (vlll) The employer shall prohibit the removal of lead from protective clothing or equipment by blowing, shaking, or any other means which disperses lead into the air. ISection 1910. l025i gi became effective March 31. 1970 according to action by U S Court of Appeals for District of Columbia Circuit.-(44 r R 14554. March 13, 19791] (h) Housekeeping. (1) Surfaces. All surfaces shall be maintained as free as practicable of ac cumulations of lead. (2) Cleaning floors, (i) Floors and other surfaces where lead accumulates may not be cleaned by the use of com pressed air. <ii) Shoveling, dry or wet sweeping and brushing may be used only where vacuuming or other equally effective methods have been tried and found not to be effective. <3) Vacuuming. Where vacuuming methods are selected, the vacuums shall be used and emptied in a manner which minimizes the reentry of lead ing or equipment worn during the work shift. (4> Lunchrooms, (i) The employer shall provide lunchroom facilities for employees who work in areas where their airborne exposure to lead is above the PEL, without regard to the use of respira tors. iii) The employer shall assure that lunchroom facilities have a tempera ture controlled, positive pressure, fil tered air supply, and are readily acces sible to employees. (iii) The employer shall assure that employees who work in areas where their airborne exposure to lead is above the PEL without regard to the use of a respirator wash their hands and lace prior to eating, drinking, smoking or applying cosmetics. iiv> The employer shall assure that employees do not enter lunchroom fa cilities with protective work clothing or equipment unless surface lead dust has been removed by vacuuming, downdraft booth, or other cleaning (C) At least monthly during the re moval period of each employee re moved from exposure to lead due to an elevated blood lead level. (ii) Follow-up blood sampling tests. Whenever the results of a blood lead level test indicate that an employees blood lead level exceeds the numerical criterion for medical removal under paragraph (kxl)(i). the employer shall provide a second (follow-up) blood sampling test within two weeks after the employer receives the results of the first blood sampling test. (iii) Accuracy of blood lead level sam pling and analysis. Blood lead level sampling and analysis provided pursu ant to tnis section shall have an accu racy (to a confidence level of 95 per cent) within plus or minus 15 percent or 6 pg/IOOmi. whichever is greater, and shall be conducted by a laboratory licensed by the Center for Disease Control, United States Department of Health, Education and Welfare (CDC) or which has received a satisfactory grade in blood lead into the workplace. method. proficiency testing from CDC in the prior [Section mo.l025(h)(2)<ii) corrected at (5) Lavatories. The employer shall twelve months. 44 FR 5446, January 26, 1979, effective Feb provide an adequate number of Iava- civ) Employee notification. Within ruary 24, 1979] lory facilities which comply with five working days after the receipt of ISection 1910.1025(h) effective date was March 31. 1979. to extent that employers must acquire vacuums tb comply, according to action by U S. Court of Appeals for District of Columbia Circuit. (44 FR 14554. March 13. 1979)| $ 1910.141(d) (1) and (2) of this Part. [Sections 1910.1025(iXl>, (i>(2>, (i)(3> (i) and (ii). and (i)(4Xi) and (iii> amend ed, and (i)(6) deleted, at 44 FR 5446, Janu ary 26, 1979, effective February 24, 1979) tj) Medical surveillance. (1) General biological monitoring results, the em ployer shall notify in writing each em ployee whose blood lead level exceeds 40 Mg/100 g: (A) of that employee's blood lead level and <B> that the standard requires temporary medical (i) Hygiene facilities and practices. (i) The employer shall institute a removal with Medical Removal Protec (1) The employer shall assure that in areas medical surveillance program for all tion benefits when an employee's where employees are exposed to lead above employees who are or may be exposed blood lead level exceeds the numerical the PEL, without regard to the use of respira above the action level for more than criterion for medical removal under tors, food or beverage is not present or 30 days per year. paragraph (kXlXi) of this section. consumed, tobacco products are not present or used, and cosmetics are not applied, except in change rooms, lunchrooms, and showers required under paragraphs (iX2WiM4) of this section. (2) Change rooms. (1) The employer shall provide clean change rooms for employees who work in areas where their airborne exposure to lead is above the (ii) The employer shall assure that all medical examinations and proce-, dures are performed by or under the supervision of a licensed physician. (Iii) The employer shall provide the required medical surveillance including mul tiple physician review under paragraph (j)(3)(iii) without cost to employees and at a reasonable time and place. PEL, without regard to the use of res (2) Biological monitoring. --(1) pirators. Blood lead and ZPP level sampling (11) The employer shall assure thatchange rooms are equipped with'Sfp*-.. rate storage facilities for protections work clothing and equipment and lorM street clothes which prevent cross-cotfe tamination. (3) Showers. (i)'The employer shalfc- and analysis. The employer shall make available biological monitoring .in the foFm of' blood sampling and analysis Cor -lead and zinc protopor phyrin levels to each employee cov ered under paragraph (JXlxi) of this section on the following schedule: assure that employees who_work_in (A) At least every 6 months to each areas where their airborne exposure to lead employee covered under paragraph is above the PEL. without regard to (jxixi) of this secyoru (3) Medical examinations and con sultations.--(i)Frequency. The employ er shall make available medical exami nations and consultations to each em ployee covered under paragraph (JHD(i) of this section on the follow ing schedule: (A) At least annually for each em ployee for whom a blood sampling test conducted at any time during the pre ceding 12 months indicated a blood lead level at or above 40 ng/100 g: (B) Prior to assignment for each em ployee being assigned tor the first time to an area in which airborne con centrations of lead are at or above the action level; - (C) As soon as possible, upon notifi cation by an employee"either that the employee has developed signs or symp toms commonly associated with lead Intoxication, that the employee de the use of respirators, shower at the (B) At least every two months for sires medical advice concerning the ef end of the work shift. each employee whose last blood sam fects of current or past exposure to (ii> The employer shall provide pling and analysis indicated a blood lead on the employee's ability to pro shower facilities in accordance with lead level at or above 40 ut/100 g of create a healthy child, or that the em 1910.141(d)(3) of this Part whole blood. This trequency shall con ployee has demonstrated difficulty in r i V ) Occupational Safety & Health Reporter [Se. 1910.1025(jM3l(i)(C)l 16 CYWI 3-001194 TOXIC SUBSTANCES S-1J9 31:8425 breathing during a respirator fitting test or during use: and (D) As medically appropriate for each employee either removed from exposure to lead due to a risk of sus taining material Impairment to health, or otherwise limited pursuant to a final medical determination. (ii) Content Medical examinations made available pursuant to paragraph (jX3)(i)(A)-(B) of this section shall in clude the following elements: (A) A detailed work history and a medical history, with particular atten tion to past lead exposure (occupation al and non-occupational), personal habits (smoking, hygiene 1. and past gastrointestinal, hematologic, renal, cardiovascular, reproductive and neu rological problems; (B) A .thorough physical examina tion. with particular attention to teeth, gums, hematologic, gastrointes tinal. renal, cardiovascular, and neuro logical systems. Pulmonary status should be evaluated if respiratory pro tection will be used; (C) A blood pressure measurement; (D> A blood sample and analysis which determines: (1) Blood lead level; (2) Hemoglobin and hematocrit de terminations. red cell indices, and ex amination of peripheral smear mor phology; (3) Zinc protoporphyrin; (4) Blood urea nitrogen; and. (5) Serum creatinine: (E) A routine urinalysis with micro scopic examination; and (F) Any laboratory or other test which the examining physician deems necessary by sound medical practice. The content of medical examinations made available pursuant to paragraph (jX3)(i)(C>-(D) of this section shall be determined by an examining physician and. if requested by an employee, shall include pregnancy testing or labora tory evaluation-of male fertility. (ill) Multiple physician reviem meek' anism. (A) St the employer selects the initial physician who condwcto any medical examination or consultation provided to an employee under this section, the employee may designate a second physician:--gw-.. U) To review anyfBidlngs,' detent nations or recommendations of the ini tial physician: and ~ (2>- To conduct stteh examinations, consultations^ and-laboratory tests as the second physician deems necessary to facilitate this review. (B) The employer shall promptly to any other toxic substance ill epph- notify an employee of the right to cafcle); seek a second medical opinion after ( () A description, of any personal each occasion that an initial physician protective equipment used or to be conducts _a medical examination or used; consultation pursuant to this section. (5) Prior blood lead determinations; The employer may condition Its par and ticipation in.' and payment for. the ((F) All prior written medical opin multiple physician review mechanism ions concerning the employee in the' upon the employee doing the follow employer's possession or control. ing within fifteen (15) days after re (B) The employer shall provide the ceipt of the foregoing notification, or foregoing information to a second or receipt of the Initial physician's writ third physician conducting a medical ten opinion, whichever is later examination or consultation under (1) The employee informing the em this section upon request either by the ployer that he or she intends to seek a second or third physician, or by the second medical opinion, and employee. (2) The employee initiating steps to make an appointment with a second physician. (v) Written medical opinions. (A) The employer shall obtain and fumtsh the employee with a copy of a written medical opinion from each examining; (C) If the findings, determinations or consulting physician which contains or recommendations of the second the following information: physician differ from those of the ini (1) The physician's opinion as to tial physician, then the employer and whether the employee has any detect the employee shall assure that efforts ed medical condition which would are made for the two physicians to re place the employee at Increased risk of solve any disagreement. material impairment of the employee's (D) If the two physicians have been unable to quickly resolve their dis agreement, then the employer and the employee through their respective physicians shall designate a third phy sician: (f > To review any findings, determi netiorw or recommendations of the prior physicians; and health from exposure to lead: (2) Any recommended special protec tive measures to be provided to the employee, or limitations to be pllced upon the employee's exposure to wad; (,J> Any recommended Umitfiionupon the employee's use of. resnjrators, including a determinationof whether the employee can wear a powered air purifying respirator if a (2) To conduct such examinations, physician determines that the employ consultations, laboratory tests and dis ee cannot wear a negative pressure res cussions with the prior physicians as pirator, and the third physician deems necessary to < !> The results of the blood lead de resolve the disagreement of the prior terminations. physicians. (B> The employer shall instruct each (E) The employer shall act consist examining and consulting physician to: ent with the findings, determinations <(> Not reveal either in the written and recommendations of the third opinion, or in any other means of com physician, unless the employer and the employee reach an agreement munication with the employer, find ings, including laboratory results, or which is otherwise oonsistent with the diagnoses unrelated to an employee's recommendations of it least one of occupational exposure to lead: and the three physicians. (2) Advise the employee of any medi (iv) Information provided to examin cal condition, occupational or nonoc- ing and consulting physicians. (A) eupational. which dictates further The employe* shall provide an initial medical examination or treatment. physician conducting a medical exami (vi> Alternate Physician Determina nation or consultation under this sec tion Mechanisms. The employer and tion with the following Information: an employee or authorized employee (1) A copy of this regulation for lead includ ing all Appendices; (2) A description of the affected em ployee's dhttes as they relate to the employee's expoure; representative may agree upon the use of any expeditious alternate physician determination mechanism In Heu of the multiple physician review mecha nism provided by this paragraph King as the alternate mechanism oth (2) The employee's exposure level or erwise satisfies the requirements con anticipated exposure level to lead and tained in this paragraph. 12'11-80 ISsc. 1910.1025(j>(3l(vi>] Published by THE BUREAU OF NATIONAL AFFAIRS. INC, WASHINGTON. D C 20037 69 CYtyx 31:8426 REFERENCE FILE (4) Chelation. <i> The- employer shall assure that any person whom he re tains. employs, supervises or controls does not encase in prophylactic chela tion of any employee at any time. (tt) If therapeutic or diagnostic che lation is to be performed by any person in paragraph (jX4Xt>, the em ployer shall assure that it be done under the supervision of a licensed physician in a clinical setting with thorough and appropriate medical monitoring and that the employee is notified hi writing prior to ita occur rence. (k> Medical Removal Protection. (1) Temporary medical removal and return of an employee. (i) Temporary removal due to elevat ed blood lead levels. (A) First year of the standard. During the first year following the ef fective date of the standard, the em ployer shall remove an employee from work having a daily eight hour TWA exposure to lead at or above 100 pg/m% on each occasion that a periodic and a follow-up blood sampling test conduct ed pursuant to this section indicate that the employee's blood lead level ia at or above 80 pg/100 g of whole blood: (B) Second year of the standard. During the second year following the effective date of the standard, the em ployer shall remove an employee from work having a daily 8-hour TWA expo sure to lead at or above SO pg/m' on each occasion that a periodic and a follow-up blood sampling test conduct ed pursuant to. this section indicate that the employee's blood lead level ia. at or above 70 pg/100 g of whole Mooch' (C) Third year of ike standard, and thereafter. Beginning with the third year following the effective date of the standard, the employer shall remove an employee from week having as exposure to lead at or above the action level on each occasion that a periodic and a follow-up Wood sam pling test conducted pursuant to this section Indicate that the employee's Wood lead level is at or above $6 pg/ 166 g of whole blood: and, <D) Fifth year of the stawdaitband thereafter. Beginning with the^ftjEWycar following the effective daSt of the standard, the employer shall remove an employee from work having an exposure to lead at or aboveilkhe action level on each occasion that the average of the last three blood sam subsequent' final medical determina pling tests conducted pursuant to this tion results in a medical finding, deter section (or the average of all Mood mination. or opinion that the employ sampling tests conducted over the pre ee no longer has a detected medical vious six (6) months, whichever is condition which places the employee longer) indicates that the employee's at Increased risk of material impair blood lead level is at or above 50 pg/ ment to health from exposure to lead. 100 g of whole blood: provided, howev er. that an employee need not be re <B> For the purposes of this section, moved if the last blood sampling test the requirement that an employer indicates a blood lead level at or below return an employee to his or her 40 pg/100 g of whole Wood. former Job status is not intended to Ui) Temporary removal due to a expand upon or restrict any rights an final medical determination. (A) The employee has or would have had. employer shall remove an employee absent temporary medical removal, to from work having an exposure to lead a specific job classification or position at or above the action level on each oc under the terms of a collective bar casion that a final medical determina gaining agreement. tion results in a medical finding, deter <lv) Removal of other employee spe mination. or opinion that the employ cial protective measure or limitations. ee has a detected medical condition The employer shall remove any limita which places the employee at in: tions placed on an employee or end creased risk of material impairment to any special protective measures pro health from exposure to lead. vided to an employee pursuant to a (B) For the purposes of this section, final' medical determination when a the phrase ``final medical determina subsequent final medical determina tion" shall mean the outcome of the tion Indicates that the limitations or multiple physician review mechanism special protective measures are no or alternate medical, determination longer necessary. mechanism used pursuant to the medi cal surveillance provisions of this sec tion. (C) Where a final medical determi nation results in any recommended special protective measures for an em ployee, or limitations on an employee's exposure to lead, the employer shall implement and act consistent with the recommendation. (ill) Return of the employee to former job status. (A) The employer shall return an employe^ to his or her former job status: U> For an employee removed due to a blood lead level at or above 80 pg/ 100 g. when two consecutive blood sampling tests indicate that the em ployee's blood lead level is at or below 60 pg/100 g Of whole blood: (v) Employer options pending a final medical determination. Where the multiple physician review mechanism, or alternate medical determination mechanism -used pursuant to the medi cal surveillance provisions of this sec tion, has not yet resulted in a final medical determination with respect to an employee, the employer shall set as follows: <A> Removal, The employer may remove the employee from exposure to lead, provide special protective measures to the employee, or piece limitations upon the employee, con sistent with the medical findings, de terminations, or recommendations of any of the physicians who have re viewed the employee's health status. (2) For an employee removed due to (B) Return. The employer may a blood lead level at or above 70 pg/ return the employee to his or her 100 g. when two consecutive blood former job status, end any special pro sampling tests indicate that the em tective measures provided to the em ployee's blood lead level is at or below ployee, and remove any limitations 50 pg/100 g of whole blood; placed upon the