Small Entity 

Compliance Guide

for the Respirable 

Crystalline Silica Standard for 

General Industry and Maritime

OSHA 3911-12 2023
Occupational Safety and Health Act of 1970

“To assure safe and healthful working conditions for working men 

and women; by authorizing enforcement of the standards developed 

under the Act; by assisting and encouraging the States in their 

efforts to assure safe and healthful working conditions; by providing 

for research, information, education, and training in the field 

of occupational safety and health.”

Material contained in this publication is in the public domain and may 

be reproduced, fully or partially, without permission. Source credit is 

requested but not required.

This information will be made available to sensory-impaired individuals 

upon request. Voice phone: (202) 693-1999; teletypewriter (TTY) number: 

1-877-889-5627. 

This publication provides a general overview of a particular standardsrelated topic. This publication does not alter or determine compliance 

responsibilities which are set forth in OSHA standards and the 

Occupational Safety and Health Act. Moreover, because interpretations 

and enforcement policy may change over time, for additional guidance 

on OSHA compliance requirements the reader should consult current 

administrative interpretations and decisions by the Occupational Safety 

and Health Review Commission and the courts.

Cover photo courtesy of NIOSH.
Small Entity 

Compliance Guide

for the Respirable Crystalline Silica Standard 

for General Industry and Maritime

Occupational Safety and Health Administration

U.S. Department of Labor

OSHA 3911-12 2023
This guidance document provides an 

overview of OSHA’s Respirable Crystalline 

Silica Standard for General Industry and 

Maritime. It is advisory in nature and 

informational in content. It is not a standard 

or regulation, and it neither creates new legal 

obligations nor alters existing obligations 

created by the Occupational Safety and 

Health Administration (OSHA) standards or 

the Occupational Safety and Health Act of 

1970 (OSH Act). Pursuant to the OSH Act, 

employers must comply with safety and 

health standards and regulations issued and 

enforced either by OSHA or by an OSHAapproved state plan. In addition, the Act’s 

General Duty Clause, Section 5(a)(1), requires 

employers to provide their workers with a 

workplace free from recognized hazards that 

are causing or likely to cause death or serious 

physical harm.

In addition, Section 11(c)(1) of the Act 

provides that “No person shall discharge 

or in any manner discriminate against any 

employee because such employee has filed 

any complaint or instituted or caused to be 

instituted any proceeding under or related 

to this Act or has testified or is about to 

testify in any such proceeding or because 

of the exercise by such employee on behalf 

of himself or others of any right afforded by 

this Act.” Reprisal or discrimination against 

an employee for reporting an incident, injury, 

or workplace violation, for participating 

in medical surveillance, or because of 

the results of medical surveillance would 

constitute a violation of Section 11(c) of the 

OSH Act.
TABLE OF CONTENTS

INTRODUCTION.......................................................................................................................................1

SCOPE – PARAGRAPH (A) OF THE STANDARD ..................................................................................1

Exposures from Sorptive Clay Processing.....................................................................................2

Exposures Below 25 μg/m3 Under Any Foreseeable Conditions.................................................2

General Industry and Maritime Work Indistinguishable from Table 1 Construction Work ......2

DEFINITIONS – PARAGRAPH (B) OF THE STANDARD........................................................................3

PERMISSIBLE EXPOSURE LIMIT (PEL) – PARAGRAPH (C) OF THE STANDARD.............................3

EXPOSURE ASSESSMENT – PARAGRAPH (D) OF THE STANDARD................................................4

REGULATED AREAS – PARAGRAPH (E) OF THE STANDARD ...........................................................8

METHODS OF COMPLIANCE – PARAGRAPH (F) OF THE STANDARD.............................................9

RESPIRATORY PROTECTION – PARAGRAPH (G) OF THE STANDARD...........................................14

HOUSEKEEPING – PARAGRAPH (H) OF THE STANDARD................................................................14

MEDICAL SURVEILLANCE – PARAGRAPH (I) OF THE STANDARD.................................................15

COMMUNICATION OF HAZARDS – PARAGRAPH (J) OF THE STANDARD ...................................23

RECORDKEEPING – PARAGRAPH (K) OF THE STANDARD..............................................................25

DATES – PARAGRAPH (L) OF THE STANDARD..................................................................................26

APPENDIX I: OSHA RESPIRABLE CRYSTALLINE SILICA STANDARD FOR 

GENERAL INDUSTRY AND MARITIME...............................................................................................27

WORKERS’ RIGHTS...............................................................................................................................52

OSHA ASSISTANCE, SERVICES AND PROGRAMS .........................................................................52

Establishing a Safety and Health Program...................................................................................52

Compliance Assistance Specialists...............................................................................................52

No-Cost On-Site Safety and Health Consultation Services for Small Business......................52

Cooperative Programs....................................................................................................................53

Occupational Safety and Health Training.....................................................................................53

OSHA Educational Materials..........................................................................................................53

OSHA REGIONAL OFFICES ..................................................................................................................54

HOW TO CONTACT OSHA....................................................................................................................55
Small Entity Compliance Guide for the Respirable Crystalline Silica Standard for General Industry and Maritime 1

INTRODUCTION

This guide is intended to help small businesses 

understand and comply with the Occupational 

Safety and Health Administration’s (OSHA) 

Respirable Crystalline Silica standard for 

General Industry and Maritime. Employees 

exposed to respirable crystalline silica are at 

increased risk of developing serious adverse 

health effects including silicosis, lung cancer, 

chronic obstructive pulmonary disease, and 

kidney disease. This guide describes the steps 

that employers are required to take to protect 

employees in general industry and maritime 

from the hazards associated with exposure 

to respirable crystalline silica. Employers 

in the construction industry should refer 

to the Small Entity Compliance Guide 

for Occupational Exposure to Respirable 

Crystalline Silica in Construction.

