Document G6oZ8mvKnY88xKzeRrr5GK0bq

Federal Register / Vol. 51, No. 119 / Friday, June 20, 1986 / Rules and Regulations 22727 administration of the standardized the pulmonary function testing to detect questionnaire contained in Appendix D, the early stages of asbestos-induced Part 1 during, the initial examination and respiratory disease. In addition, updating of the abbreviated information from these questionnaires standardized questionnaire contained in can be used to increase medical Part 2 of Appendix 0 during peHodic knowledge about specific work examinations, (4) a physical exposures, doses, and durations and examination, including a chest their relations to the later development roentgenogram (if deemed necessary by of asbestos-related disease, and'can l the physician) and pulmonary function also be used by OSHA to revise the j tests, and (6) any other examinations or permissible exposure limits for asbestos, , tests deemed necessary by the if this is determined to be necessary'. J examining physician. OSHA has granted greater discretion The content of the revised standard's to the examining physician by allowing required physical examination is him or her to choose whether to consistent with the identification of the administer chest X rays. The Agency adverse health effects that have been believes that the physician is the best associated with asbestos.exposure. A judge of whether it Is necessary! and-at complete work history including what intervals to conduct these X rays i. information.on any past occupational and will make this judgment based on ; exposures to toxic substances is the employee's health and the exposure ) necessary for implementing an effective conditions prevailing in the employee's i medical surveillance program. work.environment. V Information regarding such past To aid in the physician's evaluation of j. exposures can alert the physician as to an employee's health in relation to.that the employee's current health status and employee's assigned work duties, the possible health consequences or paragraph (m)(3) requires that the > continued exposure to asbestos. As employer provide the examining discussed in Section IV (Health Effects) physician with the following i of the Preamble. OSHA has determined information: (1) a copy of this standard | that asbestos can cause lung cancer, nnd appendix I; (2) a description of the mesothelioma, asbestosis, and an employee's duties as they relate to the increase in esophageal, stomach, colo- employee's asbestos exposure; (3) the jt rectal, kidney, laryngeal, pharyngeal. employee's representative or anticipated I and buccal cavity cancers. It is therefore level of exposure, to asbestos; (4). (important that the physical examination information .regarding the employee's be directed to a determination of the use of any personal protective condition of the pulmonary, equipment, including respiratory cardiovascular, and gastrointestinal. equipment; and (5) information from systems. In addition, a complete . previous work-related medical: . assessment of pulmonary status is . " examinations that is not otherwise j essential for employees required to work available to the physician. : in asbestos-containing atmospheres; this These requirements have-been ' is accomplished through a pulmonary included in' the revised standard to ;. function test that measures forced vital ensure that employers provide jf capacity (FVC) and forced expiratory examining physicians with adequate it volume at one second (REVi), and if da ta to facilitate analysis of the test | desired by the physician a chest X ray. results and to aid in the determination i'These tests are designed to allow of the overall health status of the physicians to diagnose the presence and . employee; they are also consistent with J extent of pulmonary fibrosis caused by requirements in other recent OSHA I the accumulation of asbestos fibers in health standards'. Appendix I provides | the lungs and additionally to determine general information to the examining I' an employee's capability to wear physician on the adverse effects of I negative-pressure respirators. asbestos exposure and on the | The respiratory disease . appropriate diagnosis for specific tests | questionnaires contained in Appendix D for asbestos-related diseases, such as J must be administered to construction the proper interpretation of chest X rays | employees during their medical and spirometry readings. Inclusion of `i examinations. These questionnaires will such informational appendices is ;j elicit information from the employee standard in OSHA rulemakings, e.g., ; about his or her work environment and ethylene oxide (49 FR 25798, (une 22, | job responsibilities; symptoms of 1984) and inorganic arsenic (43 FR 19628. | possible respiratory illness such as. May 5.1978). f coughing, chesttightness, add The revised asbestos standard breathlessness; tobacco smoking habits; mandates at paragraph (m)(4) that the t and occupational-history, and will be employer receive a written opinion from. 5 used in conjunction with the results of the physician that shall include the results of the medical examination, the physician's opinion as to whether the employee has any medical conditions that would increase his or her risk of material health impairment from asbestos exposure, any recommended limitations on employees or upon the use of personal protective equipment such as respirators, and a statement that the employee has been informed by the physician of the results of the medical examination and of any medical conditions that may result from asbestos exposure. The employer shall instruct the physician not to reveal in the written opinion specific findings or diagnoses unrelated to occupational exposure to asbestos. The employer is also required to provide a copy of the physician's written opinion to the affected employee within fifteen days of its receipt. These requirements have been added to the revised standard for construction to ensure adequate communication between the employer, the employee, and the physician, and are consistent with requirements in other OSHA health standards e g., ethylene oxide (49 FR 25798: june 22.1984), inorganic arsenic (43 FR 19628; May 5.1978). and lead (43 FR 53011; Nov. 14,1978). OSHA's analysis of the record evidence on these medical surveillance requirements is discussed below. Section 6(b)(7) of the OSH Act mandates that . . . where appropriate, any such standard (promulgated under subsection (6)(b)] shall prescribe the type and frequency of medical examinations or other tests Which shall be made available, by the employer or at his . cost, to employees exposed to such hazards in order to most effectively determine whether the health of such employees is adversely affected by such exposure. OSHA accordingly includes medical surveillance requirements in all of its health standards. In addition, the Agency considers these programs to be an appropriate means of monitoring the adequacy of the standard's permissible exposure limit. Most commenters favored the inclusion of medical surveillance provisions in the revised rule for asbestos in the construction industry (Exs. 84t-424, 64--457,123-A. 277, 330. Trs. 6/20. 6/26, 6/27, 7/3, and 7/12J..A few commenters. however, questioned the feasibility of requiring medical monitoring for the construction industry because of the high turnover rate and transient nature of the construction work force and because it is expensive (Exs. 84-233, Trs. 6/21, 7/6, and 7/10): For.example, the Asbestos Information Association of North America (ALA/NA) stated that i .1 1 I GLEASON-000975