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Introduction
Who should be included in the program?
Appendix B - Medical Surveillance Guidelines		 Medical Protocol Requirements
Recordkeeping
Forms
Written Medical Opinion for Employee
Written Medical Opinion for Employer		 Authorization for Crystalline Silica Opinion to Employer
Crystalline Silica Medical Surveillance Summary Record

Introduction

A medical surveillance program can supplement a dust monitoring and control program, however, it should not be a substitute for a dust monitoring and control program. An effective medical surveillance program can have the following objectives:

  • Establish a medical baseline with which to objectively assess changes in an exposed worker's respiratory system.

  • Provide for early detection of abnormalities. Early detection of silicosis allows medical interventions at a stage when they are most beneficial.

  • Provide for early detection of other abnormalities which may or may not be occupationally related.
  • Provide data that can be used in epidemiological studies of crystalline silica exposures and silicosis.
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Who should be included in a medical surveillance program?

The General Industry Standard requires that employers make medical surveillance available at no cost to the employee, and at a reasonable time and place, for each employee who will be occupationally exposed to respirable crystalline silica above the PEL for 30 or more days per year. 

The Construction Standard requires that employers make medical surveillance available at no cost to the employee, and at a reasonable time and place, for each employee who will be required under the standard to use a respirator for 30 or more days per year.  

All medical examinations and procedures are to be conducted by a Physician or other Licensed Health Care Professional (PLHCP).

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Medical Protocol Requirements 

Per the Silica Standards, the Medical Protocol requirements include:

Initial Examination

Initial (baseline) examinations are to be made available to employees within 30 days after initial assignment, unless the employee has received a medical examination that meets the requirements of the Silica standards within the last three years.  

The examination shall consist of:

  • A medical and work history, with emphasis on: past, present, and anticipated exposure to respirable crystalline silica, dust, and other agents affecting the respiratory system; any history of respiratory system dysfunction, including signs and symptoms or respiratory disease (e.g., shortness of breath, cough, wheezing); history of tuberculosis; and smoking status and history;

  • A physical examination with special emphasis on the respiratory system;

  • A chest X-ray (a single posteroanterior radiographic projection or radiograph of the chest at full inspiration recorded on either film (no less than 14 x 17 inches and no more than 16 x 17 inches at full inspiration) or digital radiography systems), interpreted and classified according to the International Labour Organization (ILO) International Classification of Radiographs of Pneumoconioses by a NIOSH-certified "B" reader;

  • A pulmonary function test (PFT) to included forced vital capacity (FVC) and forced expiratory volume at one second (FEV1) and FEV1/FVC ratio, administered by a spirometry technician with current certification from a NIOSH-approved spirometry course;

  • Testing for latent tuberculosis infection;

  • Any other tests deemed appropriate by the PLHCP.

Periodic Examinations

Medical examinations, including the chest x-ray and PFT are to be made available at least every three years, or more frequently if recommended by the PLHCP.

Information provided to the PLHCP

The employer must ensure that the examining PLHCP has a copy of the Silica Standard(s), and be provided with the following information:

  • A description of the affected employee's former, current, and anticipated duties as they relate to the employee's occupational exposure to respirable crystalline silica;

  • The employee's former, current, and anticipated levels of occupational exposure to respirable crystalline silica;

  • A description of any personal protective equipment used or to be used by the employee, including when and for how long the employee has used that equipment; and,

  • Information from records of employment-related medical examinations previously provided to the affected employee and currently within the control of the employer.

PLHCP's Written Medical Opinion for the employee

The employer must ensure that the PLHCP explains to the employee the results of the medical examination and provides each employee with a written medical report within 30 days of each medical examination performed.  The written report must contain:

  • A statement indicating the results of the medical examination, including any medical condition(s) that would place the employee at increased risk of material impairment to health from exposure to respirable crystalline silica and any medical conditions that require further evaluation or treatment;

  • Any recommended limitations on the employee's use of respirators;

  • Any recommended limitations on the employee's exposure to respirable crystalline silica; and

  • A statement that the employee should be examined by a specialist if the chest X-ray provided is classified as 1/0 or higher by the B Reader, or if referral to a specialist is otherwise deemed appropriate by the PLHCP.
A sample Employee notification form, per the Silica Standards, can be found by clicking this link.

PLHCP's Written Medical Opinion for the employee

The employer must obtain a written medical opinion from the PLHCP within 30 days of the medical examination.  The written opinion must contain only the following:
  • The date of the examination;

  • A statement that the examination has met the requirements of the OSHA Silica Standard; and,

  • Any recommended limitations on the employee's use of respirators.
If the employee provides written authorization, the written opinion can also contain either or both of the following:
  • Any recommended limitations on the employee's exposure to respirable crystalline silica;

  • A statement that the employee should be examined by a specialist if the chest X-ray provided is classified as 1/0 or higher by the B Reader, or if referral to a specialist is otherwise deemed appropriate by the PLHCP.
OSHA's sample Employers Notification form can be found by clicking this link.

OSHA's sample Written Authorization form can be found by clicking this link.

Additional examinations
If the PLHCP's written medical opinion indicates that an employee should be examined by a pulmonary specialist, the employer shall make available a medical examination by a pulmonary specialist within 30 days after receiving the PLHCP's written medical opinion.

The examining pulmonary specialist is to be provided with all the information that the employer is obligated to provide to the PLHCP.

The employer shall ensure that the specialist explains to the employee the results of the medical examination and provides each employee with a written medical report within 30 days of the examinations.  The written report must contain the following:
  • A statement indicating the results of the medical examination, including any medical condition(s) that would place the employee at increased risk of material impairment to health from exposure to respirable crystalline silica and any medical conditions that require further evaluation or treatment;

  • Any recommended limitations on the employee's use of respirators; and

  • Any recommended limitations on the employee's exposure to respirable crystalline silica.
The employer shall obtain a written opinion from the specialist within 30 days of the medical examination.  The written opinion must contain the following:
  • The date of the examination;

  • Any recommended limitations on the employee's use of respirators.

  • Any recommended limitations on the employee's exposure to respirable crystalline silica.
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Recordkeeping

Per OSHA standard  29 CFR 1910.1020 - Access to employee exposure and medical records, medical records shall be maintained for at least 30 years following the employee's termination of employment, unless the employee is employed for less than one year and the records are provided to the employee upon termination.

The record must contain the following information about the employee:

  • Name and social security number;

  • A copy of the PLHCP's and specialist's written opinions; and

  • A copy of the information provided to the PLHCPs and pulmonary specialists as required by the OSHA Silica Standards

Sample Crystalline Silica Medical Surveillance Records (pdf version)

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