This document provides guidance only, 

and does not alter or determine compliance 

responsibilities, which are laid out in OSHA 

standards and the Occupational Safety and 

Health Act. This guide does not replace the 

official Respirable Crystalline Silica standard for 

general industry and maritime. The employer 

must refer to the standard to ensure that it is in 

compliance. Moreover, because interpretations 

and enforcement policy may change over time, 

for additional guidance on OSHA compliance 

requirements the reader should consult current 

administrative interpretations and decisions 

by the Occupational Safety and Health Review 

Commission and the courts. 

What is Respirable Crystalline Silica? 

Crystalline silica is a common mineral found in 

naturally occurring and man-made materials 

like stone or artificial stone countertops and 

sand. Amorphous silica, such as silica gel, is 

not crystalline silica.

Employees can be exposed to respirable 

crystalline silica – very small particles typically 

at least 100 times smaller than ordinary sand 

found on beaches or playgrounds – during the 

manufacturing of products like glass, pottery, 

ceramics, brick, concrete, and artificial stone. 

They can also be exposed during abrasive 

blasting with sand and during the use of 

industrial sand in operations such as foundry 

work and hydraulic fracturing. 

SCOPE – PARAGRAPH (A) OF THE STANDARD

The standard applies to all occupational 

exposures to respirable crystalline silica, 

except for the following: 

■ Construction work as defined by 29 

CFR 1910.12(b), which is covered by the 

respirable crystalline silica construction 

standard (29 CFR 1926.1153); 

■ Agricultural operations, which are covered 

by OSHA’s occupational safety and health 

standards for agriculture and,

■ Exposures that result from the processing 

of sorptive clays.

The standard also does not apply to the 

following: 

■ Where the employer has objective data that 

employee exposure to respirable crystalline 

silica will remain below 25 micrograms per 

cubic meter of air (25 μg/m3) as an 8-hour 

time-weighted average (TWA) under any 

foreseeable conditions;

■ Where the employer chooses to comply with 

the construction standard (29 CFR 1926.1153) 

for tasks performed that are indistinguishable 

from a construction task listed on Table 1 

of the construction standard, provided the 

tasks are not performed regularly in the same 

environment and conditions.
2 Occupational Safety and Health Administration

Exposures from Sorptive Clay 

Processing

Exposures from the processing of sorptive 

clays are excluded from this standard. 

Sorptive clays such as bentonite are specific 

types of clay found in a few geologic 

deposits in the country that are used in a 

range of consumer products and industrial 

applications, such as pet litter and sealants 

for landfills. The occluded quartz found in 

sorptive clays is considerably less toxic than 

unoccluded quartz, and there is insufficient 

evidence for its inclusion in the standard. 

However, the processing of sorptive clays 

remains subject to the permissible exposure 

limit (PEL) in 29 CFR 1910.1000 Table Z-3 (i.e., 

the formula that is approximately equivalent 

to 100 μg/m3). 

Exposures Below 25 μg/m3 Under 

Any Foreseeable Conditions

Exposures that will not exceed 25 μg/m3

averaged over an 8-hour day under any 

foreseeable conditions are excluded from 

the standard. Employers must have objective 

data demonstrating employee exposure to 

respirable crystalline silica associated with 

a particular product or material or a specific 

process, task, or activity will remain below 

this level. 

When using the phrase “any foreseeable 

conditions” OSHA is referring to situations 

that can reasonably be anticipated. OSHA 

considers failure of engineering controls to be 

a situation that is reasonably foreseeable. It 

is foreseeable that controls could breakdown 

and lead to over exposures. Although 

engineering controls are usually a reliable 

means for controlling employee exposures, 

equipment does occasionally fail. Thus, the 

standard applies where exposures below 

25 μg/m3 as an 8-hour TWA are expected 

or achieved, but only because engineering 

controls are being used to limit exposures.

General Industry and Maritime 

Work Indistinguishable from Table 1 

Construction Work

For general industry and maritime work that 

is indistinguishable from work covered by 

Table 1 in the construction silica standard, the 

employer may comply with the construction 

standard, including the specified exposure 

control methods in Table 1 for that task. The 

task must not be performed regularly in the 

same environment and conditions. 

For example, an employee repairing or 

maintaining existing power delivery lines 

(considered a general industry task) uses 

a handheld drill that is the same as that 

used while installing new power delivery 

lines (considered a construction task). 

This maintenance task is the same as the 

construction task and would occur in a 

variety of locations. The employer could 

protect the employee doing the maintenance 

task by following the entire construction 

standard, including the Table 1 entry for the 

specific task. 

Conversely, the construction standard 

could not be used by a general industry and 

maritime employer for sanding or cutting 

of concrete blocks in a concrete block 

manufacturing plant, because that is a task 

performed regularly in the same environment 

and conditions. Such an employer would 

not require the accommodation of Table 1, 

which is intended in part to address tasks 

performed in different environments and 

conditions. Similarly, an employer whose 

business includes chipping out concrete from 

inside the drums of ready-mixed concrete 

trucks using pneumatic chipping tools may 

not follow the construction standard because 

that task will be performed regularly and in a 

relatively stable and predictable environment.
Small Entity Compliance Guide for the Respirable Crystalline Silica Standard for General Industry and Maritime 3

DEFINITIONS – PARAGRAPH (B) OF THE STANDARD

Definitions are included in the standard to 

describe the meaning of terms used. Some of 

these terms are further explained as follows:

Action level means an airborne concentration 

of 25 μg/m3 calculated as an 8-hour TWA. 

Exposures at or above the action level trigger 

requirements for exposure assessment and 

medical surveillance. 

Employee exposure means the exposure 

to airborne respirable crystalline silica that 

would occur if the employee were not using 

a respirator. 