employee, consistent -< J) For ah employee removed due to with the medical findings, determina a blood lead level at or above 60 pg/ tions, or recommendations of any of 100 g, or' due to an average blood lead the physicians who have reviewed the level at or above 50 pg/100 g, when employee's health status, with two ex two consecutive blood sampling tests ceptions. If (I) the initial removal, indicate that the employee's blood special protection, or limitation of the lead level is at or below 40 pg/100 g of employee resulted from a final medi whole blood: cal determination which differed from <<> For an employee removed due to the finding*, determinations, or rec a final medical determination, when a ommendation* of the initial physician, or K. i * Occupational Sofety & Health Reporter (Se. 1910.102S(kM1)M(B)I 70 CTWI 3-00U96 TOXIC SUBSTANCES S-159 31:8427 (2) the employee has been on removal status for the preceding eighteen months due to an elevated blood lead level, then the employer shall await a final medical determination. (2) Medical removal protection bene fits. (i) Provision of medical removal pro tection benefits. The employer shall provide to an employee up to eighteen (18) months of medical removal pro tection benefits on each occasion that an employee is removed from exposure to lead or otherwise limited pursuant to this section. (li) Definition of medical removal protection benefits. For the purposes of this section, the requirement that an employer provide medical removal protection benefits means that the employer shall maintain the earnings, seniority and other employment rights and benefits of an employee cs though the employee had not been removed from normal exposure to lead or oth erwise limited. (iii) Follow-up medical surveillance during the period of employee removal or limitation. During the period of time that an employee is removed from normal exposure to lead or oth erwise limited, the employer may con dition the provision of medical remov al protection benefits upon the em ployee's participation In follow-up medical surveillance made available pursuant to this section. (fv) Workers' compensation claims. If a removed employee files a claim for workers' compensation payments for a lead-related disability, then the em ployer shall continue to provide medi cal removal protection benefits pend ing disposition of the claim. To the extent that an award is made to the employee for earnings lost during the period of removal, the employer's medical removal protection obligation shall be reduced by such amount. The employer shall receive no credit for workers' compensation payments re ceived by the employee for treatment related expenses. <v) Other credits. The employer's ob ligation to provide medical removal protection benefits to a removed em ployee shall be reduced to the extent that the employee receives compensa tion for earnings lost during the period of removal either from a public ly or employer-funded compensation program, or receives OMAme .from'employ ment with another emplofSrmade possible by virtue of the employee's removal. (vi) Employees whose blood lead levels do not adequatSj/, decline within IS months of removaL The employer shall take the following measures with respect to any employee removed from exposure to lead due to an elevated blood lead level whose blood lead level has not declined within the past eigh teen (18) months of removal so that the employee has been returned to his or her former job status: (A) The employer shall make availa ble to the employee a medical exami nation pursuant to this section to obtain a final medical determination with respect to the employee: <B> The employer shall assure that the final medical determination ob tained indicates whether or not the employee may be returned to his or her former job status, and if not. what steps should be taken to protect the employee's health; (C) Where the final medical determi nation has not yet been obtained, or once obtained indicates that the em ployee may not yet be returned to his or her former job status, the employer shall continue to provide medical re moval protection benefits to the em ployee until either the employee is re turned to former job status, or a final medical determination Is made that the employee is Incapable of ever safely returning to his or her former job status. (D) Where the employer acts pursu ant to a final medical determination which permits the return of the em ployee to his or her former job status despite what would otherwise be an unacceptable blood lead level, later questions concerning removing the employee again shall be decided by a final medical determination. The em ployer need not automatically remove such an employee pursuant to the blood lead level removal criteria pro vided by this section. (vii) Voluntary Removal or Restric tion of An Employee. W'here an em ployer. although, not required by this section to do so, removes an employee from exposure to lead or otherwise places limitations on an employee due to the effects of lead exposure on the employee's medical condition, the em ployer shall provide medical removal protection benefits to the employee equal to that required by paragraph (k K2K1) of this section. (1) Employee information and train ing. (1) Training program. (I> Each employer who has a work place in which there is a potential ex posure to airborne lead at any level shall inform employees of the content of Appendices A and B of this regula tion. (ii> The employer shall institute a training program for and assure the participation of all employees who are subject to exposure to lead at or above the action level or for whom the possi bility of skin or eye irritation exists. (iii) The employer shall provide ini tial training by 180 days from the ef fective date for those employees cov ered by paragraph (l)(l)(ii) oh the standard's effective date and prior to the time of initial Job assignment for those employees subsequently covered by this paragraph. (iv) The training program shall be repeated at least annually for each employee. (v> The employer shall assure that each employee is informed of the fol lowing: (A) The content of this standard and its appendices: (B) The specific nature of the oper ations which could result in exposure to lead above the action level; (C) The purpose, proper seletfcon. fitting, use. and limitations Of reJbira- tors: f (D) The purpose and a description of the medical surveillance programwknd the medical removal protection.T>ro- gram including information concern ing the adverse health effects associat ed with excessive exposure to lead (with particular attention to the ad verse reproductive effects on both males and females); (E) The engineering controls and work practices associated with the em ployee's job assignment: (F) The contents of any compliance plan in effect; and (G) Instructions to employees that chelating agents should not routinely be used to remove lead from their bodies and should not be used at all except under the direction of a li censed physician: (2) Access to information and train ing materials. (i) The employer shall make readily available to all affected employees a copy of this standard and its appendi ces. (il) The employer shall provide, upon request, all materials relating to the employee information and train ing program to the Assistant Secretary and the Director. 12-11-80 (See. 1910.1025 (IM2)(ii)l Published by THE BUREAU OF NATIONAL AFFAIRS. INC , WASHINGTON. D C 20037 71 CYWI 3-001197 31:8428 REFERENCE FILE (iii) In addition to the information required by paragraph (l)(l)(v), the employer shall include as part of the training program, and shall distribute to employees, any materials pertaining to the Occupational Safety and-Health Act. the regulations issued pursuant to that Act. and this lead standard, which are made available to the em ployer by the Assistant Secretary. (m) Signs. (1) General (i) The employer may use signs required by other statutes, regulations or ordinances in addition to. or in combination with, signs re quired by this paragraph. (il) The employer shall assure that no statement appears on or near any sign required by this paragraph which contradicts or detracts from the mean ing of the required sign. (2) Signs, (i) The employer shall post the following warning signs in each work area where the PEL is exceeded: WARNING LEAD WORK AREA POISON NO SMOKING OR EATING <ii> The employer shall .assure that signs required by this paragraph are il luminated and cleaned as necessary so that the legend is readily visible. (2) Medical surveillance. (1) The em ployer shall establish and maintain an accurate record for each employee subject to medical surveillance as re-, quired by paragraph (J) of this section. (ii) This record shall include: (A) The name, social security number, and description of the duties of the employee; (B) A copy of the physician's written opinions; (C) Results of any airborne exposure monitoring done for that employee and the representative exposure levels supplied to the physician: and (D) Any employee medical com plaints related to exposure to lead. (lit) The employer shall keep, or assure that the examining physician keeps, the following medical records: (A) A copy of the medical examina tion results including medical and work history required under para graph (J) of this section: (B) A description of the laboratory procedures and a copy of any stand ards or guidelines used to interpret the test results or references to that information; <C) A copy of the results of biologi cal monitoring. (Iv) The employer shall maintain or assure that the physician maintains those medical records for at least 40 years, or for the duration of employ Assistant Secretary and the Director for examination and copying. (ii) Environmental monitoring, medical removal, and medical records required by this paragraph shall be provided upon re quest to employees, designated represen tatives, and the Assistant Secretary in ac cordance with 29 CFR !910.20(aMe) and (g)-(i). Medical removal records shall be provided in the same manner as environ mental monitoring records. [Section 1910.1025(n)(4)(ii) amended by 45 FR 35212, May 23. 1980. effective August 21, 1980; corrected by 45 FR 54333, August 15, 1980) (5) Transfer of records, (i) Whenever the employer ceases to do business, the successor employer shall receive and retain all records required to be maintained by paragraph (n) of this section. (ii) Whenever the employer ceases to do business and there is no successor employer to receive and retain the rec ords required to be maintained by this section for the prescribed period, these records shall be transmitted to the Di rector. (ill) At the expiration of the reten tion period for the records required to be maintained by this section, the em ployer shall notify the Director at least 3 months prior to the disposal of such records and shall transmit those records to the Director if requested (n) Recordkeeping. ment plus 20 years, whichever is within the period. (1) Exposure monitoring. (1) The em ployer shall establish and maintain an accurate record of all monitoring re quired in paragraph (d> of this section. longer. (Si Medical removals, (i) The em ployer shall establish and maintain an accurate record for each employee re (iv) The employer shall also comply with any additional requirements involving transfer of records set forth in 29 CFR 1910.20(h). (ii) This record shall include: (A) The date(s), number, duration, location and results of each of the samples taken, including a description of the sampling procedure used to de termine representative employee expo sure where applicable: <B) A description of the sampling and analytical methods used and evi dence of their accuracy; (C) The type of respiratory protec moved from current exposure to lead (Section 19I0.1025(n)(5)(iv) added at 45 pursuant to paragraph <k> of this sec FR 35212, May 23, 1980, effective August tion. 21, 1980] (ii) Each record shall include: (A) The name and social security number of the employee; (B) The date on each occasion that the employee was removed from cur rent exposure to lead as well as the corresponding date on which the em ployee was returned to his or her former job status; (o) Observation of monitoring. (1) Employee observation. The employer shall provide affected employees or their designated representatives an op portunity to observe any monitoring of employee exposure to lead conduct ed pursuant to paragraph (d) of this section. tive devices worn, if any: (C> A brief explanation of how each (2) Observation procedures, (i) (D) Name, social security number, and job classification of the employee monitored and of all other employees whose exposure the measurement, is intended to represent; and- (E) The environmental vJjStBles that could affect the measurenfsht of employee exposure. r (iii) The employer shall mgjntain these monitoring records for af'least 40 years or for the duration of-employ ment plus 20 years, whichever is longer. removal was or Is being accomplished; Whenever observation of the monitor and ing of employee exposure to lead re (D) A statement with respect to each quires entry into an area where the removal indicating whether or not the use of respirators, protective clothing reason for the removal was an elevat or equipment is required, the employ ed blood lead level. er shall provide the observer with and (ill) The employer shall maintain assure, the use of such respirators, f-vch medical removal record for at clothing and such equipment, and least the duration of an employee's shall require the observer to comply employment. with all other applicable safety and (4) Availability. (1) The employer health procedures. shall make available upon request all (U) Without Interfering with the records required to be maintained by monitoring, observers shall be entitled paragraph (n) of this section to the to: > * Oecupot*onol Safety & Heolth Reporter [Ssc. 1910.1025 (ol(2)(ii)! 72 CYWI 3-001198 TOXIC SUBSTANCES S-159 31:8429 f- (A' Receive an explanation of the (D) Quantitative fit testing required under XV. For additional information measurement procedures: (f)(3)(H) -- one year from effective date. <B> Observe all steps related to the Qualitative fit testing is required in the in monitoring of lead performed at the terim. Appendix C to Section 1(10.1025--Medical Surveillance Guidelines place of exposure: and (7) Written compliance plans re L Medical Surveillance and monitoring (C) Record the resuits obtained or quired by paragraph (e)(3) shall be requirements for workers exposed to receive copies of the results when re completed and available for inspection inorganic lead turned by the laboratory. and copying as soon as possible but no Q. Advene health effects of inorganic lead ip) Effective date. This standard shall later than the following schedule: HI. Medical evaluation become effective March 1. 1979. except as noted throughout standard. ISection 1910.1025ip> corrected at 44 FR 5446. January 26. 1979. effective February 24. 1979: Section 1910.1025<p) amended to re vise effective date in accordance with action (A) Employers for whom compliance with the PEL or interim level is required within 1 year from the effective date--6 months from the effective date. (B> Employers in secondary smelting and refining, lead storage battery manufartur IV. Laboratory evaluation Appendix A to Section 1910.102S-- Substance Data Sheet For Occupational Exposure to Lead of U S. Court of Appeals for the District of tng lead pigment manfacturing and nonfer /. Substance Identification Columbia Circuit. 144 FR 14554. March 13, rous foundry industries--1 year from the ef 1979)1 fective date. A. Substance: Pure lead (Pb) is a <q) Appendices. The inlormation <C) Employers in primary smelting and re heavy metal at room temperature and contained in the appendices to this section is not intended by itself, to create any additional obligations not otherwise imposed by this standard nor detract from any existing obliga tion. ' (r) Startup dates. All obligations of this standard commence on the effec tive date except as follows: fining industry--1 year from the effective date for the interim level: 5 years from the effective date for PEL. (D> Plans for construction of hygiene fa cilities. if required--6 months from the ef fective date. (8) The permissible exposure limit in paragraph (c) shall become effective 150 days from the effective date. pressure and is a basic chemical element It can combine with various other substances to form numerous lead compounds. B. Compounds Covered by the Standard: The word "lead" when used in thin standard means elemental lead, all inorganic lead compounds and a (1) The initial determination under Appendix A to Section 1914.1025--Subetanee class of organic lead compounds called paragraph (d)(2) shall be made as soon Data Sheet far Occupational Expoeure to as possible but no later than 30 days Load from the effective date. I. Subalance Identification (2) Initial monitoring under para-, A. Substance graph (d)(4) shall be completed as B. Compounds Covered by the Standard soon as possible but no later than 90 CUsee days from the affective date. D. Permissible Expoeure (3) .Initial biological monitoring and E. Action Level medical examinations under para 0. Basic Health Hazard Data lead soaps. This standard does not apply to other organic lead compounds. C. Uses: Expoeure to lead occurs In ft least 120 different occupations, ifidudljtgprimary and secondary lead smelting, r lead storage battery manufacturing. leU pigment manufacturing and use. soldesL manufacturing and use. shipbuilding tfhd graph (j> shall be completed as soon a* A. Ways In which lead enters your body ship repairing, auto manufacturing, and possible but no later than 180 days B. Effects of overexposure to lead printing. from the'Effective date. Priority for 1. Short-term (acute) overexposure D. Permissible Exposure: The biological monitoring and medical ex 2. Long-term (chronic) overexposure animations shall be given to emplov- 3. Health protection goal of the standard) ees whom the employer believes to be 4. Reporting signs and symptoms of health at greatest risk from continued expo problems sure. (4) Initial training and education shall be completed as soon as possible Appendix B to Section 1414.11128 Standard Summary Employee but no later than 180 days from the ef L Permissible Exposure Limit--paragraph (c) fective date. Q. Exposure Monitoring--paragraph (d) (5) Hygiene and lunchroom facilities under paragraph (i) shall be in oper ation as soon as possible but no later than 1 year from the effective year. UI. Methods of Compliance--paragraph (e) IV. Respiratory Protection--paragraph (f) V. Protective Work Clothing 4 Equipment-- paragraph (g) VI. Housekeeping--paragraph (h) (6) Respiratory protection required VIL Hygiene Facilities 4 Practices-- Permissible Exposure Limit (PEL) set by the standard is 50 micrograms of lead per cubic meter of air (50 fig/m1), averaged over an 8-hour work-day. E. Action Level: The standard establishes an action level of 30 micrograms per cubic meter of air (30 time weighted average, based on an 8-hour work-day. The action level initiates several requirements of the standard, such as exposure monitoring, medical surveillance, and training and education. by paragraph (f) shall be provided as paragraph (i) soon as possible but no later than the VU1. Medical Surveillance--paragraph (j) following schedule: IX Medical Removal Protection--paragraph (A) Employees wJTffiSL^-hour TWA expo M sure exceeds 200 pg/nt*s>gf> the effective, X Employee Information 4 Training-- date. ff ` paragraph (1) n. Health Hazard Data A. Ways in which lead enters your body. When absorbed into your body in certain doses lead is a toxic substance. (B> Employees whose g-flour TWA expo XL Signs--paragraph (m) sure exceeds the PEL bjt is less than 200 XQ. Recordkeeping--paragraph (n) w/m1--ISO days from thffective date. (C) Powered, air-purlfytwr respirators pro vided under (fXDtii)--210 days from the nfective dale. XlILObcarvatton of Monitoring--paragraph (o) XIV. Effective Date--paragraph (p) The object of the lead standard is to prevent absorption of harmful quantities of lead. The standard is intended to protest you not only from the immediate toxic effects of lead, but also from the 12-11-80 [Sec. 1910.1025. Appendix A] Published by THE BUREAU OF NATIONAL AFFAIRS, INC., Washington, D.C. 20037 73 CYWI 3-001199 31:8430 REFERENCE FILE serious toxic effects that may not which arise after periods of exposure as or who were exposed to lead become apparent until years of exposure short as days or an long as several years. themselves. Lead exposure also may have passed. (Section 1910.1025. Appendix A(II)(B) result in decreased fertility, and Lead can be absorbed into your*body (11 corrected at 44 FR 68827, Novem abnormal menstrual cycles in women. by inhalation (breathing) and ingestion ber 30. 