Document KJXVrd4JzQk3Y7koR61KaoVw2
FILENAME: Flintkote (FLK)
DATE: 1976 Sept 9
DOC#: FLK026
DOCUMENT DESCRIPTION: Memo RE OSHA General Asbestos Medical Examination with Attached Medical Exam Report Form
THE F L I N T K O T E C O M P A N Y . INTER-OFFICE CORRESPONDENCE '
. ii
FROM: J. C. Schmitt
SUBJECT*
OSHA Bulletin #76-7 Medical Examinations OSHA Asbestos Standard
DATE: Sept ember 9, 1976
HEAVY EMPHASIS ON
iuNTKoig H E L P
LOSS PREVENTION
This Bulletin is a restatement of OSHA Bulletin No. 30 issued
December 18, 1972, Which is hereby superseded.
.
OSHA Standard 1910.1001 pertaining to asbestos dust exposure specifies that hourly and salaried employees exposed to airborne concentrations of asbestos fiber be given pre-placement, termination and annual physical examinations. The first of the annual exam inations vas to have been given on or before January 31, 1973.
The definition of enplpyees Who are exposed to airborne concentrations
of asbestos fiber is not provided in the standard. The standard
requires that medical examinations be provided for each employee
"exposed to airborne concentrations of asbestos fibers". The
Review Commission has ruled that the Standard places n o quantitative
limitation on the amount of exposure, therefore medical examinations
must be provided ___ Whenever employees are exposed to any trace
of asbestos - no matter how temporary or insignificant_____ " . (See -
OSHA Bulletin #75-16 dated December 15, 1975)..
~
The use of respirators does not relieve the employer from the responsibility of providing medical examinations for employees.
In addition to the matter of exposure definition, there re other factors pertaining to the physical examinations Which bear consid eration. They are as follows:
1. Examination Content
The minimum examination procedure is stated in O S H A . standard 1910.1001 a (j) One of the requirements is a history to elicit ayxnptomology of respiratory disease. This history should be expanded to include cardiovascular, gastrointestinal and cardiopulmonary symptomatology. The medical history should be taken by the examining physician
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September 9, 1976
; or other qualified medical personnel and it shoulp develop data on smoking habits and previous exposure to harmful
dusts.
A suggested medical questionnaire to be provided to the
examining physician for his consideration is attached, as
Enclosure A. It should be noted, however, that the form
and content of the questionnaire for purposes of obtaining
a medical history is up to the examining physician.
*' *
2. Selection of Physician
In most cases, the regular plant physician will perform the examination or make arrangements for the testing work* If assistance is needed in the selection of an examining physician, the local office of the workmen's compensation insurance carrier or compensation service organization should be contacted for a reference. Some mobile Health Services are qualified to conduct both physical and medical tests, and may be used for this routine testing. In all cases, qualifications of physicians or medical services should be checked. Upon request, the Corporate Insurance Department will obtain names of recommended physicians, or Health Services, if local efforts to select one have been unsuccessful.
3. Medical Files
The availability and maintenance of medical records is described in the OSHA Standard 1910.1001a (j) (6) (i&ii). All concerned should become familiar with these sections. In part, these provide that the examining physician must provide the employer with a complete and accurate written record of all medical examinations. These records are to be maintained in the local personnel files for twenty years. Copies of examination reports which reveal medical problems are to be forwarded to the Corporate Insurance Department.
4 notification to Employees to Medical Problems
In the event a medical o r physical problem is discovered during an examination, the employee is to be advised
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September 9, 1976
orally by the examining physician at the time o f the % examination. If in the opinion of the examining I
physician this problem is serious or of such a nature t as to recommend further medical attention notification
will be sent to the employees personal physician.
This notification can be made only with the consent
of the employee, in writing using the form illustrated
in Enclosure B, or a similar form supplied ]y the
examining physician. This form is to be completed b y
each employee prior to the medical examination. The
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examining physician will then submit a report directly
to the employee's personal physician. Zf the medical
problem is occupationally connected the local office
of the workmen's compensation insurance carrier or
compensation service organization must be notified.
Any questions relative to examinations of personnel engaged in occupations having an exposure to airborne concentrations of asbestos fiber should be referred to the Corporate Insurance Department.