High-efficiency particulate air (HEPA) filter

means a filter that is at least 99.97 percent 

efficient in removing mono-dispersed particles 

of 0.3 micrometers in diameter. HEPA-filtered 

vacuuming is an example of a housekeeping 

method that minimizes employee exposure to 

respirable crystalline silica. 

Objective data means information, such as air 

monitoring data from industry-wide surveys 

or calculations based on the composition of a 

substance, demonstrating employee exposure 

to respirable crystalline silica associated with 

a particular product or material or a specific 

process, task, or activity. The data must reflect 

workplace conditions closely resembling or 

with a higher exposure potential than the 

processes, types of material, control methods, 

work practices, and environmental conditions 

in the employer’s current operations. 

Physician or other licensed health care 

professional [PLHCP] is an individual whose 

legally permitted scope of practice (i.e., 

license, registration, or certification) allows 

him or her to independently provide or be 

delegated the responsibility to provide some 

or all of the particular health care services 

required by this standard. 

Specialist means an American Board 

Certified Specialist in Pulmonary Disease 

or an American Board Certified Specialist in 

Occupational Medicine.

PERMISSIBLE EXPOSURE LIMIT (PEL) – PARAGRAPH (C) OF 

THE STANDARD

Employers must ensure that their employees’ 

exposures to respirable crystalline silica do not 

exceed the PEL, which is 50 μg/m3 as an 8-hour 

TWA. This means that over the course of any 

8-hour work shift, exposures can fluctuate, but 

the average exposure to respirable crystalline 

silica cannot exceed 50 μg/m3. The PEL applies 

to the three forms of respirable crystalline 

silica that are covered by the standard: quartz, 

cristobalite, and trydimite. Quartz is by far the 

most common form of crystalline silica found 

in general industry and maritime workplaces, 

and in most cases, quartz will be the only form 

of respirable crystalline silica analyzed in air 

samples used to measure employee exposures. 
4 Occupational Safety and Health Administration

Calculation of TWA Exposures

Both the PEL and the action level are expressed as TWA exposures. TWA measurements account 

for variable exposure levels over the course of a work shift by averaging periods of higher and lower 

exposures. The TWA exposure for an 8-hour work shift is calculated using a simple formula:

TWA = (Ca Ta + Cb Tb . . . Cn Tn) ÷ 8

Where: 

TWA is the time-weighted average exposure for the work shift

C is the concentration during any period of time (T) where the concentration remains constant; and 

T is the duration in hours of the exposure at the concentration (C)

For example, assume that an employee is exposed to respirable crystalline silica in an 8-hour workday 

as follows: 

Two hours exposure at 100 μg/m3

Two hours exposure at 50 μg/m3

Four hours exposure at 10 μg/m3

Entering this information in the formula, we get: 

(2 x 100 + 2 x 50 + 4 x 10) ÷ 8 = 42.5 μg/m3

Because 42.5 μg/m3 is higher than 25 μg/m3, this employee’s TWA exposure would be above the action 

level, but below the PEL of 50 μg/m3. 

EXPOSURE ASSESSMENT – PARAGRAPH (D) OF THE STANDARD

Employers must assess the 8-hour TWA 

exposure for each employee who is or may 

reasonably be expected to be exposed 

to respirable crystalline silica at or above 

the action level of 25 μg/m3 as an 8-hour 

TWA. The purposes of assessing employee 

exposures include: identifying where 

exposures are occurring; helping the 

employer select control methods and make 

sure those methods are effective; preventing 

employees from being exposed above the 

PEL; providing employees with information 

about their exposure levels; and allowing 

the employer to give the PLHCP performing 

medical examinations information about 

employee exposures. 

Employers can choose between two options 

for assessing exposures: 

■ The performance option; or

■ The scheduled monitoring option.

Performance Option

The performance option gives employers 

flexibility to determine the 8-hour TWA 

exposure for each employee based on 

any combination of air monitoring data 

or objective data that can accurately 

characterize employee exposures to 

respirable crystalline silica. 
Small Entity Compliance Guide for the Respirable Crystalline Silica Standard for General Industry and Maritime 5

Air monitoring data are any results of air 

monitoring (analyzed according to the 

procedures and requirements in Appendix 

A) that the employer has done to meet the 

requirements of the standard. 

Objective data is information that 

demonstrates employee exposure to 

respirable crystalline silica associated with 

a particular product or material or a specific 

process, task, or activity. The data must reflect 

workplace conditions that closely resemble 

or could result in higher exposures than the 

processes, types of material, control methods, 

work practices, and environmental conditions 

in the employer’s current operations. 

Examples of objective data are information 

such as:

■ Air monitoring data from industry-wide 

surveys;

■ Calculations based on the composition of 

a substance;

■ Area sampling results and exposure 

mapping profile approaches; and 

■ Historical air monitoring data collected by 

the employer.

Employers choosing the performance 

option must:

■ Conduct the exposure assessment before 

work begins;

■ Reassess exposures whenever a change 

in production, process, control equipment, 

personnel, or work practices may 

reasonably be expected to result in new 

or higher exposures at or above the action 

level, or when the employer has any reason 

to believe that new or additional exposures 

at or above the action level have occurred;

■ Be able to demonstrate that employee 

exposures have been accurately 

characterized; and

■ Make sure that the exposure assessment 

reflects the exposures of employees on 

each shift, for each job classification, in 

each work area.

The performance option may be especially 

useful when measuring employee exposures 

is challenging, such as when tasks are 

performed only occasionally. 

The performance option gives employers 

flexibility for characterizing the exposures 

of all employees. For example, instead of 

Examples of Using Objective Data to Conduct Exposure Assessments 

under the Performance Option

1. Industry-wide surveys of typical tasks or operations, which include well-documented procedures for 

measuring exposures and methods for controlling dust, could be used by employers to characterize 

employee exposures where employees perform tasks consistent with those described in the survey.