1979| The course of pregnancy may be (eating). Lead (except for certain organic adversely affected by exposure to lead lead compounds not covered by the (2) Long-term (chronic) overexposure. since lead crosses the placental barrier standard, such as tetraethyl lead) is not Chronic overexposure to lead may result and poses risks to developing fetuses. absorbed through your skin. When lead is scattered in the air as a dust, fume or mist it can be inhaled and absorbed in severe damage to your blood-forming, nervous, urinary and reproductive Children bom of parents either one of systems. Some common symptoms of whom were exposed to excess lead through you lungs and upper respiratory chronic overexposure include loss of levels are more likely to have birth tract. Inhalation of airborne lead is appetite, metallic taste in the mouth defects, mental retardation, behavioral generally the most important source of anxiety, constipation, nausea, pallor, disorders or die during the first year of occupational lead absorption. You can excessive tiredness, weakness, childhood. also absorb lead through your digestive system if lead gets into you mouth and is swallowed. If you handle food, cigarettes, chewing tobacco, or make-up which have lead on them or handle them with hands contaminated with lead this will contribute to ingestion. insomnia, headache, nervous irritability, muscle and joint pain or soreness, fine tremors, numbness, dizziness, hyperactivity and colic. In lead colic there may be severe abdominal pain. Damage to the central nervous system Overexposure to lead also disrupts the blood-forming system resulting in decreased hemoglobin (the substance in the blood that carries oxygen to the cells) and ultimately anemia. Anemia is characterized by weakness, pallor and fatigability as a result of decreased A significant portion of the lead that in general and the brain oxygen carrying capacity in the blood. you inhale or ingest gets into your blood (encephalopathy) in particular is one of stream. Once in your blood stream, lead 1 most severe forms of lead poisoning. is circulated throughout your body and .3 most severe, often fatal form of stored in various organs and body encephalopathy may be preceded by tissues. Some of this lead is quickly vomiting, a feeling of dullness filtered out of your body and excreted progressing to drowsiness and stupor, but some remains in the blood and other poor memory, restlessness, irritability, tissues. As exposure to lead continues, tremor, and convulsions. It may arise the amount stored in your body will suddenly with the onset of seizures, increase if you are absorbing more lead followed by coma, and death. There is a than your body Is excreting. Even tendency for muscular weakness to though you may not be aware of any develop at the same time. This immediate symptoms of disease, this weakness may progress to paralysis lead stored in your tissues can be slowly often observed as a characteristic "wrist (3) Health protection goals of the standard. Prevention of adverse health effects for most workers from exposure to lead throughout a working lifetime requires that worker blood lead (PbB) levels be maintained at or below forty micrograms per one hundred grama of whole blood (40 pg/lOOg). The blood lead levels of workers (both male and female workers) who intend to have children should be maintained below 30 pg/lOOg to minimize adverse reproductive health effects to the parents and to the developing fetus. causing irreversible damage, first to drop" or "foot drop" and is a individual cells, then to your organs and manifestation of a disease to the The measurement of your blood lead whole body systems. nervous system called peripheral level is the most useful indicator of the B. Effects ofoverexposure to lead--{1) neuropathy. amount of lead being absorbed by your body. Blood lead levels (PbB) are most Short term (acute) overexposure. Lead is Chronic overexposure to lead also often reported in units of milligrams a potent, systemic poison that serves no results in kidney disease with few, if (mg) or micrograms (pg) of lead (1 known useful function once absorbed by any. symptoms appearing until mg *1000 pg) per 100 grams (lOOg). 100 your body. Taken in large enough doses, extensive and most likely permanent milliters (100 ml) or deciliter (dl) of lead can kill you in a matter of days. A condition affecting the brain called acute encephalopathy may arise which develops quickly to seizures, coma, and death from cardiorespiratory arrest A kidney damage has occurred. Routine laboratory tests reveal the presence of this kidney disease only after about two-thirds of kidney function is lost When overt symptoms of urinary blood. These three units are essentially the same. Sometime PbB's are expressed in the form of mg* or pg*. This is a shorthand notation for 100g, 100 ml or dl short term dose of lead can lead to acute encephalopathy. Short ternL.^, ' occupational exposures OfthfT^,magnitude are highly unusual IfSnot impossible. Similar forms of - * dysfunction arise, it (a often too late to correct or prevent worsening conditions, and-progression to kidney dialysis or death is possible. PbB measurements show the amount of lead circulating in your blood stream, out do not give any information about the amount of lead stored in your encephalopathy may, however, Sr&e Chronic overexposure to lead impairs various tissues. PbB measurements from extended, chronic exposures the reproductive systems of both men merely show current absorption of lead, lower doses of lead. There is no sharp and women. Overexposure to lead may not the effect that lead is having on your dividing line between rapidly result in decreased sex drive, impotence body or the effects that past lead developing acute effects of lead, and and sterility in men. Lead can alter the exposure may have already caused. Past chronic efects which take longer to structure of sperm cells raising the risk research into lead-related diseases, acquire. Lead adversely affects of birth defects. There is evidence of however, has focused heavily on numerous body systems, and causes miscarriage and stillbirth in women associations between PbBs and various forms of health impairment and disease whose husbands were exposed to lead diseases. As a result your PbB is an L r* i t* . I. Occupational Safety & Health Reporter [Sec. 1910.1025. Appendix A) 74 CYWI 3-001200 TOXIC SUBSTANCES S-1S1 31:8431 important indicator of the likelihood that at no cost to you and at a reasonable instrument monitoring of the air for the you will gradually acquire a lead-related time and place. presence of lead and must cover the health impairment or disease. The standard contains a procedure exposure of a representative number of Once your blood lead level climbs above 40 pg/lOOg, your risk of disease increases. There is ajyide variability of individual response to lead, thus it is whereby you can obtain a second opinion by a physician of your choice if the employer selected the initial physician. This procedure, however, employees who are reasonably believed to have the highest exposure levels. If your employer has conducted appropriate air sampling for lead in the difficult to say that a particular PbB in a was delayed by the Court of Appeals in past year he may use these results. If given person will cause a particular March of 1979, and will not go into effect there have been any employee effect. Studies have associated fatal until after the Court's decision on the complaints of symptoms which may be encephalopathy with PbBs as low as ISO overall validity of the standard. attributable to exposure to lead or if pg/100g. Other studies have shown Appendix B to Section 1910.1025-- other forms of diseases in some workers Employee Standard Summary with PbBs well below 80 ;ig/100g. Your PbB is a crucial indicator of the risks to This appendix summarizes key your health, but one other factor is also provisions of the standard that you as a extremely important This factor is the worker should become familiar with. length of time you have had elevated PbBs. The longer you have an elevated The appendix discuses the entire standard, but some portions of the PbB, the greater the risk that large standard were temporarily postponed quantities of lead are being gradually stored in your organs and tissues (body (stayed) by federal court on March 1. 1979. This litigation concerns the burden). The greater your overall body validity of the entire lead standard, and burden, the greater the chances of substantial permanent damage. a final decision is1 expected in 1980.. Most of the lead standard is currently The best way to prevent all forms of lead-related impairments and diseases-- both short term and long term- is to maintain your PbB below 40 legally in effect however. The following discussion in the Appendix notes those few provisions of the standard which have been temporarily stayed. there is any other information or observations which would indicate employee exposure to lead, this must also be considered as part of the initial determination. This initial determination must have been completed by March 31. 1979. If this initial determination shows that a reasonable possibility exists that any employee may be exposed, without regard to respirators, over the action level (30 fig/m') your employer must set up an air monitoring program to determine the exposure level of every employee exposed to lead at your workplace. In canying out this air monitoring program, your employer is not required to monitor the exposure of every 1 ftg/lOOg. The provisions of the standard /. Permissible Exposure Limit (PEL)- employee, but he must monitor a I- are designed with this end in mind. Your paragraph (c) representative number of employeeJhnd employer has prime responsibility to The standards sets a permissible job types. Enough sampling must be| assure that the provisions of the exposure limit (PEL) of fifty micrograms done to enable each employee's , standard are complied with both by the of lead per cubic meter of air (50 fig/m*), exposure level to be reasonably Jf company and by individual workers. averaged over an 8-hour work-day. This represented by at least one full shift' (at You as a worker, however, also have a is the highest level of lead in air to least 7 hours) air sample. In addition, responsibility to assist your employer in which you may be permissibly exposed these air samples must be taken under complying with the standard. You can over an 8-hour workday. Since it is an 8- conditions which represent each Slay a key role in protecting your own ealth by learning about the lead hour average it permits short exposures employee's regular, daily exposure to above the PEL so long as for each 8-hour lead. All initial exposure monitoring hazards and their control learning what work day your average exposure does must have been completed by May 30. the standard requires, following the not exceed the PEL 1979. standard where it governs your own This standard recognizes that your If you are exposed to lead and air actions, and seeing that your employer daily exposure to lead can extend sampling is performed, your employer is complies with provisions governing his beyond a typical 8-hour workday as the required to quickly notify you in writing actions. result of overtime or other alterations in of air monitoring results which represent (4) Reporting signs and symptoms of your work schedule. To deal with this, your exposure. If the results indicate health problems. You should the standard contains a formula which your exposure exceeds the PEL (without immediately notify your employer if you reduces your permissible exposure when regard to your use of respirators), then develop signs or symptoms associated you are exposed more than 8 hours. For your employer must also notify you of with lead poisoning or if you desire example, if you are exposed to lead for this in writing, and provide you with a medical advice concerning the effects of 10 hours a day, the maximum permitted description of the corrective action that current or past exposure to lead on your average exposure would be 40 jtg/m*. will be taken to reduce your exposure. ability to have a tealthy child. You Your exposure must be rechedced by should also noBfy*yaur.employer if you IL Exposure Monitoring-paragraph (d) monitoring every six months if your have difficulty breaChg during a If lead is present in the workplace exposure is over the action level but respirator fit test or while wearing a where you work in any quantity, your below the PEL Air monitoring must be respirator. In each o&hese cases your employer is required to make an initial repeated every three months if you are employer must makqjgyailable to you determination of whether the action exposed over the PEL Your employer appropriate medical-examinations or level is exceeded for any employee. This may discontinue monitoring for you if 2 consultation* These must be provided initial determination must include consecutive measurements, taken at 1-31-80 {Sec. 1910.1025. Appendix 8] Published by THE BUREAU OF NATIONAL AFFAIRS, INC., Washington, D.C. 20037 23 CYWI 3-001201 31:8432 REFERENCE FILE least two weeks apart are below the Your employer is required to select of test material that leaks into the action level. However, whenever there respirators from the seven types listed facepiece of your respirator. is a production, process, control, or in Table II of the Respiratory Protection You must also receive from your personnel change at your workplace section of the standard Any respirator employer proper training in the use of which may result in new or additional chosen must be approved by the Mine respirators. Your employer is required to exposure to lead, or whenever there is Safety and Health Administration teach you how to wear a respirator, to any other reason to suspect a change (MSHA) or the National Institute for know why it is needed, and to which may result in new or additional Occupational Safety and Health understand its limitations. exposure to lead, your employer must (NIOSH). This respirator selection table Until March 1,1980, your employer perform additional monitoring. will enable your employer to choose a must test the effectiveness of your type of respirator which will give you a negative pressure respirator initially and III. Methods of Compliance--paragraph proper amount of protection based on at least every six months thereafter with M your airborne lead exposure; Your a "qualitative fit test" In this test, the fit Your employer is required to assure employer may select a type of respirator of the facepiece is checked by seeing if that no employee is exposed to lead in that provides greater protection than you can smell a substance placed excess of the PEL. The standard that required by the standard: that is, , outside the respirator. If you can. there establishes a priority of methods to be one recommended for a higher is appreciable leakage where the ' used to meet the PEL. Due to the temporary ruling by the United States concentration of lead than is present in facepiece meets your face. your workplace. For example, a The standard provides that if your Circuit Court of Appeals, your employer powered air purifying respirator (PAPR) respirator uses filter elements, you must will not be legally required to use the is much more protective than a typical be given an opportunity to change the preferred engineering and work practice negative pressure respirator, and may filter elements whenever an increase in controls. Until the litigation is also be more comfortable to wear. A breathing resistance is detected.You completed, your employer may meet the PAPR has a filter, cartridge or canister also must be permitted to periodically PEL by requiring you to wear to clean the air, and a power source leave your work area to wash your face respirators. Alternatively, the employer which continuously blows filtered air and respirator facepiece whenever may choose to implement engineering into your breathing zone. Your employer necessary to prevent skin irritation. If and work practice controls even though might make a PAPR available to you to you ever have difficulty in breathing they are not legally required. Also, ease the burden of having to wear a during a fit test or while using a OSHA's previous lead standard is still respirator for long periods of time. The respirator, your employer must make a in effect This does require your standard provides that you can obtain a medical examination available to you to employer to use feasible engineering PAPR upon request but this requirement determine whether you can safely wear and administrative controls to reduce has been stayed as a part of the pending a respirator. The result of this employee exposure levels, but only to a litigation. examination may be to give you a level of 200 micrograms of lead per cubic Your employer must also start a positive pressure respirator (which meter of air (200 jig/m1). Respiratory Protection Program. This reduces breathing resistance) or to IV. Respiratory Protection--paragraph If) Your employer Is required to provide program must include written provide alternative means of protection. procedures for the proper selection, use. cleaning, storage, and maintenance of V. Protective Work Clothing and respirators. Equipment-paragraph (g) and assure your use of respirators when your exposure to lead is not controlled below the PEL by other means. The employer must pay the cost of the respirator. Whenever you request one, your employer is also required to provide you a respirator even if your air exposure level does not exceed the PEL. You might desire a respirator when, for Your employer must assure that your If you are exposed to lead above the respirator facepiece fits properly. Proper PEL, or if you are exposed to lead fit of a respirator facepiece is critical. compounds such as lead arsenate or Obtaining a proper fit on each employee lead azide which can cause skin and eye may require your employer to make irritation, your employer must provide available two or three different mask you with protective work clothing and types. In order to assure that your equipment appropriate for the hazard. If respirator fits properly and that work clothing is provided, it must be facepiece leakage is minimized, provided in a