Chapter 7 Medical Monitoring and Surveillance of the Worker
7.4 Scheduling and Tracking of Physicals
The scheduling and tracking of employee physicals is generally not a responsibility of the industrial hygienist. However, depending on the size of the company, the industrial hygienist may be responsible for providing safety and health services, along with keep- ing track of all workers and their required physicals. At a minimum, the industrial hygienist should understand and review the scheduling and tracking mechanism used to ensure that the company is meeting regulatory requirements associated with worker qualification and confirm that appropriate scheduling and tracking of physicals is occurring. The frequency with which the physicals must occur is dependent on the spe- cific contaminant the employee is exposed to and, in some cases, the concentration of the exposure. For example, the occupational health standard for inorganic lead dictates that a medical surveillance program must be made available to all employees exposed to lead above an action level of 30 μg/m3 time-weighted average for more than 30 days each year. Under this program, the blood lead level of all employees who are exposed to lead above the action level is to be evaluated at least every 6 months. This fre- quency is increased to every 2 months for employees whose blood lead level is between 40 μg/100 g and the level requiring employee medical removal. For employees who are removed from exposure to lead due to an elevated blood level, their blood lead level must be monitored monthly; therefore, even if an employee is no longer performing the job that caused the exposure, he or she may still need to be in a medical surveillance program until such time his or her blood levels decrease to acceptable values. It is also worthy to note that OSHA requires a worker to be placed into a medical removal pro- tection program if his or her blood lead levels are substantially elevated or otherwise at risk of sustaining material health impairment from continued substantial exposure to lead. The industrial hygienist should be familiar with all job categories within the company or institution and understand the different mechanisms through which an employee could be exposed to physical, chemical, or biological contaminants, and the medical requirements associated with those job categories.
Some companies use an employee work assignment analysis to assist in identi- fying essential job functions and the associated physical or chemical hazards. An employee work assignment analysis can be generated when an employee is hired to document anticipated environmental and workplace conditions to be encountered,
and it is provided to the occupational health medical provider as a background document for the establishment of a medical surveillance program for a worker.
The employee work assignment analysis can also be used to initially assign a worker to a similar exposure group (SEG), which the industrial hygienist uses to identify and manage hazards in the workplace. An example employee work assign- ment analysis form is provided in Table 7.2. The form is very useful in providing a vehicle to communicate with the occupational health medical provider about anticipated exposures and related medical surveillance programs, such as hearing conservation, asbestos work, lead work, and confined spaces. The form is also use- ful in managing compliance with the Americans with Disabilities Act (ADA) and fitness-for-duty issues.
TABLE 7.2
Example Employee Work Assignment Analysis Form Employee Work Assignment Analysis
Page 1 Date: 01/01/2017
Employee name: Joe Smith Job title: Industrial hygienist Assigned manager: Candy Cane
Work Assignment Assigned SEG
• Daily office work with computers 1
• Perform industrial hygiene instrumentation daily checks and calibration
1
• Perform sampling and monitoring in the field
3
• Attend meetings 1
• Respond to emergencies in the field 4 Physical Job Activities
Average time spent sitting/day? <4 hours/day Average time spent walking and
standing/day?
<4 hours/day How often is climbing involved in the
job?
<1 hour/day Average time on computer/day? <4 hours/day Average time spent operating a motor
vehicle/day?
<2 hours/day
(Continued)
TABLE 7.2 (CONTINUED)
Example Employee Work Assignment Analysis Form Amount of time spent handling
material and equipment?
<1 hour/day Are work activities performed in hot
or cold environments?
Yes. The employee may perform industrial hygiene sampling and monitoring in both hot and cold environments for <10 hours/week.
Will the employee be required to lift objects greater than 10 lb?
No. General job duties will require the employee to lift calibration and instrumentation equipment, along with stretching when performing monitoring, but not expected to be >10 lb.
Are there repetitive activities the employee may be performing?
Yes. The employee will be doing computer work and programming industrial hygiene instruments.
Will the employee be required to kneel as part of his or her job functions?
Yes. The employee may be required to kneel when performing sampling and monitoring activities.
Will the employee be using tools that vibrate?
No. The employee will not be using vibrating tools.
Employee Work Assignment Analysis Page 2
Date: 01/01/2017
Employee name: Joe Smith Job title: Industrial hygienist Assigned manager: Candy Cane
Required Work Qualifications 1. Wear a respirator wearer
2. Work with hazardous waste 3. Chemical management 4. Emergency response 5. Work with asbestos 6. Work with beryllium 7. Work with lead
8. Work with in a confined space
(Continued)