2. Employers can use direct-reading instruments to measure real-time levels of respirable dust in the 

air. If the employer has information on the percentage of respirable crystalline silica in that dust (for 

example, from the analysis of a bulk sample or information from a safety data sheet), he or she can 

then calculate the level of respirable crystalline silica in air.

3. Historical air monitoring data collected by the employer could be used to assess employee exposures 

if the employer can show that the data were collected during work operations and conditions that are 

consistent with the processes, types of material, control methods, work practices, and environmental 

conditions in the employer’s current operations. 
6 Occupational Safety and Health Administration

conducting air monitoring on two employees 

who perform the same job on different shifts, 

the employer could determine that there are 

no differences in exposure between those 

two employees, and characterize the exposure 

of the second employee based on the air 

monitoring results of the first employee.

Under the performance option, employers 

can characterize employee exposure within 

a range to account for exposure variability. 

Employers can also use that option to show 

that exposures exceed the PEL by a certain 

level, such as less than 10 times the PEL, 

after using all feasible controls. The employer 

would then know that he or she must provide 

respiratory protection with an assigned 

protection factor (APF) of at least 10.

Scheduled Monitoring Option 

The scheduled monitoring option lets 

employers know when and how often 

they must perform exposure monitoring 

to measure employee exposures. When 

following the scheduled monitoring option, 

employers must make sure that: 

■ Results represent the employee’s TWA 

exposure to respirable crystalline silica 

over an eight-hour workday; 

■ Samples are collected from the 

employee’s breathing zone; and 

■ Samples are collected outside respirators 

so that they represent the exposure 

that would occur without the use of the 

respirator.

OSHA intends for employers using the 

scheduled monitoring option to conduct 

initial monitoring as soon as work begins so 

that they are aware of exposure levels and 

where control measures are needed.

Under the scheduled monitoring option, just 

as under the performance option, employers 

must correctly characterize each employee’s 

exposure to respirable crystalline silica. 

Exposure monitoring must include, at a 

minimum, one full-shift sample taken for each 

job function in each job classification, in each 

work area, and on each shift. Characterizing 

each employee’s exposure may involve 

monitoring all exposed employees or a smaller 

number of employees whose exposures can 

then represent those of other employees.

Representative sampling involves monitoring 

the employee or employees reasonably 

expected to have the highest exposure to 

respirable crystalline silica (for example, the 

employee closest to an exposure source). 

This exposure is then assigned to the other 

employees in the group who perform the 

same tasks on the same shift and in the same 

work area.

Representative monitoring is allowed when 

several employees perform the same job on 

the same shift and under the same conditions. 

How Often Employers Must 

Monitor under the Scheduled 

Monitoring Option 

Under the scheduled monitoring option, how 

often monitoring must be done depends 

on the results of initial monitoring and, 

thereafter, any required further monitoring, 

as follows:

■ If the initial monitoring indicates that 

employee exposures are below the action 

level, no further monitoring is required. 

■ If the most recent exposure monitoring 

reveals employee exposures at or above 

the action level but at or below the PEL, the 

employer must repeat monitoring within 

six months of the most recent monitoring. 

■ If the most recent exposure monitoring 

reveals employee exposures above the 

PEL, the employer must repeat monitoring 

within three months of the most recent 

monitoring. 

■ When two non-initial monitoring results 

taken consecutively, at least 7 days 

apart but within 6 months of each other, 

are below the action level, employers 
Small Entity Compliance Guide for the Respirable Crystalline Silica Standard for General Industry and Maritime 7

may stop monitoring for employees 

represented by those results, as long as 

no changes occur that could reasonably 

be expected to result in new or additional 

exposures at or above the action level.

Reassessment of Exposures 

The employer must reassess exposures 

whenever a change in production, process, 

control equipment, personnel, or work 

practices may reasonably be expected to 

result in new or additional exposures to 

respirable crystalline silica at or above the 

action level, or when the employer has any 

reason to believe that new or additional 

exposures at or above the action level have 

occurred. For example, reassessment would 

be required when a material used in a process 

is replaced by a material with a higher silica 

content because the change could reasonably 

be expected to result in higher exposures to 

respirable crystalline silica. 

Employers do not have to conduct additional 

monitoring simply because a change has 

occurred, so long as the change is not 

reasonably expected to result in new or 

additional exposures to respirable crystalline 

silica at or above the action level. For 

example, reassessment is not required when 

a task is moved from an enclosed space 

to a larger location, or when a product is 

replaced with another product that has lower 

crystalline silica content in the same process. 

Methods of Sample Analysis 

(Appendix A of the Standard) 

Appendix A of the silica standard lists 

laboratory procedures for measuring 

respirable crystalline silica in air samples. 

Employers must make sure that all air 

samples taken to meet the requirements 

of the silica standard are analyzed by a 

laboratory that follows the procedures in 

Appendix A. If employers hire an outside 

laboratory to do the analyses for respirable 

crystalline silica, they can rely on a 

statement from that laboratory that it follows 

Appendix A. For example, the laboratory 

could indicate that it analyzes samples 

according to Appendix A of the standard in 

the laboratory report or on its website. 

Employee Notification

Employers must notify each affected 

employee of the results of the exposure 

assessment within 15 working days 

of completing it. “Affected” means all 

employees whose exposures were assessed, 

including employees whose exposures were 

represented by other employees’ exposure 

measurements, and those whose exposure 

assessments were based on objective data. 

The 15-day period for notification starts when:

■ An employer following the performance 

option finishes the exposure assessment; 

or 

■ An employer following the scheduled 

monitoring approach receives the 

laboratory results.