clean and dry condition at example, you have received medical beginning on March 1,1980 your least weekly, and daily if your airborne advice that your lead absorption should employer must give you a "quantitative exposure to lead is greater than 200 pgf be decreased Or, you may intend to fit test" if you use a negative pressure m*. Appropriate protective work have children in the near future, and respirator. Any respirator which has a clothing and equipment can include want to reduce the level of le_%giin your filter, cartridge or canister which cleans coveralls or similar full-body work body to minimise adverse reprodnetiye tne work room air before you breathe it clothing, gloves, hats, shoes or effects. While respirators are the^ptst' and which requires the force of your disposable shoe coverlets, and face satisfactory means of controlling ybur inhalation to draw air thru die filtering shields or vented goggles. Your exposure, they are capable of providing element is a negative pressure employer is required to provide all such significant protection if property qjjpsen. respirator. A positive pressure respirator equipment at no cost to you. He is fitted worn, cleaned maintained and supplies air to you directly. A responsible for providing repairs and replaced when they stop providing quantitative fit test uses a sophisticated replacement as necessary, and also is adequate protection. machine to measure the amount, if any. responsible for the cleaning, laundering Occupational Safety & Health Reporter [Sec. 1910.1025, Appendix Bl 24 CYWI 3-001202 TOXIC SUBSTANCES S-151 31 :8433 or disposal of protective clothing and may not be entered with protective periodic biological monitoring and equipment Contaminated work clothing clothing or equipment unless surface medical examinations. or equipment must be removed in dust has been removed by vacuuming, change rooms and not worn home or you downdraft booth, or other cleaning will extend your exposure and expose method. Finally, workers exposed above your family since lead.from your the PEL must wash both their hands and clothing can accumulate in your house, faces prior to eating, drinking, smoking car, etc. Contaminated clothing which is or applying cosmetics. to be cleaned, laundered or disposed of must be placed in closed containers in the change room. At no time may lead be removed from protective clothing or equipment by any means which disperses lead into the workroom air. All of the facilities and hygiene practices just discussed are essential to minimize additional sources of lead absorption from inhalation or ingestion of lead that may accumulate on you, your clothes, or your possessions. Strict Your employer's obligation to offer you medical surveillance is triggered by the results of the air monitoring program. Medical surveillance must be made available to all employees who are exposed in excess of the action level for more than 30 days a year. The initial phase of the medical surveillance program, which includes blood lead level tests and medical examinations, must be completed for all covered employees no later than August 28.1979. [Section 1910.1025, Appendix B(V) cor compliance with these provisions can rected at 44 FR 68827, November 30, virtually eliminate several sources of Priority within this first round of medical surveillance must be given to 1979] lead exposure which significantly employees whom the employer believes V7. Housekeeping-paragraph (h) contribute to excessive lead absorption. to be at greatest risk from continued exposure (for example, those with the Your employer must establish a housekeeping program sufficient to VIII. Medical Surveillance-paragraph (j) longest prior exposure to lead, or those with the highest current exposure). maintain all surfaces as free as The medical surveillance program is Thereafter, the employer must practicable of accumulations of lead part of the standard's comprehensive, periodically make medical dust Vacuuming is the preferred method approach to the prevention of lead-- surveillance--both biological monitoring of meeting this requirement and the use related disease. Its purpose is to and medical examinations--available to of compressed air to clean Boors and supplement the main thrust of the all covered employees. other surfaces is absolutely prohibited. standard which is aimed at minimizing Dry or wet sweeping, shoveling.' or airborne concentrations of lead and brushing may not be used except where sources of ingestion. Only medical Biological monitoring under the standard consists of blood lead level . (PbB) and zinc protoporphyrin tests af vaccuming or other equally effective methods have been tried and do not work. Vacuums must be used and emptied in a manner which minimizes the reentry of lead into the workplace. VII. Hygiene Facilities andPracticesparagraph (i) The standard requires that change rooms, showers, and filtered air lunchrooms be constructed and made available to workers exposed to lead above the PEL These requirements have temporarily been delayed by the court of appeals in situations where new facilities must be constructed, or where substantial renovations must be made to existing facilities. When the PEL is exceeded and these facilities axe available, however, the employer must assure that food and beverage is not present or consumed, tobacco products are hot present or used, and cosmetics are not applied, except in these facilities. Change-to^hfejihowersvand. lunchrooms, if availabuSbust be used surveillance can determine if the other provisions of the standard have affectively protected you as an individual. Compliance with the standard's provision will protect most workers from the adverse effects of lesd exposure, but may not be satisfactory to protect individual workers (1] who have high body burdens of lead acquired over past years. (2) who have additional' uncontrolled sources of nonoccupational lead exposure, (3) who exhibit unusual variations in lead absorption rates, or (4) who have specific non-work related medical conditions which could be aggravated by lead exposure (e.g- renal disease, anemia). In addition, control systems may fail or hygiene and respirator programs may be inadequate. Periodic medical surveillance of individual workers will help detect those failures. Medical surveillance will also be important to protect your reproductive ability--regardless of whether you are a man or woman. least every 6 months after the initial f*B test A zinc protoporphyrin (ZPP) test a a very useful blood test which measuifck an effect of lead on your body, but thir test has been temporarily stayed by die Court. Thus biological monitoring under the standard is currently limited to PbB testing. If a worker's PbB exceeds 40 jtg/ lOOg the monitoring frequency must be increased from every 6 months to at least every 2 months and not reduced until two consecutive PbBs indicate a blood lead level below 40 pg/lOOg. Each time your PbB is determined to be over 40 pg/i00g, your employer must notify you of this in writing within five working days of his receipt of tbe test results. The employer must also inform you that the standard requires temporary medical removal with economic protection when your PbB exceeds certain criteria (See Discussion of Medical Removal ProtectionParagraph (It)). During die first year of the standard, this removal criterion is 80 pg/lOOg. Anytime your PbB exceeds 80 by workers exposed in excess of the All medical surveillance required by pg/lOOg your employer must make PEL After showering, neclothing or the standard must be performed by or available to you a prompt follow-up PbB equipment worn during tag shift may be under the supervision of a licensed test to ascertain your PbB. If the two worn home, and this includes shoes and physician. The employer must provide tests both exceed 80 pg/ioog and you underwear. Your dwnxiothing worn required medical surveillance without are temporarily removed, then your during the shift should be carried home cost to employees and at a reasonable employer must make successive PbB and cleaned carefully so that it does not time and place. The standard's medical tests available to you on a monthly contaminate your home. Lunchrooms surveillance program has two parts* basis during the period of your removal. 1*31-80 (Sms . 1910.1025, Appendix Bl Published by THE BUREAU OF NATIONAL AFFAIRS, INC., Washington, D.C. 20037 25 CYWl 3-001203 31:8434 REFERENCE FILE Medical examinations beyond the contains a multiple physician review they have acquired a disease or other initial one must be made available on an mechanism which would give you a adverse medical condition as a result of annual basis if your blood lead level chance to have a physician of your occupational lead exposure. If this is exceeds 40 ng/l00g at any time during choice directly participate in the true, these workers might have legal the preceding year. The initial medical surveillance program. If you rights to compensation from public examination will provide information to were dissatisfied with an examination agencies, their employers, firms that establish a baseline to which by a physician chosen by your supply hazardous products to their subsequent data can be compared. An employer, you could select a second employers, or other persons. Some initial medical examination must also be physician to conduct an independent states have laws, including worker made available (prior to assignment) for analysis. The two doctors would compensation laws, that disallow a each employee being assigned for the attempt to resolve any differences of worker who learns of a job-related first time to an area where the airborne opinion, and select a third physician to health impairment to sue, unless the concentration of lead equals or exceeds resolve any firm dispute. This multiple worker sues within a short period of the action level. In addition, a medical physician review mechanism, however, time after learning of the impairment examination or consultation must be has been temporarily delayed by the (This period of time may be a matter of made available as soon as possible if Court of Appeals. As a result, generally months or years.) An attorney can be you notify your employer that you are your employer will choose the physician consulted about these possibilities. It experiencing signs or symptoms who conducts medical surveillance should be stressed that OSHA is in no commonly associated with lead under the lead standard--unless you way trying to either encourage or poisoning or that you have difficulty and your employer can agree on die discourage claims or lawsuits. However, breathing while wearing a respirator or choice of a physician or physicians. since results of the standard's medical during a respirator fit test. You must Some companies and unions have surveillance program can significantly also be provided a medical examination agreed in advance, for example, to use affect the legal remedies of a worker or consultation if you notify your certain independent medical who has scquired a job-related disease employer that you desire medical advice laboratories or panels of physicians. or impairment, it is proper for OSHA to concerning the effects of current or past Any of these arrangements are make you aware of this. exposure to lead on your ability to acceptable so long as required medical The medical surveillance section of procreate a healthy child. surveillance is made available to the standard also contains provisions Finally, appropriate follow-up medical workers. dealing with chelation. Chelation is the examinations or consultations may also The standard requires your employer use of certain drugs (administered in pill be provided for employees who have to provide certain information to a form or injected into the body) to reduce been temporarily removed from physician to aid in his or her the amount of lead absorbed in body exposure under the medical removal examination of you. This information tissues. Experience accumulated by the protection provisions of the standard includes (1) the standard and its medical and scientific communities has (See Part IX. below). appendices, (2) a description of your largely confirmed the effectiveness of The standard specifies the minimum duties as they relate to lead exposure, this type of therapy for the treatment of content of pre-assignment and annual (3) your exposure level, (4) a description very severe lead poisoning. On the other medical examinations. The content of of personal protective equipment you hand, it has also been established that other types of medical examinations and wear. (5) prior blood lead level results, there can be a long list of extremely consultations is left up to the sound and (6) prior written medical opinions harmful side effects associated with the discretion of the examining physician. concerning you that the employer has. use of chelating agents. The medical Pre-assignment and annual medical After a medical examination or community has balanced the advantages examinations must include (1) a detailed consultation the physician must prepare and disadvantages resulting from the work history and medical history, (2) a a written report which must contain (1) use of chelating agents in various thorough physical examination, end (3) the physician's opinion as to whether circumstances and has established a series of laboratory tests designed to you have any medical condition which when the use of these agents is check your blood chemistry and your places you at increased risk of materia) acceptable. The standard includes these kidney function. In addition, at any time impairment to health from exposure to accepted limitations due to a history of upon your request a laboratory lead. (2) any recommended special abuse of chelation therapy by some lead evaluation of male fertility will be made protective measures to be provided to companies. The most widely used (microscopic examination of a sperm you. (3) any blood lead level chelating agents are calcium disodium sample), or a pregnancy test will be determinations, and (4) any EDTA (Ca Nat EDTA), Calcium given. recommended limitation on ybur use of Disodium Venenata (Venenata), and d- The standard does not reqgjre that respirators. This last element must penirillamine (pendllamine or you participate in any of the madjcal include a determination of whether you Cupramine). procedures, tests, etc. which yo^F ' can wear a powered air purifying The standard prohibits "prophylactic employer is required to make available respirator (PAPR) if you are found chelation" of any employee by any to you. Medical surveillance canfc unable to wear a negative pressure person the employer retains, supervises however, play a very important raisin respirator. or controls. "Prophylactic chelation" is protecting your health. You are strongly The medical surveillance program of the routine use of chelating or similarly encouraged, therefore, to participate in a the lead standard may at some point in acting drugs to pnveat elevated blood meaningful fashion. The standard time serve to notify certain workers that levels In workero who are Occupational Safety & Health Reporter tSse. 1910.10SS. Apptndix Bl 2e CYWI 3-001204 TOXIC SUBSTANCES S-184 31:8435 occupationally exposed to lead, or the Excessive lead absorption subjects work out consistent with existing use of these drugs to routinely lower blood lead levels to predesignated you to increased risk of disease. Medical procedures for job assignments. Each removal protection (MRP) is a means of removal must be accomplished in a concentrations believed to be 'safe'. It protecting you when, for whatever manner consistent with existing should be emphasized that where an reasons, other methods, such as collective bargaining relationships. Your employer takes a worker who has no engineering controls, work practices, employer is given broad discretion to symptoms of lead poisoning and has and respirators, have failed to provide implement temporary removals so long chelation carried out by a physician the protection you need. MRP involves as no attempt is made to override (either inside or outside of a hospital) the temproary removal of a worker from existing agreements. Similarly, a solely to reduce the worker's blood lead his or her regular job to a place of removed worker is provided no right to level, that will generally be considered significantly lower exposure without veto an employer's choice which prophylactic chelation. The use of a any loss of earnings, seniority, or other satisfies the standard. hospital and a physician does not mean employment rights or benefits. The that prophylactic chelation is not being purpose of this program is to cease performed. Routine chelation to prevent further lead absorption and allow your increased or reduce current blood lead body to naturally excrete lead which levels is unacceptable whatever the has previously been absorbed. setting. Temporary medical removal can result The standard allows the use of from an elevated blood lead level, or a "therapeutic" or "diagnostic" chelation medical opinion. Up to eighteen months if administered under the supervision of of protection is provided as a result of a licensed physician in a clinical setting either form of removal. The vast with thorough and appropriate medical majority of removed workers, however, monitoring. Therapeutic chelation will return to their former jobs long responds to severe lead poisoning where before this eighteen month period there are marked symptoms. Diagnostic expires. The standard contains special chelation involved giving a patient a provisions to deal with the dose of the drug then collecting all urine extraordinary but possible case where a excreted for some period of time as an longterm worker's blood lead level does aid to the diagnosis of lead poisoning. not adequately decline during eighteen In cases where the examining months of removal. physician determines that chelation is appropriate, you must be notified in writing of this fact before such During the first year of the standard, if your blood lead level is 80 pg/lOOg or treatment. This will inform you of a potentially harmful treatment, and allow you to obtain a second opinion. above you must be removed from any exposure where your air lead level without a respirator would be 100 pg/mJ or above. If you are removed from your [Section 1910.1025, Appendix B(VII) normal job you may not be returned corrected at 44 FR 68827, November 30, until your blood lead level declines to at 1979) least 60 jig/lOOg. These criteria for IX, Medical Removal Protection removal and return will change Paragraph (k) according to the following schedule: In most cases, employers will likely transfer removed employees to other jobs with sufficiently low lead exposure. Alternatively, a worker's hours may be reduced so that the time weighted average exposure is reduced, or he or she may be temporarily laid off if no other alternative is feasible. In all of these situation, MRP benefits must be provided during the period of removal--i.e., you continue to receive the same earnings, seniority, and other rights and benefits you would have had if you had not been removed. Earnings includes more than just your base wage; it includes overtime, shift differentials, incentives, and other compensatiorwou would have earned if you had not teen . removed. During the period of remewai you must also be provided with - appropriate follow-up medical . surveillance. If you were removed because your blood lead level was too high, you must be provided with a monthly blood test If a medical opinion caused your removal, you must be provided medical tests or examinations that the doctor believes to be appropriate. If you do not participate in this follow up medical surveillance, you may lose your eligibility for MRP benefits. ftamovai blood lead 4*9/100 g) Air toad Return Mood ttad 4^9/100 g) When you are medically eligible to return to your former job, your employer Aft* M* 1, 1961_____ _____ _____ _____ __ 60 and ab*......