Document yqjvL71o4pYwY0rgwpJ0jaD2

Federal Register / Vol. 51* No. 119 / Friday. }une 20, 1986 / Rules and Regulations 22727 administration of the standardized questionnaire contained in Appendix D. Part 1 during.the initial examination and updating of the abbreviated standardized questionnaire contained in Part 2 of Appendix 0 during periodic examinations, (4) a physical examination, including a chest roentgenogram (if deemed necessary by the physician) and pulmonary function tests, and (6) any other examinations or tests deemed necessary by the examining physician. The content of the revised standard's required physical examination is consistent with the identification of the adverse health effects that have been associated with asbestos'.exposure. A complete work history including information.on any past occupational exposures to toxic substances is necessary for implementing an effective medical surveillance program. Information regarding such past exposures can alert the physician as to the employee's current health status and the possible health consequences of continued exposure to asbestos. As discussed in Section IV (Health Effects) of the Preamble. OSHA has determined that asbestos can cause lung cancer, mesothelioma, asbestosis, and an increase hi esophageal, stomach, colo rectal, kidney, laryngeal, pharyngeal.and buccal cavity cancers, it is therefore i important that the physical examination f be directed to a determination of the condition of the pulmonary, cardiovascular, and gastrointestinal. systems. In addition, a complete assessment of pulmonary status is , essential for employees required to work in asbestos-containing atmospheres; this is accomplished through a pulmonary function test that measures forced vital capacity (FVC) and forced expiratory volume at one second (REW), and if desired by the physician a chest X ray. | These tests are designed to allow physicians to diagnose the presence and extent of pulmonary fibrosis caused by the accumulation of asbestos fibers in the. lungs and additionally to determine an employee's capability to wear | negative-pressure respirators. The respiratory disease questionnaires contained in Appendix D _ must be administered to construction | employees during their medical ^ examinations. These questionnaires will ^ elicit information from the employee ; about his or her work environment and s job responsibilities; symptoms of I. possible respiratory illness such as ' coughing, chest tightness, ahd breathlessness; tobacco smoking habits: and occupational-history, and will be used in conjunction with the results of the pulmonary function testing to detect results of the medical examination, the the early stages of asbestos-induced physician's opinion as to whether the respiratory disease. Iii addition, employee has any medical conditions information from these questionnaires that would increase his or her risk of can be used to increase medical material health impairment from knowledge about specific work asbestos exposure, any recommended exposures, doses, and durations and limitations on employees or upon the their relations to the later development use of personal protective equipment of asbestos-related disease, and'can such as respirators, and a statement that also be used by OSHA to revise the the employee has been informed by the permissible exposure limits for asbestos, physician of the results of the medical if this is determined to be necessary. examination and of any medical OSHA has granted greater discretion conditions that may result from asbestos to the examining physician by allowing exposure. The employer shall instruct him or her to choose whether to the physician not to reveal in the written administer chest X rays. The Agency opinion specific findings or diagnoses believes that the physician is the best unrelated to occupational exposure to judge of whether it is necessary! and-at asbestos. The employer is also required what intervals to conduct these X rays to provide a copy of the physician's and will make this judgment based on written opinion to the affected employee the employee's health and the exposure within fifteen days of its receipt. These conditions prevailing in the employee's requirements have been added to the work.environment. revised standard for construction to To aid in the physician's evaluation of ensure adequate communication an employee's health in relation to.that between the employer, the employee, employee's assigned work duties, and the physician, and are consistent paragraph (m)(3) requires that the with requirements in other OSHA health employer provide the examining physician with the following information: (1) a copy of this standard standards e.g., ethylene oxide (49 FR 25798; June 22.1984), inorganic arsenic (43 FR 19628; May 5,1978), and lead (43 nnd appendix l; (2) a description of the FR 53011; Nov. 14,1978). OSHA's employee's duties as they relate to the analysis of the record evidence on these employee's asbestos exposure; (3) the medical surveillance requirements is employee's representative or anticipated discussed below. level of exposure, to asbestos; (4) Section 8(b)(7) of the OSH Act . information regarding the employee's mandates that use of any personal protective equipment, including respiratory equipment; and (5) information from - . . . where appropriate, any such.standard ' [promulgated under subsection (6}{b)] shall prescribe the type and frequency .of medical previous work-related medical, examinations or other tests Which shall be examinations that is not otherwise made available, by the employer or at his . available to the physician. These requirements have-been included in'the revised standard to ensure that employers provide 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. examining physicians with adequate OSHA accordingly includes medical data to facilitate analysis of the test surveillance requirements in all of its results and to aid in the determination health standards. In addition, the of the'overall health status of the Agency considers these programs to be employee; they are also consistent-with an appropriate means of monitoring the requirements in other recent OSHA adequacy of the standard's permissible health standards'. Appendix I provides exposure limit. general information to the examining Most commenters favored the physician on the adverse effects of inclusion of medical surveillance asbestos exposure and on the provisions in the revised rule for appropriate diagnosis for specific tests asbestos in the construction industry for asbestos-related diseases, such as (Exs. 84^-424. 84-457,123-A, 277, 330. the proper interpretation of chest X rays Trs. 6/20, 6/28, 6/27, 7/3. and 7/12). A and spirometry readings, inclusion of few commenters, however, questioned such informational appendices is the feasibility of requiring medical standard in QSHA rulemakings, e.g., monitoring for the construction industry ethylene oxide (49 FR 25798, June 22, because of the high turnover rate and 1984) and inorganic arsenic (43 FR 1962B. transient nature of the construction May 5,1978). work force and because it is expensive The revised asbestos standard (Exs. 84-233, Trs. 6/21. 7/6, and 7/10): mandates at paragraph (m)(4) that the ' For.exampJe, the Asbestos Information employer receive a written opinion from, Association of North America (ALA/NA) the physician that shall include the stated that |r i GLEASON-000975