Employers must either notify each employee in 

writing or post the results in a location that all 

affected employees can access. In cases where 

an employee might have moved onto another 

job or jobsite, the assessment results could be 

included with the employees’ final paycheck.

Exposures can be characterized and reported 

as a range (for example, between the action 

level and the PEL), but must reflect exposures 

that would occur if the employee were not 

using a respirator.

When an exposure assessment reveals 

exposures above the PEL, the written 

notification must also describe the corrective 

action the employer is taking to reduce 

employee exposures to or below the PEL. 

Corrective actions include engineering 

controls. However, if engineering controls 

are not feasible or the employer needs more 

than 15 days to identify the right engineering 

controls, respiratory protection is the 

corrective action that would be described in 

the written notification. 
8 Occupational Safety and Health Administration

Observation of Monitoring 

The employer must let affected employees 

or their designated representatives 

observe any air monitoring of employee 

exposure to respirable crystalline silica. 

When observation of monitoring requires 

entry into an area where use of protective 

clothing or equipment, such as a respirator, 

is required, the employer must provide the 

observer with that protective clothing or 

equipment. The employer must provide the 

protective clothing and equipment at no 

cost, and make sure that the observer uses 

such clothing or equipment.

However, if the observer does not need to 

enter an area requiring the use of protective 

clothing or equipment in order to effectively 

observe monitoring (for example, if 

monitoring can be viewed from outside the 

hazardous areas), no protective clothing or 

equipment would be needed. 

REGULATED AREAS – PARAGRAPH (E) OF THE STANDARD

Regulated areas are workplace areas where 

exposures to respirable crystalline silica are, 

or can reasonably be expected to be, above 

the PEL. The standard for general industry 

and maritime requires employers to establish, 

demarcate, and limit access to regulated 

areas. The employer must also provide 

respirators and make sure they are used by 

those who must enter regulated areas. 

The purpose of a regulated area is to:

■ Ensure that employees know that silica 

levels are likely to exceed the PEL within 

the regulated area; 

■ Restrict the number of employees who 

could be exposed above the PEL by 

requiring the employer to mark areas 

where exposures are or are likely to be 

higher than the PEL; and 

■ Ensure that all who enter are properly 

protected with an appropriate respirator.

Establishing Regulated Areas

Employers must establish regulated areas 

where exposures to airborne concentrations 

of respirable crystalline silica are, or can 

reasonably be expected to be, greater 

than the PEL. Information used to measure 

employees’ exposures can be used to 

determine where regulated areas are 

required and identify the boundaries of 

these areas. For example, employers can 

use any combination of personal samples 

(air samples collected near the employee’s 

breathing zone), or objective data such 

as exposure mapping and real-time 

measurements to establish regulated areas. 

Demarcating Regulated Areas

Employers must demarcate (mark off) 

regulated areas from the rest of the 

workplace in a manner that decreases the 

number of employees exposed to respirable 

crystalline silica within the regulated area. 

Cones, stanchions, tape, barricades, lines, 

or textured flooring are some of the ways of 

marking the boundaries of regulated areas. 

Employers must post a sign at each entrance 

to regulated areas that reads:

DANGER

RESPIRABLE CRYSTALLINE SILICA

MAY CAUSE CANCER

CAUSES DAMAGE TO LUNGS

WEAR RESPIRATORY PROTECTION IN THIS AREA

AUTHORIZED PERSONNEL ONLY

The signs show employees that they are 

entering a regulated area, and the content of 

the sign ensures the employee will know the 

hazards associated with the area, as well as 

the need for respiratory protection.
Small Entity Compliance Guide for the Respirable Crystalline Silica Standard for General Industry and Maritime 9

Limiting Access to Regulated Areas

Employers must limit access to regulated 

areas to: 

■ Persons authorized by the employer and 

required by work duties to be present in 

the regulated area. This includes persons 

whose work is with or near the respirable 

crystalline silica-producing materials, 

but may also include maintenance and 

repair personnel, management, quality 

control engineers, or other employees if 

their job duties require them to be in the 

regulated area;

■ Any person entering the area as a 

designated representative of employees to 

observe silica exposure monitoring; or

■ Any person authorized by the Occupational 

Safety and Health Act or regulations issued 

under it to be in a regulated area (e.g., 

OSHA enforcement personnel).

Access restrictions limit the number of 

persons who may enter into or walk or drive 

vehicles through areas where exposures 

exceed the PEL. Therefore, it protects 

employees who would otherwise be exposed 

when needlessly spending time in or passing 

through the regulated area. 

Providing Respirators to those 

Entering Regulated Areas

The employer must:

■ Provide each employee and the employee’s 

designated representative entering 

a regulated area with an appropriate 

respirator that meets the requirements 

for respiratory protection under the 

Respiratory Protection standard; and,

■ Require the employee and representative to 

use the respirator while in the regulated area. 

Persons must put on respirators before 

entering, and take off respirators after exiting 

the regulated area. The employer must 

provide and ensure the use of the appropriate 

respirator to any employees or representatives 

who enter these areas, regardless of their 

work activities or the amount of time they 

spend inside. Requiring all employees and 

representatives to wear respirators in a 

regulated area ensures that they are protected. 

METHODS OF COMPLIANCE – PARAGRAPH (F) OF THE STANDARD

The methods of compliance section of the 

standard requires employers to protect 

employees following the hierarchy of controls, 

which relies on engineering and work 

practice controls for reducing exposures and 

allows for respirator use, in addition to those 

controls, only when feasible engineering 

controls cannot reduce exposures to 

acceptable levels. The methods of compliance 

section also requires employers to prepare a 

written exposure control plan, and it crossreferences other OSHA standards that apply 

to abrasive blasting.