-.............. m moron. Mind above-------- At or batow 40. 90 and atoova-------- At or beta* 40. must return you to your "former job status." This means that you are entitled to the position, wages, benefits, etc- you would have had if you had not been removed. If you would still be in your You may also be removed from exposure evenifjfcttr blood lead levels are below these crifiie if a final medical determinate indicates that you temporarily neqd reduced lead .exposure for medicaTreasons. If the physician who is implementing your employers medical program makes a implement the physician's recommendation. If you are removed in this manner, you may only be returned when the doctor indicates that it is safe for you to do so. The standard does not give specific instructions dealing with what an employer must do with a removed old job if no removal had occurred that is where you go back. If not. you are returned consistent with whatever job assignment discretion your employer would have had if no removal had occurred. MRP only seeks to maintain your rights, not expand them or diminish them. final written opinion recommending worker. Your job assignment upon If you are removed under MRP and your removal or other special protective removal is a matter for you, your you are also eligible for worker measures, your employer must employer and your union (if any) to compensation or other compensation for 12-23-82 [Sac. 1910.1025. Appendix B! Published by THE BUREAU OF NATIONAL AFFAIRS, INC., Washington, D C. 20037 17 CYWI 3-001205 31:8436 REFERENCE FILE lost wages, your employer's MRP XI. Recordkeeping--Paragraph (n) provide the observer with any personal benefits obligation is reduced by the amount that you actually receive from these other sources. This is also true if you obtain other employment during the time you are laid off with MRP benefits. The standard also covers situations where an employer voluntarily removes a worker from exposure to lead due to the effects of lead on the employee's medical condition, even though the standard does not require removal. In these situations MRP benefits must still be provided as though the standard required removal. Finally, it is important to note that in all cases where removal is required, respirators cannot be used as a substitute. Respirators may be used before removal becomes necessary, but not as an alternative to a transfer to a low exposure job, or to a lay-off with MRP benefits. Your employer is required to keep all records of exposure monitoring for airborne lead. These records must include the name and job classification of employees measured, details of the sampling and analytic techniques, the results of this sampling, and the type of respiratory protection being worn by the person sampled. Your employer is also required to keep all records of biological monitoring and medical examination results. These must include the names of the employees, the physician's written opinion, and a copy of the results of the examination. All of the above kinds of records must be kept for 40 years, or for at least 20 years after your termination of employment, whichever is longer. Recordkeeping is also required if you are temporarily removed from your job under the medical removal protection protective devices required to be worn by employees working in the area that is being monitored. The employer must require the observer to wear all such equipment and to comply with all other applicable safety and health procedures. XIV. Effective Date--Paragraph (p) The standard's effective data is March 1.1979, and employer obligations under the standard begin to come into effect as of that date. XV. For Additional Information A. Copies of the Standard and explanatory materials can be obtained free of charge by calling or writing the OSHA Office of Publications, Room S-1212, United States Department of Labor, Washington, D.C 20210: Telephone (202) 528-6138. The following X. Employee Information and program. This record must include your publications are available: Training--Paragraph (1) name and social security number, the 1. The standard and summaiy of the Your employer is required to provide date of your removal and return, how an information and training program for the removal was or is being all employees exposed to lead above the accomplished, and whether or not the action level or who may suffer skin or reason for the removal was an elevated statement of reasons (preamble). Federal Register, Volume 43, pp. 5295253014, November 14,1978. 2. The full statement of reasons eye irritation from lead. This program blood lead level Your employer is (preamble) Federal Register, vol. 43, pp. must inform these employees of the required to keep each medical removal 54354-54509, November 21,1978. specific hazards associated with their record only for as long as the duration of 3. Partial Administrative Stay and work environment protective measures an employee's employment Corrections to the standard, (44 FR which can be taken, the danger of lead The standard requires that if you 5446-5448) January 28,1979. to their bodies (including their request to see or copy environmental 4. Notice of the Partial Judicial Stay reproductive systems), and their rights monitoring, blood lead level monitoring, (44 FR 14554-14555) March 13.1979. under the standard. In addition your or medical removal records, they must 5. Corrections to the preamble. employer must make readily available be made available to you or to a Federal Register, vol. 44, pp. 20680- to all employees, including those representative that you authorize. Your 20681, April 8,1979. exposed below the action level, a copy union also has access to these records. 6. Additional correction to the of the standard and its appendices and Medical records other than PbB's must preamble concerning the construction must distribute to all employees any also be provided upon request to you, to industry. Federal Register, vol 44, p. materials provided to the employer by your physician or to any other person 50338, August 28.1979. the Occupational Safety and Health Administration (OSHA). Your employer is required to complete this training program for all employees whom you may specifically designate. Your union does not have access to your personal medical records unless you. authorize their access. [Appendix B. Section XV. Part A, item 7 revised by 47 FR. 51117, November 12, 1982] by August 28,1979. After this date, all new employees must be trained prior to initial assignment to areas where there is a possibility of exposure over the action level. This training program must also be provided at least annually therm&left. XI. Signs--Paragraph (m) w I Section 1910.1025. Appendix B(XI) corrected at 44 FR 68827, November 30, 1979! XIII. Observations of Monitoring -- Paragraph (o) When air monitoring for lead is performed at your workplace as required by this standard, your 7. Appendices to the standard (Appendices A. B. C), Federal Register. Voi. 44. pp. 6098080995. October 23.1979. & Corrections to appendices. Federal Register. Vol. 44.68828. November 30.1979. 9. Revision to the standard and additional appendices (Appendices 0 and E). Federal Register, Vol. 47, pp. (pages for this notice). November 12.1982. The standard requires that the e following warning sign be posted idp* work areas where the exposure to IffSd exceeds the PEL: -- emptoyer must allow you or someone you designate to act as an observer of the monitoring. Observers are entitled to an explanation of the measurement procedure, and to record the results [Appendix B. Section XV, Part A, item 8 and 9 added by 47 FR 51117, November 12. 1982] B. Additional information about the WARNING obtained. Since results will not normally standard, its enforcement, and your LEAD WORK AREA NO SMOKING OR EATING be available at the time of the monitoring, observers are entitled to record or receive the results of the employer's compliance can be obtained from the nearest OSHA Area Office listed in your telephone directory under This requirement, however, has been monitoring when returned by the United States Govemment/Department stayed by the Court of Appeals. laboratory. Your employer is required to of Labor. Occupational Safety & Health Reporter [Sac. 1910.1025. Appendix B) 18 CYWI 3*001206 TOXIC SUBSTANCES S-1J1 31:8437 Appendix C to Section 1910.1025-- Section 1 provides a detailed action level of 30 pg/m'TWA for more Medical Surveillance Guidelines description of the monitoring procedure than 30 days each year. This program Introduction The primary purpose of the Occupational Safety and Health Act of 1970 is to assure, so far as possible, safe and healthful working conditions for every working man and woman. The including the required frequency of blood testing for exposed workers, provisions for medical removal protection (MRP), the recommended right of the employee to a second medical opinion, and notification and recordkeeping requirements of the consists of periodic blood sampling and medical evaluation to be performed on a schedule which is defined by previous laboratory results, worker complaints or concerns, and the clinical assessment of the examining physician. occupational health standard for inorganic lead was promulgated to protect workers exposed to inorganic lead including metallic lead, all inorganic lead compounds and organic lead soaps. Under this final standard in effect as of March 1,1979, occupational exposure to inorganic lead* is to be limited to 50 pg/m* (micrograms per cubic meter) based on an 8 hour time-weighted average (TWA). This level of exposure eventually must be achieved through a combination of engineering, work practice and other administrative controls. Periods of time ranging from 1 to 10 years are provided for different industries to implement these controls. employer. A discussion of the requirements for respirator use and respirator monitoring and OSHA's position on prophylactic chelation therapy are also included in this section. Under this program, the blood lead level of all employees who are exposed to lead above the action level of 30 pg/n is to be determined at least every six months. The frequency is increased 4o Section 2 discusses the toxic effects .and clinical manifestations of lead poisoning and effects of lead every two months for employees whose last blood lead level was between 40 pg/100 g whole blood and the level intoxication on enzymatic pathways in requiring employee medical removal to heme synthesis. The adverse effects on both male and female reproductive capacity and on the fetus are also discussed. be discussed below. For employees who are removedfrom exposure to lead due to an elevated blood lead, a new blood Section 3 outlines the recommended medical evaluation of the worker ' exposed to inorganic lead including details of the medical history, physical lead level must be measured monthly. A zinc protoporphyrin (ZPP) measurement is strongly recommended on each occasion that a blood lead level The schedule which is based on examination, and recommended measurement is made. ZPP monitoring is individual industry considerations is laboratory tests, which are based on the one of several requirements of the ^ given in Table 1. Until these controls are toxic effects of lead as discussed in standard that has been temporarily t in place, respirators must be used to meet the 50 pgkn* exposure limit The standard also provides for a program of biological monitoring and medical surveillance for ail employees exposed to levels of inorganic lead above the action level of 30pg/m* (TWA) for more than 30 days per year. The purpose of this document is to outline the medical surveillance provisions of the standard for inorganic lead, and to provide further information to the physician regarding the examination and evaluation of workers exposed to inorganic lead. [Section 1910.1025, Appendix C footnote Section 2. stayed by pending litigation over the* - Section 4 provides detailed information concerning the laboratory tests available for the monitoring of exposed workers. Included also is a discussion of the relative value of each lead standard. Unless otherwise notfi in this document, all provisions erf tht standard pertaining to medical ' surveillance and medical removal r protection are currently in effect test and the limitations and precautions An annua) medical examination and which are necessary in the consultation performed under the interpretation of the laboratory results. guidelines discussed in Section 3 is to be [Section 1910.1025, Appendix C corrected at 44 FR 68827, November 30, 1979] made available to each employee for whom a blood test conducted at any time during the preceding 12 months /. Medical surveillance and monitoring requirements for workers exposed to inorganic lead indicated a blood lead level at or above 40 ug/100 g. Also, an examination is to be given to all employees prior to their assignment to an area in which airborne added at 44 FR 68827, November 30, 1979} Under the occupational health standard for inorganic lead, a program lead concentrations read) or exceed the action level. In addition, a medical 'The term inorganic lead used throughout the medical surveillance appendices is meant to be synonymous with the definition of lead set forth in the standard. of biological monitoring and medical surveillance is to be made available to all employees exposed to lead above the Table 1 examination must be provided as soon as possible after notification by an employee that the employee has developed signs or symptoms commonly associated with lead intoxication, that W`- ' " Eflacfea the employee desires medical advice Pamadbta artatm tmd tarotrt* bduatry (x/my Mar. 1, Mar. 1, Mar. t, Mar. 1, Mar. 1* Mar. 1. regarding lead exposure and the ability If7t 1M0 toot 1902 1994 1900 (*naf> to procreate a healthy child, or that the . 200 200 200 100 100 employee has demonstrated difficulty in 90 2. SacowdaryiaadpwiurfcMi ......... --. -- 200 200 200 100 80 90 3. L--d-Bod toaaary manuMcaMwQ ......... . 200 200 too 100 90 90 200 too 100 100 90 90 . 200 200 200 100 60 90 . *1 ootar nduaata*............. ... ..... .................-- 200 10 90 90 80 90 Xbtwm kvu ib b tchinti without mane* or wHW prowebon through centwmton wtpnmnng. iwrt procbo lead due to B risk of Sustaining material ndomr *dnnnM wHt Whit* Saw * aro bang impWiwWS 'Mprou.1 mat b* mad to mow t* 50 /m* impairment to health. Of Otherwise 1-31-80 [Sac. 1910.1025. Appandix Cl Published by THE BUREAU OF NATIONAL AFFAIRS, INC., Washington, D.C. 20037 29 CYWl 3-001207 31:6436 TM1 REFERENCE FILE Mar. 1. 1979- Mar. 1.1960 Mv. 1.1991 Mar. 1. 1992 Mar. 1. 1993 (AnaQ A. Stood toad raoumng <mpto)M mcdfcat romevaL fir**! must >90^100 fl_ _>70>^/i00fl_ >60*g/i00g_ pg/iOO g.. ^9<Vg/T00 g or avaraga o tail vm Mood aam* 6a eordrmad wite aacond totowKy Wood taad tovM wrffun two ptaa oral Mood tumptaa owar praviOMa 9 mordha waaka oi rapc*t> tmwmm a owar a tong*r ama panod) a SO >*g/ 100 g or graatar untaaa taa> Mood tampia * 40 P9/100 g or laaa. S. Paduanqr wMcft amMo^<aaa axpoaad to action taval of taad (30 pQ/m* TWA) must hava Mood taad lava! chscfcad (ZPR m atao strongly raeommandad aach oeeatoon that btood taad o6- tamad.): 1. U* Mood taad taval taw than 40 pg/iOO'g-------------------- Evary 9 months. Evary 9^month*. &wry 9 mortha. Evary 9 month*. Evary month*. 2. Cast Mood taad itvai bahvaan 40 pg/100 g and taval Evary 2 months. Evary 2 months. Evary Months. Evtry 2 months. Evary 2 month* requiring madicai ramoval (saa A abova). 3. Emptoyaaa ramovad from upourt to taad bacauas of an Evsry 1 month _ Evary 1 month . Evary 1 month . Evary 1 month _ Evary 1 month. CPsrnMaWaasOorT^agoauralm* ter worfcam ramovad from aorti dua to an atavatad Mood Mod tavol (without rsgard to raapvater pnttcton).. a Blood Mod tovst confimtod rfte a aacond Mood anatyste. at which ampteyao may ratum to work. PormaaiMa aapoaura without rsgard to raapvator protection a feted by ndustry in TaMa L <100*g/m*9 <50 >*g/m*9 <30pg/ma* <30 j*g/m'9 <3&|*g/m*9hrTWA hr TWA. hr TWA. hr TWA hr TWA <60 pg/100 g_<50 pg/100 g__<40 pg/100 g__ <40 jig/100 g._ <40 ag/109 g Non.--Whan maMcal opinion tndtestas that an amptoysa a at dak of matantf tmpamant bom axpoaura to load, tea phyaiaan can ramova an omployaa from ssposuras aacaadlng tea action lavst for tosa) or raoommond apaoal protect* maaauraa as daamad appropnata and nsestaary. Madicai monrtomg during tea modteal rsmoval pnnod can bs mora Wringoni tean notad in tea taMaatovadtha pfiyvoan ao spaodia* Ratum to work or ramovoi of immsons and tpaaal proteeoom parmnad whan tea phywdato indicatss te* ttte womar * rw tongar * nak of mMMMpOT*'* [Section 1910.1025, Appendix C, Table 2 corrected at 44 FR 68827, November 30, 19791 limited or specially protected pursuant to medical recommendations. Results of biological monitoring or the recommendations of an examining physician may necessitate removal of an employee from further lead exposure pursuant to the standard's medical removal protection (MSP) program. The object of the MRP program is to provide temporary medical removal to workers either with substantially elevated blood lead levels or otherwise at risk of sustaining material health impairment from continued substantial exposure to lead. The following guidelines which are summarized in Table Z were created under the standard for the temporary removal of an exposed employee and his or her subsequent return to work in an exposure area. Under die standard's ultimate worker removal criteria, a worker is to be removed from any work having any eight hour TWA exposure to lead of 30 Mg/m* or more whenever either of the following circumstances apply; (1) a . blbod lead level of 60 pg/100 g or greater is obtained and confirmedfry a second follow-up blood lead leveled* - performed within two weeks after me employer receives the results of th^firet blood sampling test or (2) the average,of the previous throe blood lead """ ' determinations or the average of~afr blood lead determinations conducted during the previous six months. whichever encompasses the longest time employee whose blood lead level period, equals or exceeds 30 pg/100 g, exceeds 40 p.g/100 g. In addition each unless the last blood sample indicates a such employee is to be informed that the blood lead level at or below 40 jig/100 g standard requires medical removal with in which case the employee need not be MRP benefits, discussed below, when an removed. Medical removal is to continue employee's blood lead level exceeds the until two consecutive blood lead levels above defined limits. are 40 fig/100 g or less. In addition to the above blood lead' During the first two years that the ultimate removal criteria are being phased in. the return criteria have been set to assure that a worker's blood lead level hat substantially declined during the period of removal. From March 1, 1979 to March 1.1960, the blood lead level requiring employee medical removal is 80 Mg/100 g. Workers found to have a confirmed blood lead at this level orgreater need only be removed from work having a daily 6 hour TWA exposure to lead at or above 100 pg/m*. Workers so removed are to be returned to work when their blood lead levels are at or below 60 pg/100 g of whole blood From March 1,1980 to March 1,1961, the blood lead level requiring medical removal is 70 pg/100g. During this period workers need only be removed from fobs having a daily 6 hour TWA exposure to lead at or above 50 Mg/m* level criteria, temporary worker removal may aleo take place as a result of medical determinations and recommendations. Written medical opinions must be prepared after each examination pursuant to the standard. If the examining physician includes a medical finding, determination or opinion that the employee has a medical condition which places the employee at increased risk of material health impairment from exposure to lead, then the employee must be removed from exposure to lead at or above the action level Alternatively, if the examining physician recommends special protective measures for an employee (e.g* use of a powered air purifying respirator) or recommends limitations on an employee's exposure to lead, then the employer must implement these recommendations.' Recommendations and are to be returned to work when a may be more stringent than the specific level of SO jig/100 g is achieved. provisions of the standard. The Beguming March 1.1981, return depends examining physidan, therefore, is given on a worker's blood lead level declining to 40 Mg/lOO g of whole blood broad flexibility to tailor special protective procedures to the needsnf As part of the standard, die employer individual employees. This flexibility ie required to notify In writing each extends to the evaluation and \ 0 Occupational Safety & Health Reporter ISk . 