NAME
i"
% '
__________ f PERSONAL PHYSICIAN:
NOTIFY IN EMERGENCY:
IDICAL EXAMINATION REPORT
ENCLOSURE A
JOB TITLE ADDRESS
NAME NAME
TYPE OF EXAMINATION - SEX OSHA Standard 191Q1001
BIRTH
DATE i
STREET
[ c i t y STATE ZIP
ADDRESS ADDRESS
PHONE NUMBS] PHONE NUMBS]
TO BE ANSWERED BY INDIVIDUAL
HAVE YOU EVER BEEN AFFLICTED WITH ANY OF THE FOLLOWING PHYSICAL AILMENTS :
( ) NO ( ) NO ( ) NO ( ) NO ( ) NO ( ) NO ( ) NO ( ) NO ( ) NO ( ) NO
( ) YES ( ) YES ( ) YES ( ) YES ( ) YES ( ) YES ( ) YES ( ) YES ( ) YES ( ) YES
Allergies Asbestosis Asthma Bladder Disorder Bronchitis Cancer or Tumor .Dermatitis (Skin) Emphysema Eye Trouble Frequent Colds
or Sore Throats
( ) NO ( ) NO ( ) NO ( ) NO ( ) NO ( ) NO ( ) NO (.) NO
( ) NO
( ) YES ( ) YES ( ) YES ( ) YES ( ) YES ( ) YES ( ) YES ( .) YES
( ) YES
Hay Fever Headache Severe Kidney Trouble Pleurisy Pneumonia Silicosis Sinus Trouble Tuberculosis of Lungs
or Other Parts of Body Ulcer
OTHER
IF a n y OF TEE ABOVE HAVE BEEN ANSWERED "YES "-EXPLAIN
HAVE YOU EVER BEEN UNDER OBSERVATION OR TREATMENT IN ANY HOSPITAL, CLINIC, OR SANITAIUM' REIATED TO ANY OF THE ABOVE LISTED AILMENTS? { ) NO ( ). YES-EXPIAIN
HAVE YOU ANY PHYSICAL DISABILITY RELATED TO ANY OF THE ABOVE LISTED AILMENTS? ( ) NO ( ) YES-EXPLAIN
HAVE YOU EVER BEEN DISABLED, LAID OFF OR COMPENSATED BECAUSE OF A GOVERNMENT OR OCCUPATIONAL DISABILITY RELATED TO ANY OF THE ABOVE LISTED AILMENTS? ( ) NO ( ) YES-EXPLAIN
v /
....
/
AVE YOU EVER BEEN REJECTED FOR INSURANCE OR EMPLOYMENT BECAUSE
ONDITION RELATED TO ANY OF THE BEFORE MENTIONED AILMENTS?
) NO .( ) YES-EXPLAIN
OF A
PHYSICAL
AS ANY PARENT, BROTHER, OR SISTER HAD TUBERCULOSIS, ASTHMA, EMPHYSEMA OR OTHER
UIMONARY CONDITION?
) NO ( ) YES-EXPLAIN
v' -.
AVE YOU EVER BEEN EXPOSED TO. A N ENVIRONMENT HAVING ANY OF THE FOLLOWING IN
UGH CONCENTRATION:
) NO ( )YES Chemicals (Kind)
( ) NO ( ) YES Gas (Kind)
) NO ( ) YES Dust (Kind)
.() NO ( ) YES Noisy Environment (Where)
HEN DID YOU LAST CONSULT A PHYSICIAN? REASON:
*
OW WOULD YOU CLASSIFY YOUR HEALTH:
) EXCELLENT
( ) GOOD
( ) POOR
O YOU SMOKE? ( ) NO 0 WHAT EXTENT?
( ) YES
HAVE YOU EVER SMOKED? ( ) NO HOW LONG?
( ) YES
)
ENCLOSURE B
.
NAME OF EXAMINING PHYSICIAN
ADDRESS
J
Name of Employee (Please Print)
Employee's Personal or Family Physician * Name _______________________
Address ___________________'
(Insert name of Examining Physician) is authorized to forward at his discretion* results of my routine medical examination to the physician listed above.
Signed Date
eitployee