Engineering and Work 

Practice Controls

Employers must use engineering and 

work practice controls to reduce and keep 

employee exposure to respirable crystalline 

silica to or below the PEL of 50 μg/m3, 

unless the employer can demonstrate that 

such controls are not feasible. If feasible 

engineering and work practice controls are 

not able to reduce employee exposures to 

or below the PEL, employers must still use 

feasible controls to reduce exposures to the 

lowest possible level and then use respiratory 

protection along with those controls. 
10 Occupational Safety and Health Administration

The main types of engineering controls for 

silica are wet methods and local exhaust 

ventilation. Wet methods involve applying 

water or foam at the point of dust generation to 

keep dust from getting into the air. An example 

is a grinder that delivers water at the point of 

contact. Local exhaust ventilation removes dust 

by capturing it at or near the point where it is 

created. An example is an exhaust hood that 

captures dust at the point where it is created. 

Another engineering control is isolation. 

Isolation separates employees from the dust 

source by containing the dust or isolating 

employees. An example is a properly 

ventilated control booth.

Work practice controls involve performing a 

task in a way that reduces the likelihood or 

levels of exposure. Work practice controls 

are often used with engineering controls 

to protect employees. Employees must 

know the appropriate work practices for 

maximizing the effectiveness of controls and 

minimizing exposures. Examples of work 

practice controls include: 

■ Inspecting and maintaining controls to 

prevent or fix malfunctions that would 

result in increased exposures;

■ Ensuring that tools with wet controls spray 

water at the point of dust generation;

■ Positioning local exhaust hoods directly 

over the exposure source and not opening 

windows near the local exhaust source;

■ Wetting down silica dust before sweeping 

it up; and

■ Scheduling work so that tasks that involve 

high exposures are performed when no 

other employees are in the area.

Reducing exposures through the primary use 

of engineering and work practice controls is 

known as the hierarchy of controls, and it is 

a long-standing OSHA policy. Advantages of 

engineering controls are that they:

■ Control crystalline silica-containing 

dust particles at the source, thus 

minimizing exposures to all persons in the 

surrounding work area; 

■ Are reliable, predictable, and provide 

consistent levels of protection to a large 

number of employees; 

■ Can be monitored; and

■ Are generally less prone to human error than 

is the use of personal protective equipment. 

Under the hierarchy of controls, respirators 

can be another effective way to protect 

employees. However, respirators may be 

less practical or effective than engineering 

controls for the following reasons: 

■ They must be selected for each worker, 

fitted, occasionally refitted, and regularly 

maintained (including replacing filters and 

other parts as necessary). 

■ Employees have to consistently and 

correctly use properly fitted respirators 

but may resist wearing them because 

respirators can be uncomfortable, 

especially in hot weather. 

■ Respirators may put a physical strain 

on employees’ bodies, as a result of the 

respirator’s weight and because they 

increase breathing resistance. Employees 

with some health conditions cannot wear 

respirators because the physical strain of 

wearing the respirator increases their risk 

of illness, injury, and even death. 

■ Respirators can create safety concerns 

because they interfere with workers’ ability 

to hear, see, smell, and communicate. 

■ Respirators only protect the employees 

wearing them. 

Even when engineering and work practice 

controls cannot reduce exposure levels 

to or below the PEL, those controls must 

be used to reduce exposures as low as 

possible. This reduction in exposure levels 

benefits employees by reducing the required 

protection factor of the respirator, and thus 

increasing the choices of respirators that can 

be used. For example, if feasible engineering 

controls reduce exposures from 50 times to 

less than 10 times the PEL, employers could 

provide approved half-mask respirators with 

an APF of 10 that may be lighter and easier to 

use compared to full-facepiece respirators.
Small Entity Compliance Guide for the Respirable Crystalline Silica Standard for General Industry and Maritime 11

Written Exposure Control Plan

All employers covered by the standard must 

develop and implement a written exposure 

control plan. Written exposure control 

plans describe workplace exposures and 

ways to reduce those exposures, such as 

engineering controls, work practices, and 

housekeeping methods. The plans improve 

employee protections by making sure 

that employers identify all exposures and 

controls to prevent overexposures. Such 

plans are also useful for letting employees 

know what kind of protections they should 

expect to see on the job. 

What Must be Included in a Written 

Exposure Control Plan

Below is a list of what the employer must 

include in each section of the written 

exposure control plan, with general examples 

of the types of information that could be 

included and sample entries for tasks 

conducted at a glass manufacturing plant. 

The plan must include a description of 

workplace tasks involving exposures to 

respirable crystalline silica. Employers must 

list all tasks that employees perform that could 

expose them to respirable crystalline silica dust. 

Example: 

Raw Material Handling: Sand is delivered 

from rail cars or trucks to storage silos through 

enclosed, pneumatic conveyor systems.

Batch Operations: Sand is transferred from 

storage facilities to weigh stations, mixers 

and furnaces through enclosed pneumatic 

conveyor systems.

The plan must include a description of 

engineering controls, work practices, and 

respiratory protection used to limit employee 

exposure to respirable crystalline silica for 

each task. For each task that employees 

perform, employers must describe types of 

controls used, like:

■ Enclosures, 

■ Effective work practices, as in checking 

the enclosure for leaks, and 

■ If required, appropriate respiratory 

protection, like a respirator with an APF 

of 10. 

Employers could also describe signs that 

controls are not working effectively, such as 

an increase in visible dust or no water being 

delivered to the material. 

Example:

Controls: 

 For raw material handling and batch 

operating tasks, pneumatic conveyor 

systems are enclosed and maintained at 

negative pressure. 

 Water is misted onto sand before it is mixed 

in batch operations.

Work practices: 

 Check that connections between rail cars 

or trucks and storage silos are effectively 

sealed before transferring sand. 

 Apply water mist to sand before batch 

operations. 