1910.1028, Appendix Cl 30 CYWI 3-Q01208 TOXIC SUBSTANCES S-152 31:8439 management of pregnant worker* and opinion concerning potential lead that an employee is at risk of material male and female worker* who are poisoning or toxicity. If an employee health impairment This is based on the planning to raiae children. Bated on the wishes a second opinion, he or she can numerous inadequacies of respirators history, physical examination, and make an appointment with a physician including skin rash where the facepiece laboratory studies, the physician might of his or her choice. This second makes contact with the skin, recommend special protective measures physician will review the findings, unacceptable stress to breathing in some or medical removal for an employee recommendations or determinations of workers with underlying who is pregnant or who is planning to the first physician and conduct any cardiopulmonary impairment difficulty conceive a child when, in the examinations, consultations or tests in providing adequate fit the tendency physician's judgment, continued deemed necessary in an attempt to for respirators to create additional exposure to lead at the current job make a final medical determination. If hazards by interfering with vision, would pose a significant risk. The return the first and second physicians do not hearing, and mobility, and the of the employee to his or her former job agree in their assessment they must try difficulties of assuring the maximum status, or the removal of special to resolve their differences. If they effectiveness of a complicated work' protections or limitations, depends upon cannot reach an agreement then they practice program involving respirators. the examining physician determining must designate a third physician to Respirators do, however, serve a useful, that the employee is no longer at resolve the dispute. This multiple function where engineering and work increased risk of material impairment or physician review mechanism has been practice controls are inadequate by that special measures are no longer temporarily stayed during the pending providing supplementary, interim, or needed. litigation, but OSHA recommends that it short-term protection, provided they are During the period of any form of special protection or removal, the employer must maintain the worker's earnings, seniority, and other employment rights and benefits (as though the worker had not been removed) for a period of up to 18 months. This economic protection will maximize meaningful worker participation in the medical surveillance program, and is appropriate as part of the employer's overall obligation to provide a safe and healthful workplace. The provisions of MRP benefits during be used if disputes arise over medical determinations. The employer must provide examining and consulting physicians with the following specific information: a copy of the lead regulations and all appendices, a description of the employee's duties as related to exposure, the exposure level to lead and any other toxic substances (if applicable), a description of personal protective equipment used, blood lead levels, and all prior written medical opinions regarding the employee in the employer's possession or control The employer must also obtain from the properly selected for the environment in which the employee will be working, properly fitted to the employee, maintained and cleaned periodically^ and worn by the employee when required. In its final standard on occupational exposure to inorganic lead. OSHA has prohibited prophylactic chelation. #. Diagnostic and therapeutic chelation am permitted only under the supervision of a licensed physician with appropriate L medical monitoring in an acceptable clinical setting. The decision to initiate the employee's removal period may, however, be conditioned upon physician and provide the employee with a written medical opinion chelation therapy must be made on an individual basis and take into account participation in medical surveillance. On rare occasions, an employee's blood lead level may not acceptably containing blood lead levels, the physicians's opinion as to whether the employee is at risk of material the severity of symptoms felt to be a result of lead toxicity along with blood lead levels, ZPP levels, and other decline within 18 months of removal impairment to health, any recommended laboratory tests as appropriate. EDTA This situation will arise only in unusual protective measures for the employee if and penicillamine which are the primary circumstances, thus the standard relies further exposure is permitted, as well as chelating agents used in the therapy of on an individual medical examination to any recommended limitations upon an occupational lead poisoning have determine how to protect such an employee's use of respirators. significant potential side effects and employee. This medical determination is Employers must instruct each their use must be justified on the basis to be based on both laboratory values, physician not to reveal to the employer of expected benefits to the worker. including lead levels, zinc in writing or in any other way his or her Unless frank and severe symptoms are protoporphyrin levels, blood counts, end findings, laboratory results, or diagnoses present, therapeutic chelation is not other tests felt to be warranted, as well which are felt to be unrelated to recommended given the opportunity to as the physician's judgment that any occupational lead exposure. They must remove a worker from exposure and symptoms or findings on physical also instruct each physician to advise allow the body to naturally excrete examination are a result of lead toxidty. the employee of any occupationally or accumulated lead. As a diagnostic aid, The medical determination may be that non-occupationally related medical the chelation mobilization test using the employee is incapable of eversafely condition requiring further treatment or CA-EOTA has limited applicability. returning to his or her Htiier job status. evaluation. According to some investigators, the test The medical determination may provide The standard provides for the use of can differentiate between lead-induced additional removal timgpast 18 months respirators where engineering and other and other nephropathies. The test may for some employees or sgecify special primary controls have not been fully also provide an estimation of the mobile protective measures to.oe Implemented. implemented. However, the use of fraction of the total body lead burden. The lead standard provides for a respirator protection shall not be used in Employers are required to assure that multiple physician review in cases lieu of temporary medical removal due accurate records are maintained on where the employee wishes a second to elevated blood lead levels or-fmdings exposure monitoring, medical 1-31-80 [Sac. 1910.1025, Appendix Cl Published by THE BUREAU OF NATIONAL AFFAIRS. INC., Washington, D.C. 20037 31 3.0012 c-rm 31:8440 REFERENCE FILE surveillance, and medical removal for effects to the parents and developing to the later stages of clinical disease, each employee. Exposure monitoring fetus. The adverse effects of lead on disruption of these enzyme processes and medical surveillance records must reproduction are being actively over a working lifetime is considered to be kept for 40 years or the duration of researched and OSHA encourages the be a material impairment of health. employment plus 20 years, whichever is longer, while medical removal records must be maintained for the duration of employment. All records required under the standard must be made available upon request to the Assistant Secretary of Labor for Occupational Safety and Health and the Director of the National Institute for Occupational Safety and Health. Employers must also make environmental and biological monitoring and medical removal records available to affected employees and to former employees or their authorized employee representatives. Employees or their specifically designated representatives have access to their entire medical surveillance records. In addition, the standard requires that the employer inform all workers exposed to lead at or above the action level of the provisions of the standard physician to remain abreast of recent developments in the area to best advise One of the eventual results of lead- pregnant workers or workers planning induced inhibition of enzymes in the to conceive children. heme synthesis pathway is anemia which can be asymptomatic if mild but The spectrum of health effects caused associated with a wide array of by lead exposure can be subdivided into symptoms including dizziness, fatigue, five developmental stages: normal, and tachycardia when more severe. physiological changes of uncertain Studies have indicated that lead levels significance, pathophysiological as low as 50 pg/100 g can be associated changes, overt symptoms (morbidity), with a definite decreased hemoglobin. ~ and mortality. Within this process there although most cases of lead-induced are no sharp distinctions, but rather a anemia, as well as shortened red-cell continuum of effects. Boundaries survival times, occur at lead levels between categories overlap due to the exceeding 80 pg/100 g Inhibited wide variation of individual responses hemoglobin synthesis is more common and exposures in the working in chronic cases whereas shortened population. OSHA's development of the erythrocyte life span is more common in lead standard focused on. acute cases. pathophysiological changes as well as later stages of disease. ` In lead-induced anemias, there is 1. Heme Synthesis Inhibition. The usually a reticulocytosis along with the presence of basophilic stippling, and and all its appendices, the purpose and earliest demonstrated effect of lead ringed sideroblasts. although none of the description of medical surveillance and involves its ability to inhibit at least two above are pathognomonic for lead- provisions for medical removal protection if temporary removal is enzymes of the heme synthesis pathway at very low blood levels. Inhibition of induced anemia. required. An understanding of the delta aminolevulinic acid dehydrase 2. NeurologicalEffects. Inorganic lead potential health effects of lead exposure (ALA-D) which catalyzes the has been found to have toxic effects on by all exposed employees along with conversion of delta-aminolevulinic acid both the central and peripheral nervous full understanding of their rights under (ALA) to protoporphyrin is observed at systems. The earliest stages of lead- the lead standard is essential for an a blood lead level below 20 ng/100 g induced central nervous system effects effective monitoring program. whole blood. At a blood lead level of 40 first manifest themselves in the form of [Section 1910.1025, Appendix C(I) cor ug/100 g. more than 20% of the behavioral disturbances and central rected at 44 FR 68827, November 30, population would have 70% inhibition of. nervous system symptoms including 1979] ALA-D. There is an exponential irritability, restlessness, insomnia and increase in ALA excretion at blood lead other sleep disturbances, fatigue, II. Adverse health effects ofinorganic levels greater than 40 fig/100 g. vertigo, headache, poor memory, tremor, lead Although the toxicity of lead has been known for 2.000 years, the knowledge of the complex relationship between lead exposure and human response is still being refined. Significant research into the toxic properties of lead continues throughout the world, and it should be anticipated that our understanding of thresholds of effects and margins of safety will be improved in future years. The provisions of the lead standard are founded on two prime jne$Ucat judgments: first the preventjgn.of adverse health effects from Sjposiire to lead throughout a working lifetime Another enzyme, ferrochelatase, is also inhibited at low blood lead levels. Inhibition of ferrochelatase leads to increased free erythrocyte protoporphyrin (FEP) in the blood which can then bind to zinc to yield zinc protoporphyrin. At a bloiod lead level of SO pg/100 g or greater, nearly 100% of the population will have an increase in FEP. Ihere is also an exponential relationship between blood lead levels greater than 40 pg/100 g and the associated ZPP level which has led to the development of the'ZPP screening test for lead exposure. depression, and apathy. With more severe exposure, symptoms can progress to drowsiness, stupor, hallucinations, delerium, convulsions and coma. The most severe and acute form of lead poisoning which usually follows ingestion or inhalation of large amounts of lead is acute encephalopathy which may arise precipitously with the onset of intractable seizures, coma, cardiorespiratory arrest and death within 48 hours. While there is disagreement about what exposure levels are needed to produce the earliest symptoms, most requires that worker blood lfad levels While the significance of these effects experts agree that symptoms definitely be maintained at or below 4tg&/100 g is subject to debate, it is OSHA's can occur at blood lead levels of 80 $ig/ and second, the blood lead lews of position that these enzyme disturbances 100 g whole blood and therefore workers, male or female, who intend to are early stages of a disease process recommend a 40 pg/100 g maximum. parent in the near future should be which may eventually result in the The central nervous system effects maintained below 30 pg/100 g to clinical symptoms of lead poisoning. frequently are not reversible following minimize adverse reproductive health Whether or not the effects do progress discontinued exposure or chelation Occupational Safety & Health Reporter (Sac. 1910.1028. Appendix C) 32 CYWI 3-001210 TOXIC SUBSTANCES S-1S1 31:8441 therapy and when improvement does occur, it is almost always only partial. The peripheral neuropathy resulting glomeruli and dilated and atrophied blood are comparable to concentrations proximal tubules; all represent end stage of lead in the umbilical cord at birth. kidney disease. Azotemia can be Transplacental passage becomes from lead exposure characteristically progressive, eventually resulting in frank detectable at 12-14 weeks of gestation involves only motor function with uremia necessitating dialysis. There is and increases until birth. minimal sensory damage and has a occasionally associated hypertension There is little direct data on damage marked predilection for the extensor and hyperuricemia with or without gout to the fetus from exposure to lead but it muscles of the most active extremity. Early kidney disease is difficult to is generally assumed that the fetus and The peripheral neuropathy can occur detect The urinalysis is normal in early newborn would be at least as with varying degrees of severity. The lead nephropathy and the blood urea susceptible to neurological damage as earliest and mildest form which can be nitrogen and serum creatinine increase young children. Blood lead levels of 50- detected in workers with blood lead only when two-thirds of kidney function 60 ug/100 g in children can cause levels as low as 50jig/l00 g is is lost Measurement of creatinine significant neurobehavioral impairments manifested by slowing of motor nerve clearance can often detect earlier and there is evidence of hyperactivity at conduction velocity often without disease as can other methods of blood levels as low as 25 ug/100 g. clinical symptoms. With progression of measurement of glomerular filtration Given the overall body otliterature - the neuropathy there is development of rate. An abnormal Ca-EDTA concerning the adverse health effects of painless extensor muscle weakness mobilization test has been used to lead in children, OSHA feels that the usually involving the extensor muscles differentiate between lead-induced and blood lead level in children should be of the fingers and hand in the most other nephropathies, but this procedure maintained below 30 ug/100 g with a active upper extremity, followed in is not widely accepted. A form of population mean of 15 ug/100 g. Blood severe cases by wrist drop or. much less Fanconi syndrome with aminoaciduria, lead levels in the fetus and newborn commonly, foot drop. glycosuria, and hyperphosphaturia likewise should not exceed 30 ug/100 g. In addition to slowing of nerve indicating severe injury to the proximal Because of lead's ability to pass conduction, electromyographical studies renal tubules is occasionally seen in through the placental barrier and also in patients with blood lead levels children. because of the demonstrated adverse greater than SO pg/100 g have 5. Reproductive effects. Exposure to effects of lead on reproductive function demonstrated a decrease in the number lead can have serious effects on in both the male and female as well as of acting motor unit potentials, an reproductive function in both males and the risk of genetic damage of lead oh * increase in the duration of motor unit females. In male workers exposed to both the ovum and sperm. OSHA i'. potentials, and spontaneous lead there can be a decrease in sexual recommends a 30 ug/100 g maximum f pathological activity including drive, impotence, decreased ability to permissible blood lead level in both f fibrillations and fasciculations. Whether produce healthy sperm, and sterility. males and females who wish to bear f' these effects occur at levels of 40 pg/100 Malformed sperm (teratospermia), children. .. g is undetermined. decreased number of sperm 6. Other toxic effects. Debate and While the peripheral neuropathies can [hypospermia), and sperm with research continue on the effects of lead occasionally be reversed with therapy, decreased motility (asthenospermia) can on the human body. Hypertension has again such recovery is not assured all occur. Teratospermia has been noted frequently been noted in occupationally particularly in the more severe at mean blood lead levels of S3 jig/100 g exposed individuals although it is neuropathies and often improvement is and hypospermia and asthenospermia at difficult to assess whether this is due to only partial. The lack of reversibility is 41 ug/100 g. Furthermore, there appears lead's adverse effects on the kidney or if felt to be due in part to segmental to be a dose-response relationship for some other mechanism is involved. demyelination. teratospermia in lead exposed workers. Vascular and electrocardiogarphic 3. Gastrointestinal. Lead may also Women exposed to lead may changes have been detected but have affect the gastrointestinal system producing abdominal colic or diffuse abdominal pain, constipation, obstipation, diarrhea, anorexia, nausea experience menstrual disturbances including dysmenorrhea, menorrhagia and amenoiThea. Following exposure to lead, women have a higher frequency of not been well characterized. Lead is thought to impair thyroid function and interfere with the pituitary-adrenal axis, but again these effects have not been and vomiting. Lead colic rarely develops sterility, premature births, spontaneous well defined. at blood lead levels below SO pg/100 g. miscarriages, and stillbirths. 4. Renal Renal toxicity represents ons Germ cells can be affected by lead - ID. Medical Evaluation of the most serious health effects of lead and cause genetic damage in the egg or The most important principle in poisoning. In the early stages of disease sperm cells before conception and result evaluating a worker for any nuclear inclusion bodies can frequently in failure to implant miscarriage, occupational disease including lead be identified in proximal.renal tubular stillbirth, or birth defects. poisoning is a high index of suspicion on cells. Renal function ifeelns normal Infants of mothers with lead poisoning the part of the examining physician. As and the changes in thitttage are have a higher mortality during the first discussed in Section 2, lead can affect probably reversible. V|th more year and suffer from lowered birth numerous organ systems and produce a advanced disease there fs progressive weights, slower growth, and nervous interstitial fibrosis antHInpatred renal system disorders. Wide array of signs and symptoms, most of which are non-specific and subtle in function. Everituallyexttaslve Lead can pass through the placental nature at least in the early stages of interstitial fibrosis ensues with sclerotic barrier and lead levels in the mother's disease. Unless serious concern for lead 1-31-80 [Sue. 1910.1025, Appandix Cl Published by THE BUREAU OF NATIONAL AFFAIRS, INC., Washington, D.C. 20037 CYWI 3-001211 31:8442 REFERENCE FILE toxicity is present many of the early exposures should be elicited Any potential blood toss through the clues to diagnosis may easily be previous history.of hematological, gastrointestinal tract overlooked. neurological, gastrointestinal, renal A complete neurological examination The crucial initial step in the medical psychological gynecological, genetic, or should include an adequate mental evaluation is recognizing that a worker's reproductive problems should be status evaluation including a search for employment can result in exposure to specifically noted behavioral and psychological lead. The worker will frequent]ybe able A careful and complete review of disturbances, memory testing, to define exposures to lead and lead systems must be performed to assess evaluation for irritability, insomnia, containing materials but often will not both recojpiized complaints and subtle hallucinations, and mental clouding. volunteer this information unless or slowly acquired symptoms which the Gait and coordination should be specifically asked. In other situations worker might not appreciate a* being examined along with close observation the worker may not know of any significant The reviewof symptoms for tremor. A detailed evaluation of exposures to lead but the suspicion should include the following: peripheral nerve function including might be raised on the part of the General--weight loss, fatigue, careful sertsory and motor function physician because of the Industry or decreased appetite. testing' is warranted. Strength testing occupation of the worker. Potential Head Eyes, Ears, Nose, Threat particularly of extensor muscle groups occupational exposure to lead and its (HEENT)--headaches, visual of all extremities is of fundamental compounds occur in at least 120 disturbances or decreased visual acuity, importance. occupations. Including lead smelting, the hearing deficits or tinnitus, pigmentation Cranial nerve evaluation should also manufacture of lead storage batteries, of the oral mucosa, or metallic taste in be included in the routine examination. the manufacture of lead pigments and mouth. The abdominal examination should products containing pigments, solder Cardio-pulmonpry--shortness of include auscultation for bowel sounds manufacture, shipbuilding and ship breath: cough, chest pains, palpitations, and abdominal bruits and palpation for repair, auto manufacturing, construction, or orthopnea. organomegaly, masses, and diffuse and painting. Gastrointestinal--nausea, vomiting Once the possibility for lead exposure heartburn, abdominal pain, constipation is raised, the focus can then be directed or diarrhea. toward eliciting information from the Neurologic--irritability, insomnia, medical history, physical exam, and weakness (fatigue), dizziness, loss of finally from laboratory data to evaluate memory, confusion, hallucinations, the worker for potential lead toxicity. incoordination, ataxia, decreased A complete and detailed work history strength in hands or feet, disturbances is Important in the initial evaluation. A in gait difficulty in climbing stairs, or listing of all previous employment with seizures. abdominal tenderness. Cardiovascular examination should evaluate possible early signs of congestivqheart failure] Pulmonary status should be addressed particularly if respirator protection is contemplated. As part of the medical evaluation, tbe lead standard requires the following laboratory studies: information on Work processes, Hematologic--pallor, easy fatigability, 1. Blood lead level exposure to fumes or dust known abnormal blood lose, melena. 2. Hemoglobin and hematocrit exposures to lead or other toxic Reproductive (mala and female and determinations, red cell indices, and substances, respiratory protection used, spouse where relevant)--history of examination of the peripheral blood and previous medical surveillance infertility, impotence, low of libido, smear to evaluate red blood cell should all be Included in the worker's abnormal menstrual periods, history of morphology record Where exposure to lead is miscarriages, stillbirths, or children with 3. Blood urea nitrogen suspected information concerning on- birth defects. 4. Serum.creatinine the-job personal hygiene, smoking or Musculo-skeletal--muscle and joint 5. Routine urinalysis with microscopic eating habits in work areas, laundry pains. examination. procedures, end use of any protective The physical examination should (LA zinc protoporphyrin level (This clothing or respiratory protection emphasize the neurological requirement is currently not in effect equipment should be noted A complete gastrointestinal and cardiovascular due to the pending litigation, but is work history is essential in the medical systems. The worker's weight and blood recommended nonetheless). evaluation of a worker with suspected pressure should be recorded and the In addition to tha above, the physician lead toxicity, especially when long term oral mucosa checked for pigmentation is authorized to order any further effects such as neurotoxicity and characteristic of a possible Burtonian or laboratory or other tests which he or she nephrotoxicity are considered. lead line on the gingiva. It should be deems necessary in accordance with The medical history Is also of noted, however, that the lead Una may sound medical practice. The evaluation fundamental importance and;should- not be present even in (even lead must also include pregnancy testing or include a listing of all past aodatnent poisoning if good oral hygiene is laboratory evaluation of male fertility if medical conditions, current aedBtttpns practiced.. requested by the employee. including proprietary drug intake, t The preaanceof pallor on akin Additionsi teats which are probably previous surgeries and hospitalizetiSha, examination may indicate an anemia, not warranted on a routine basis but allergies, smoking history, alcohol fc. which if severe might also be associated may be appropriate when blood lead consumption, ana also non-occupatfonei with a tachycardia. If an anemia is and ZPP levels are equivocal include lead exposures suck as hobbies _ suspected, an active March for blood delta aminolevulinic addend (hunting, riflery). Also known childhood loss should be undertaken including coproporphyrin concentrations in the Occupational Safety & Health Reporter [Sac. 1910.1025, Appendix C] 34 c y w i 3-001212 TOXIC SUBSTANCES S-186 31:8443 urine, and dark-field illumination for total lead is deposited there. A very (mcicity than the level of blood lead detection of basophilic stippling in red important component of the total lead itself. The level of ZPP reflects lead blood cells. body burden is lead in soft tissue (liver, absorption over the preceding 3 to 4 If an anemia is detected further kidney, and brain). This fraction of the months, and therefore is a better studies including a careful examination lead body burden, the biologically active indicator of lead body burden. The ZPP of the peripheral smear; reticulocyte lead, is not entirely reflected by blood requires more time than the blood lead coum. stool for occult blood, serum iron, lead levels since it is a function of the to read significantly elevated levels: the total iron binding capacity, bilirubin, and, dynamics of lead absorption, distribution, return to normal after discontinuing lead if appropriate, vitamin BI2 and folate deposition in bone and excretion. Follow exposure is also slower. Furthermore, may be of value in attempting to identify ing discontinuation of exposure to lead, the ZPP test is simpler, faster, and less the cause of the anemia. if a peripheral neuropathy is suspected, nerve conduction studies are warranted the excess body burden is only slowly mo- expensive to perform and no bilized from bone and other relatively sta contamination is possible. Many ble body stores and excreted. Consequent investigators believe it is the most both for diagnosis and as a basis to moni ly, a high blood lead level may only reliable means of monitoring chronic. tor any therapy. represent recent heavy exposure to lead lead absorption. If renal disease is questioned, a.24 without a significant total body excess and Zinc protoporphyrin results from the hour urine collection for creatinine likewise a low blood lead level does not inhibition of the enzyme ferrochelatase clearance, protein, and electrolytes may exclude an elevated total body burden of which catalyzes the insertion of an iron be indicated. Elevated uric add levels may result from lead-induced renal lead. molecule into the protoporphyrin molecule, which then becomes heme. If disease and a serum uric add level might be performed. Also due to its correlation with recent An electrocardiogram end chest x-ray exposures, the blood lead level may may be obtained as deemed appropriate. vary considerably over short time Sophisticated and highly specialized intervals. testing'should riot be done routinely and To minimize laboratory error and where indicated shouldrie under the erroneous results due to contamination, direction of a spedalist blood specimens must be carefully iron is not inserted into the molecule then zinc, having a greater affinity for protoporphyrin, takes the place of the iron, forming ZPP. An elevation in the level of circulating ZPP may occur at blood lead levels aa low as 20-30 pg/100 g in some workeif, Once the blood lead level has rbachetW ; (Section 1910.1025, Appendix CdiD collected after thorough cleaning of the 40 ixg/100 g there is more markedzisep corrected at 44 FR 68827, November 30, 1979} skin with appropriate methods using lead-free blood containers and analyzed the ZPP value from its normal range ofc less than 100 ng/100 ml. Increases in IV. Laboratory Evaluation The blood lead level it present remains the single most important test to monitor lead exposure arid is the test bye reliable laboratory. Under the standard, samples must be analyzed in laboratories which are approved by the Center for Disease Control (CDC) or used in the medical surveillance which have received satisfactory grades program under the lead standard to in proficiency testing by the CDC in the guide employee medical removal. The previous year. Analysis is to be ZPP which has several advantages over the blood lead level Is, due to die pending litigation, not required under made using atomic absorption spectro photometry, anodic stripping voltam metry, or any method which meets the the standard. Because of its relatively accuracy requirements set forth by the recent development and the lack of standard. extensive data concerning its interpretation, the ZPP currently remains an ancillary teat This section will discuss the blood lead level and ZPP in detail and will outline their relative advantages and disadvantages. Other blood tests currently available to evaluate lead exposure will also be reviewed. The blood lead leveljs a good index of current or recentiead'aajerptioa when there is no anemia pwent and when the worker has not taken any chelating agents. HoweveiHslood lead levels along with urinary laed levels do not necessarily indicate the total body The determination of lead in urine is generally considered a less reliable monitoring technique than analysis of whole blood primarily due to individual variability in urinary excretion capacity as well as the technical difficulty of obtaining accurate 24 hour urine collections. In addition, worker* with renal insufficiency, whether due to lead or some other cause, may have decreased lead clearance and consequently urine lead levels may underestimate the true lead burden. Therefore, urine lead levels should not be used as a routine teat blood lead levels beyond 40 pg/100 g * are associated with exponential increases in ZPP. Whereas blood lead levels fluctuate over short time spans. ZPP levels remain relatively stable. ZPP is measured directly in red blood cells and is present for the cell's entire 120 day life-span. Therefore, the ZPP level in blood reflects the average ZPP production over the previous 3-4 months and consequently the average lead exposure during that time interval. it is recommended that a hematocrit be determined whenever a confirmed ZPP of 50 Mg/100 ml whole blood is obtained to rule out a significant underlying anemia. If the ZPP is in excess of 100 pg/100 ml and not associated with abnormal elevations in blood lead levels, the laboratory should be checked to be sure that blood leads were determined using atomic absorption spectrophotometry, anodic stripping voltametry, or any method which meets the accuracy re quirements set forth by the standard by a CDC aproved laboratory which is experienced in lead level burden of lead and are not adequate The zinc protoporphyrin test unlike determinations. Repeat periodic blood measures of past exposure. One reason the blood lead determination, measures lead studies should be obtained in all for this is that lead has a high affinity an adverse metabolic effect of lead and individuals with elevated ZPP levels to for bone and up to 90% of the body's as such is a better indicator of lead be certain that an associated elevated blood lead level has not been missed 3-31-83 [Sec. 1910.1025. Appendix C) Published by THE BUREAU OF NATIONAL AFFAIRS, INC., Washington, D.C. 20037 .* 49 CYWI 3-001213 31:8444 REFERENCE FILE due to transient fluctuations in blood Summary. The Occupational Safety leads. and Health Administration's standard ZPP has a characteristic fluorescence for inorganic lead places significant spectrum with a peak at 594 nm which is emphasis on the medical surveillance of detectable with a hematofluorimeter. all workers exposed to levels of The hematofluorimeter is accurate and inorganic lead above the action level of portable and can provide on-site, 30 pg/m*TWA. The physician has a instantaneous results for workers who fundamental role in this surveillance can be frequently tested via a Anger program, and in the operation of the prick. medical removal protection program. However, careful attention must be Even with adequate worker education given to calibration and quality control on the adverse health effects of lead and procedures. Limited data on blood appropriate training in work practices, lead--ZPP correlations and the ZPP personal hygiene and other control levels which are associated with the measures, the physician has a primary adverse health effects discussed in responsibility for evaluating potential Section 2 are the major limitations of the lead toxicity in the worker. It is only test. Also it is difficult to correlate ZPP through a careful and detailed medical levels with environmental exposure and and work history, a complete physical there is some variation of response with examination and appropriate laboratory age and sex. Nevertheless, the ZPP testing that an accurate assessment can promises to be an important diagnostic be made. Many of the adverse health test for the early detection of lead toxicity and its value will increase as more data is collected regarding its relationship to other manifestations of effects of lead toxicity are either irreversible or only partially reversible and therefore early detection of disease is very important. lead poisoning. Levels of delta-aminolevulinic acid (ALA) in the urine are also used as a measure of lead exposure. Increasing concentrations of ALA are believed to result from the inhibition of the enzyme delta-aminolevulinic add dehydrase (ALA-D). Although the test is relatively This document outlines the medical monitoring program as defined by the occupational safety and health standard for inorganic lead. It reviews the adverse health effects of lead poisoning and describes the important elements of the history and physical examinations as they relate to these adverse effects. easy to perform, inexpensive, and rapid Finally, the appropriate laboratory the disadvantages include variability in testing for evaluating lead exposure and results, the necessity to collect a toxicity is presented. complete 24 hour urine sample which It is hoped that this review and has a specific gravity greater than 1.010, discussion will give the physician a and also the fact that ALA decomposes better understanding of the OSHA in the presence of light standard with the ultimate goal of The pattern of porphyrin excretion in protecting the health and well-being of the urine can also be helpful in the worker exposed to lead under his or identifying lead intoxication. With lead her care. poisoning, the urine concentrations of Appendix D to Section 1910.1025--Qualitative coproporphyrins 1 and IL porphobilinogen and uroporphyrin I rise. Fit Test Protocols [Appendix D added by 47 FR 51117, The most important increase, however, November 12, 1982; corrected by 48 FR is that of coproporphyrin 01; levels may 9641. March 8, 1983) exceed 5,000 pg/1 in the urine in lead This appendix specifies the only allowable poisoned individuals, but its correlation with blood lead levels and ZPP are not as good as those of ALA,Jgcreases In qualitative fit test protocols permissible for compliance with paragraph (f)(3)(ii). I. Isoamyl Acetate Protocol urinary porphyrins are norcfiagnoatlc of lead toxicity and may be te^gam ' porphyria, some liver diseased and in patients with high reticulocy. count*. A. Odor threshold screening. 