 Check to make sure sand is not released from 

any point of the pneumatic transfer system. If 

sand is being released, have a supervisor or 

engineer inspect the system. 

 Inspect enclosures and seals on the pneumatic 

transfer system for damage weekly.

 Measure pressure in the pneumatic system 

daily.

Respiratory protection: 

 No respirators are required during normal 

operations.

 See respiratory protection program for 

information on respirator requirements for 

situations such as spills or maintenance. 

The plan must include a description of 

the housekeeping methods used to limit 

employee exposure to respirable crystalline 

silica. While employees are cleaning, dust 
12 Occupational Safety and Health Administration

can become airborne and expose them to 

silica. In this part of the written exposure 

control plan, employers must list acceptable 

cleaning methods that will be used to 

prevent employees from being exposed and 

any protections that are needed if certain 

cleaning methods have to be used. 

The Housekeeping section of the standard 

requires that, when cleaning up dust that 

can contribute to employee exposures to 

respirable crystalline silica, employers must: 

■ Not allow cleaning by dry brushing and 

sweeping, unless methods such as wet 

sweeping and HEPA-filtered vacuuming 

are not feasible; 

■ Not allow cleaning of surfaces or 

clothing with compressed air, unless the 

compressed air is used together with 

a ventilation system that effectively 

captures the dust cloud or no other 

cleaning method is feasible.

This section of the written plan would include 

cleaning methods that are acceptable (e.g., 

wet sweeping), cleaning methods that are 

unacceptable because acceptable cleaning 

methods are feasible (e.g., dry sweeping), 

and special instructions (e.g., use local 

exhaust ventilation if compressed air must 

be used). Hygiene-related subjects, such as 

not using compressed air to clean clothing, 

could also be addressed in this section of the 

written exposure control plan.

Example: 

 Use the central vacuum system for cleaning. 

 Use a HEPA-filtered vacuum for cleaning spills. 

 Do not dry sweep.

Yearly Review of Written Exposure 

Control Plans

The Respirable Crystalline Silica standard 

requires employers to review and evaluate 

the effectiveness of the written exposure 

control plan at least once a year and update 

it as necessary. A yearly review is needed 

to make sure that all information in the plan 

is up-to-date. For example, the employer 

might have bought a new type of equipment 

or asked employees to conduct a new task 

involving exposure, and that information 

needs to be described in the written plan. 

Availability of the Written Exposure 

Control Plan

Employers must allow the written exposure 

control plan to be viewed or copied by 

each employee covered by the standard, 

their designated representative, and 

representatives from OSHA or NIOSH, 

upon request. Making the written exposure 

control plan available to employees and 

their designated representatives empowers 

and protects employees by letting them 

and their representatives know the silica 

hazards the employer identified and controls 

for those hazards. This allows employees 

and representatives to question employers 

if controls are not fully and properly 

implemented or maintained. Likewise, 

making written exposure control plans 

readily available to OSHA or NIOSH allows 

them to verify that employee protections 

are effective. If OSHA inspects a workplace, 

the OSHA Compliance Safety and Health 

Officer will ask to see the employer’s written 

exposure control plan.

Sample Written Exposure Control Plans

To help employers develop written exposure 

control plans, a sample plan is included below. 

This sample shows an easy-to-use format that 

can be changed to address the specific tasks 

performed by each employee. The sample 

plan meets the requirements of the standard 

and contains the level of detail that OSHA 

considers useful for employers in helping 

them protect their employees. As the sample 

shows, the plan can contain useful information 

without being long or complicated. 
Small Entity Compliance Guide for the Respirable Crystalline Silica Standard for General Industry and Maritime 13

Unions, trade associations or professional 

groups may offer sample written exposure 

control plans or other assistance to 

employers, which might be helpful, 

especially if written exposure control plans 

are tailored to a particular type of work 

performed. Although such general guidance 

may be helpful, employers must make sure 

that any plan they use is tailored to address 

all the information required by the standard 

and all tasks, tools, and controls used by 

the employer. 

Some sample plans might call for more 

information than is required by the silica 

standard (for example, information about 

exposure assessments, medical surveillance, 

and training). Employers can include this 

information in the plan if it is useful to them, 

but they are not required to do so under the 

silica standard.

Written Exposure Control Plan

Company: Countertops, Inc.

Person Completing the Plan, Title: Mary Smith, Owner

Description of Task:

 Stone or engineered stone slabs are cut using a gantry saw. 

 Stone or engineered stone slabs are ground using an electric, handheld angle-grinder.

 Stone or engineered stone slabs are polished using a high-speed polisher.

Task/Control Description

 The gantry saw is operated with recirculated water in an enclosed, ventilated booth. 

 The handheld grinders and polishers are operated using water, except for specialty cuts that are 

performed dry, in which case the grinder is equipped with a shroud attached to a HEPA-filtered vacuum.

Work Practices (for tasks described above that use wet method controls): 

 Use a hose to wet the slab off before cutting, grinding, or polishing each section.

 Make sure the slab is positioned underneath the local exhaust hood when sawing, and check flow rate 

of that local exhaust hood daily.

 Make sure that water is continuously delivered to the point of cutting, grinding, or polishing.

 Change recirculated water if silt build-up occurs. 

 Check for proper function of controls by making sure water is flowing to the blade. 

Work Practices for Dry Grinding and Polishing: 

 Check that shroud is intact and properly installed. Keep shroud flush with working surface, 

whenever possible.

 Check that vacuum hosing is intact and not kinked or bent.

 Clean or change filters as needed to prevent clogging. 

 Check for proper function of controls by making sure visible dust does not increase. 

Respiratory protection: 

 Respirators are not needed if controls are working and proper work practices are being followed. 

Housekeeping:

 Hose down floor frequently and at the end of each work shift.