1. Three 1-liter glass jars with metal lids (e.g. Mason or Belt jars) are required. 2. Odor-free water (e.g. distilled or spring water) at approximately 2S*C shall be used [Section- 1910.1025, Appenffix, C(IV) for the solutions. corrected at 44 FR 68827, November 30, 3. The isoamyl acetate (IAA) (also known 1979] as isopentyl acetate) stock solution is prepared by adding 1 cc of pure IAA to 800 cc of odor free water in a 1-liter jar and shaking for 30 seconds. This solution shall be prepared new at least weekly. 4. The screening test shall be conducted in a room separate from the room used for actual fit testing. The two rooms shall be well ventilated but may not be connected to the same recirculating ventilation system. 5. The odor test solution is prepared in a second jar by placing, .4 cc of the stock solution into 500 cc of odor free water using a clean dropper or pipette. Shake for 30 seconds and allow to stand for two to three minutes so that the IAA concentration above the liquid may reach equilibrium. This, solution may be used for only one day. 6. A test blank is prepared in a third jar by adding S00 cc of odor free water. 7. The odor test and test blank jars shall be labelled 1 and 2 for jar identification. If the labels are put on the lids they can be periodically dried off and switched to avoid people thinking the same jar always has the IAA. 8. The following instructions shall be typed on a card and placed on the table in front of the two test jars (i.e. 1 and 2): "The purpose of this test is to determine if you can smell banana oil at a low concentration. The two bottles in front of you contain water. One of these bottles also contains a small amount of banana oil. Be sure the covers are on tight, then shake each bottle for two seconds. Unscrew the lid of each bottle, one at a time, and sniff at the mouth of the bottle. Indicate to the test conductor which bottle contains banana oil." 9. The mixtures used in the IAA odor detection test shall be prepared in an area separate from where the test is performed, in order to prevent olfactory fatique in the subject. 10. If the test subject is unable to correctly identify the jar containing the odor test solution, the IAA QLFT may not be used. 11. If the test subject correctly identifies the jar containing the odor test solution he may proceed to respirator selection and fit testing. B. Respirator selection. 1. The test subject shall be allowed to select the most comfortable respirator from a large array of various sizes and manufacturers that includes at least three sizes of elastomeric half facepieces and units of at least two manufacturers. 2. The selection process shall be conducted in a room separate from the fit-test chamber to prevent odor fatigue. Prior to the selection process, the test subject shall be shown how to put on a respirator, how it should be positioned on the face, how to set strap tension and how to assess an "comfortable" respirator. A mirror shall be available to assist the subject in evaluating the fit and positioning of the respirator. This may not Occupational Safety & Health Reporter (Sec. 1910.1025, Appendix D] 50 3-00121^ TOXIC SUBSTANCES S-186 31:8445 constitute his formal training on respirator use. only a review. 3. The test subject should understand that he is being asked to select the respirator which provides the mostj:omfortable fit for him. Each respirator represents a different size and shape and, if fit properly, will provide adequate protection. 4 The test subject holds each facepiece up to his face and eliminates those which arc obviously not giving a comfortable fit. Normatly. selection will begin with a half mask and if a fit cannot be found here, the subject will be asked to go to the full facepiece respirators. (A small percentage of users will not be able to wear any half-mask.) 5. The more comfortable facepieces are recorded: the most comfortable mask is donned and worn at least five minutes to assess comfort. Assistance in assessing comfort can be given by discussing the points in =6 below. If the test subject is not familiar with using a particular respirator, he shall be directed to don the mask several times and to adjust the straps each time, so that he becomes adept at setting proper tension on the straps. a. Assessment of comfort shall include reviewing the following points with the test subject: Chin properly placed. Positioning of mask on nose. Strap tension. Fit across nose bridge. Room for safety glasses. Distance from nose to chin. Room to talk. Tendency to slip. Cheeks filled out. Self-observation in mirror. Adequate time for assessment. 7. The test subject shall conduct the conventional negative and positive-pressure fit checks (e.g. see ANSI Z88-2-1980). Before conducting the negative- or positive-pressure checks, the subject shall be told to "seat" his mask by rapidly moving the head side-to-side and up and down, taking a few deep breaths. 8. The test subject is now ready for fit testing. 9. After passing the fit test, the test subject shall be questioned again regarding the comfort of the respirator. If it has become uncomfortable, another model of respirator shall be tried. 10. The employee shall be given the opportunity to select e different facepiece and be retested if during the first two weeks of on-the-job wear the chosen facepiece becomes unacceptaSrfcuncomfortable. C. Fittest. C* - - 1. The fit test chambeFkhall be substantially similar to a clear 55 gallon drum liner suspended inverte^over a 2 foot diameter frame, so that & top of chamber is about 6 inches_above_the test subject's head. The inside top center of the chamber shall have a small hook attached. 2. F.ach respirator used for the fitting and fit testing shall be equipped with organic vapor cartridges or offer protection against organic v apors. The cartridges or masks shall be changed at least weekly. 3. After selecting, donning, and properly adjusting a respirator himself, the test subject shall wear it to the fit testing room. This room shall be separate from the room used for odor threshold screening and respirator selection, and shall be well ventilated, as by an exhaust fan or lab hook, to prevent general room contamination. 4 A copy of the following test exercises and lainbow (or equally effective) passage shall be taped to the inside of the test chamber: Test Exercises i. Normal breathing ii. Deep breathing. Be certain breaths are deep and regular. tii. Turning head from side-to-side. Be certain movement is complete. Alert the test subject not to bump the respirator on the shoulders. Have the test subject inhale when his head is at either side. iv. Nodding head up-and-down. Be certain motions are complete and made about every second. Alert the test subject not bump the respirator on the chest. Have the test subject inhale when his head is in the fully up position. v. Talking. Talk aloud and slowly for several minutes. The following paragraph is called the Rainbow Passage. Reading it will result in a wide range of facial movements, and thus be useful to satisfy this requirement. Alternative passages which serve the same purpose may also be used. Rainbow Passage When the sunlight strikes raindrops in the air. they act like a prism ar.d form a rainbow. The rainbow is a division of white light into many beautiful colors, these take the shape of a long round arch, with its path high above, and its two ends apparently beyond the horizon. There is. according to legend, a boiling pot of gold at one end. People look, but no one ever finds it When a man looks for something beyond reach, his friends say he is looking for the pot of gold at the end of the rainbow. vi. Normal breathing. 5. Each test subject shall wear his respirator for at least 10 minutes before starting the fit test. 6 Upon entering the test chamber, the test subject shall he given a 6 inch by 5 inch piece of paper tuwel or other porous absorbent single ply material, folded in half and wetted with three-quarters of one cc of pure 1AA. The test subject shall hang the wet towel on the hook at the top of the chamber. 7. Allow two minutes for the IAA test concentration to be reached before starting the fit-test exercises. This would be an appropriate time to talk with the test subject, to explain the fit test the importance,of his cooperation, the purpose for the head exercises, or to demonstrate some of the exercises. 8. Each exercise described in No. 4 above shall be performed for at least one minute. 9. If at any time during the test, the subject detects the banana-like odor of IAA. he shall quickly exit from the test chamber and leave the test area to avoid olfactory fatigue. 10. Upon returning to the selection room, the subject shall remove the respirator, repeat the odor sensitivity test, select and put on another respirator, return to the test chamber, etc. The process continues until a respirator that fits well has been found. Should the odor sensitivity test be failed, the subject shall wait about 5 minutes before retesting. Odor sensitivity will usually have returned by this time. 11. If a person cannot be fitted with the selection of half-mask respirators, include full facepiece models in the selection process. When a respirator is found that passes the test, its efficiency shall be demonstrated for the subject by having him break the face seal and take a breath before exiting the chamber. 12. When the test subject leaves the chamber he shall remove the saturated towel, returning it to the test conductor. To keep the area from becoming contaminated, the used towels shall be kept in a self-sealing bag. There is no significant IAA concentration buildup in the test chamber from subsequent tests. 13. Persons who have successfully passed this fit test may be assigned the use of the tested respirator in atmospheres with up to 10 times the PEL of airborne lead. In other words this IAA protocol may be used to assign a protection factor no higher than 10. II. Saccharin Solution Aerosol Protocol A. Taste threshold screening. 1. Threshold screening as well as fit testing employees shall use an enclosure about the head and shoulders that is approximately 12 inches in diameter by 14 inches tall wi*"at least the front portion clear and that alftws free movement of the head when a resfrator is worn. An enclosure substantially sitmjar to the 3M hood assembly of part # FT 14Jnd '' FT 15 combined is adequate2. The test enclosure shall have a three- quarter inch hole in front of the test subject's nose and mouth area to accommodate the nebulizer nozzle. 3. The entire screening and testing procedure shall be explained to the test subject prior to the conduct of the screening test. 4. The test subject shall don the test enclosure. For the threshold screening test, he shall breath through his open mouth with tongug extended. 5. Using a DeVilbiss Model 40 Inhalation Medication Nebulizer or equivalent, the test conductor shall spray the threshold check solu tion into the enclosure. This nebulizer shall be clearly marked to distinguish it from the lit test solution nebulizer. (Appendix D. II, step. A.5.. corrected by 48 FR 9641, March 8. 1983] 6. The threshold check solution consists of 0.83 grams of sodium saccharin. USP in wBter. It can be prepared by putting 1 cc of the test solution (see C6 below) in 100 cc of water. 7. To produce the aerosol, the nebulizer bulb is Firmly squeezed so that it collapses completely then released and allowed to fully expand. 8. Ten squeezes are repeated rapidly and then the test subject is asked whether the saccharin can be tasted. 9. If the first response is negative, ten more squeezes are repeated rapidly and the test subject is again asked whether the saccharin is tasted. 10. If the second response is negative ten more squeezes are repeated rapidly and the 3-31-83 [Appendix D) Published by THE BUREAU OF NATIONAL AFFAIRS INC.. Washington, O.C. 20037 51 CYWl 3-001215 31:8446 REFERENCE FILE tes: subject is again asked whether the shoulders. Have the test subject inhale when saccharin is tasted. his head is at either side. U. The test conductor will take note of the iv. Nodding head up-and-down. Be certain number of squeezes required to elicit a taste motions are complete. Alert the test subject response. not to bump the respirator on the chest. Have 32. If the saccharin is not tasted after 30 the test subject inhale when his head in the squeezes (Step 9). the test subject may not perform the saccharin fit test. 13. If a taste response is elicited, the test subject shall be asked to take note of the taste for reference in the fit test. 14. Correct use of the nebulizer means that approximately 1 cc of liquid is used at a time in the nebulizer body. fully up position. v. Talking. Talk aloud and slowly for several minutes. The following paragraph ia called the Rainbow Passage. Reading it will result in a wide range of facial movements, and thus be useful to satisfy this requirement Alternative pasaagei which serve the same purpose may also be used. 15. The nebulizer shall be thoroughly rinsed Rainbow Passage in water, shaken dry', and refilled at least each morning and afternoon or at least every four hours. B. Respirator selection. Respirators shall be selected as described When the sunlight strikes raindrops in the air. they act like a prism and form a rainbow. The rainbow is a division of white light into many beautiful colors. These take the shape of a long round arch, with its path high in section IB above, except that each above, and its two ends apparently beyond respirator shall be equipped with a the horizon. Thera ia, according to legend, a particulate filler cartridge. boiling pot of gold at one end. People look, C. Fit test. but no one ever finds it When a man looka 1. Thu fit lest uses the same enclosure for something beyond his reach, his friends described in Bt anti B2 above say he is looking for the pot of gold at the end 2. Each test subject shall wear his respirator for at least 10 minutes before starting the fit test of the rainbow. 10. Every 30 seconda. the aeroaol concentration shall be replenished using one- 3. The test subject shall don the enclosure half the number of squeeze aa initially (C8). while wearing the respirator selected in 11. The test subject shall so indicate to the section A above. This respirator shall be teat conductor if at any time during the fit test properly adjusted and equipped with a the taste of saccharin ia detected. particulate filter cartridge. 12. U the saccharin ia detected the fit ia 4. The test subject may not eat drink deemed unsatisfactory and a different [except plain water), or chew gum for 15 respirator shall be tried. minutes before the teat 13. Successful completion of the test 5. A second DeVilbiss Model 40 Inhalation protocol shall allow the use of the tested Medication Nebulizer or equivalent, is used to respirator in contaminated atmospheres up to spray the fit test solution into the enclosure. This nebulizer shall be clearly marked to distin guish it from the screening test solution nebulizer. 10 times the PEL. In other words this protocol may be used assign protection factors no higher than ten. (Appendix D. II. step C.5.. corrected by 4S FR 9641 March 8. J983] IQ. Irritant Fuma Protocol 6. The fit test solution is prepared by adding 83 grama of sodium saccharin to 100 cc of warm water. 7. As before, the teat subject shall breathe through the open mouth with tongue extended. 8. The nebulizer 1* inserted into the hole in the front of the enclosure and the fit teat solution is sprayed into the enclosure and the fit teat solution is sprayed into the enclosure using the same technique aa for the taste A. Respirator selection. Respirators shall be selected as described in section IB above, except that each respirator shall be equipped with high efficiency cartridges. (Appendix D. Ill/A corrected by 48 FR 9641, March 8, I983| B. Fit test. 1. The test subject shall be allowed to smell a weak concentration of the irritant smoke to familiarize him with its characteristic odor. threshold screening and the same number of [Appendix 0, 111, step B.I., corrected by 48 FR aqueezet required to elicit a taste response in 9641. March 8. 1983) the screening. (See B10 above). 2. The teat subject shall properly don the 9. After generation of the aerosol t4*et_ respirator selected at abova, and wear it for subject shall be instructed to perform th&` - at least 10 minute* before starting the fit test. following exercises for one minute each. Vi 3. The test conductor shall review thla i. Normal breathing. _ protocol with the test subject before testing. ii. Deep breathing. Be certain breaths aAF- 4. The test subject shall perfotm the deep and regular. m*- conventional positive pressure and negative iii. Turning head from side-to-sids. Be certain movement ia complete. Alert the teat pressure fit checks. Failure of either check shall be cause to select an alternate subject not to bump the respirator on the. respirator. 5 {Deleted] 6. |Deleted) [Appendix D. Ill, steps B.5. and 6. deleted by 48 FR 9641. March 8. 1983) 5. Break both ends of a ventilation smoke tube containing stannic oxychloride, such as the MSA part No. 5845, or equivalent Attach a short length of tubing to one end of the moke tube. Attach the other end of the smoke tube to a low pressure air pump aet to deliver 200 milliliters per minute. 6. Advise the teat subject that the smoke can be irritating to the eyes and instruct him to keep his eyes dosed while the test is performed. 7. The test conductor shall direct the stream of irritant smoke bom the tubetowards the faceseal area of the test subject He shall begin at least 12 inches from the facepiece and gradually move to within one inch, moving around the whole perimeter of the mask. 8. The following exercises shall be performed while, the respirator seal ia being challenged by the smoke. Each shall be performed for one minute. L Normal breathing. ii. Deep breathing. Be certain breaths are deep and regular. iii. Turning head from side-to-side. Be certain movement it complete. Alert the test subject not to bump the respirator on the shoulders. Have test subject inhale when his head is at either side. iv. Nodding head up-and-down. Be certain motions are complete. Alert the test subject not to bump tht respirator on the chest Have the test subject inhale when his head is in the fully up position. v. Talking--slowly and distinctly, count backwards from 100. vt. Normal breathing. 9. If the irritant nmoke produces an involuntary reaction (cough) by the test subject the test conductor shall stop the test. In this case the tested respirator Is rejected and another respirator shall be selected. 10. Each test subject passing the smoke test without evidence of a response shall be given sensitivity check of the smoke from the tame tub* to determine whether he reacts to the smoke. Failure to evoke response shall void th* fit test. 11. Steps B4. B7, B8 of this protocol shall be performed in a location with exhaust ventilation aufficient to prevent general contamination of the testing tree by the test irritant smoke. (Appendix D. Ill, step B.ll., corrected by 48 FR 9641. March 8. 1983) 12. Respirator* succetffully tested by the protocol may be used In contaminated atmospheres up to ten timet the PEL In other word* this protocol may be uaed to assign protection factors not'exceeding ten. [Appendix D, lll/B, steps 7 -- 14 renumbered as J -- 12 by 48 FR 964!. March 8, 19831 Occupational Safety & Health Reporter [Appendix 0) 52 CYWI 3-'