 Clean up wet slurry to prevent it from drying and becoming airborne.
14 Occupational Safety and Health Administration

Abrasive Blasting

In addition to complying with requirements to 

use engineering controls and work practices 

according to the hierarchy of controls, 

employers that conduct abrasive blasting 

operations using crystalline silica-containing 

blasting agents or conduct abrasive blasting 

on substrates that contain crystalline silica 

must also comply with other relevant 

standards. These standards include the 

ventilation standard for general industry (29 

CFR 1910.94), the mechanical paint removers 

standard for shipyards (1915.34), and the 

personal protective equipment standard for 

shipyards (29 CFR 1915 Subpart I). This is 

simply a cross-reference to other standards 

that employers must comply with when 

conducting abrasive blasting.

RESPIRATORY PROTECTION – PARAGRAPH (G) OF THE STANDARD

Employers must provide employees with 

appropriate respirators where required by the 

silica standard. The respirators must comply 

with requirements of the silica standard and 

with OSHA’s Respiratory Protection standard 

(29 CFR 1910.134). 

Employers must provide respiratory protection:

■ Where exposures exceed the PEL during 

periods necessary to install or implement 

feasible engineering and work practice 

controls;

■ Where exposures exceed the PEL during 

tasks, such as some maintenance and 

repair tasks, for which engineering and 

work practice controls are not feasible;

■ During tasks in which the employer has 

implemented all feasible engineering 

and work practice controls but exposures 

remain above the PEL; and

■ While the employee is in a regulated area.

Where respirator use is required, employers 

must implement a respiratory protection 

program in accordance with the Respiratory 

Protection standard. The respiratory protection 

program ensures that respirators are properly 

used in the workplace and are effective 

in protecting employees. See the Small 

Entity Compliance Guide for the Respiratory 

Protection Standard for information on the 

requirements of that standard.

Voluntary Use of Respirators

Employers may provide respirators at the 

request of employees or let employees use 

their own respirators when respirators are not 

required under the silica standard. See the Small 

Entity Compliance Guide for the Respiratory 

Protection Standard for information about 

employer responsibilities when employees 

voluntarily wear respirators. 

HOUSEKEEPING – PARAGRAPH (H) OF THE STANDARD

The Respirable Crystalline Silica standard 

requires all employers covered by the 

standard to avoid certain housekeeping 

practices. When cleaning up dust that 

could contribute to employee exposure to 

respirable crystalline silica, employers must: 

■ Not allow dry brushing or dry sweeping, 

unless methods such as wet sweeping and 

HEPA-filtered vacuuming are not feasible; 

■ Not allow cleaning of surfaces or 

clothing with compressed air, unless the 

compressed air is used together with 

a ventilation system that effectively 

captures the dust cloud or no other 

cleaning method is feasible.

Cleaning methods such as dry sweeping, 

dry brushing, and use of compressed air can 

cause respirable crystalline silica dust to get 
Small Entity Compliance Guide for the Respirable Crystalline Silica Standard for General Industry and Maritime 15

into the air and be inhaled by employees. 

Therefore, the silica standard limits the 

use of these cleaning methods to prevent 

unnecessary exposures to employees. 

Employers are required to use other cleaning 

methods such as wet sweeping and HEPAfiltered vacuums, whenever feasible, because 

such methods reduce employee exposures 

by preventing silica-containing dust from 

getting into the air. 

Feasibility of Cleaning Methods

In a very limited number of cases, cleaning 

methods such as wet sweeping or HEPAfiltered vacuums may not be safe or effective. 

When wet methods or HEPA-filtered 

vacuuming would not be effective, would 

cause damage, or would create a hazard in 

the workplace, the employer is not required to 

use these cleaning methods. However, even 

in cases where one of those cleaning methods 

may not be safe or effective, employers could 

often use another acceptable method for 

cleaning. For example, if it is not feasible to 

wet sweep near electrical equipment, a HEPAfiltered vacuum could be used for cleaning. 

Therefore, situations in which no acceptable 

cleaning methods can be used are expected to 

be very rare. 

In those rare cases where the employer 

needs to use cleaning methods such as dry 

sweeping, dry brushing, or compressed air, 

the employer must be able to show why 

cleaning methods that decrease employee 

exposures are not feasible.

When Employers Must Follow 

Housekeeping Practices

The housekeeping requirements in the 

silica standard apply only where cleaning 

“could contribute to employee exposure 

to respirable crystalline silica”. This phrase 

clarifies that employers have to follow the 

housekeeping requirements of the silica 

standard only where employees could 

be exposed to the very small (respirable) 

crystalline silica particles as are found in 

industrial sand or are created by high-energy 

tasks such as grinding stone countertops. 

MEDICAL SURVEILLANCE – PARAGRAPH (I) OF THE STANDARD

Medical surveillance is intended to (1) identify 

respirable crystalline silica-related diseases 

so that employees with those diseases 

can take actions to protect their health; (2) 

determine if an employee has any condition, 

such as a lung disease, that might make him 

or her more sensitive to respirable crystalline 

silica exposure; and (3) determine the 

employee’s fitness to use respirators. 

The standard specifies which employees 

must be offered medical surveillance, when 

and how often the examinations must 

offered, and the tests that make up medical 

examinations. The standard also specifies 

the information that the employer must give 

to the physician or other licensed health 

care professional (PLHCP) who conducts 

the examinations and the information that 

the employer must ensure that the PLHCP 

provides to the employee and employer.

All medical examinations and procedures 

required by the standard must be performed 

by a PLHCP. Medical surveillance must 

be provided at no cost to employees, and 

at a reasonable time and place. If getting 

the medical examination requires the 

employee to travel away from the worksite, 

the employer is required to cover the cost 

of travel. The employer must also pay 

employees for time spent traveling and taking 

medical examinations.
16 Occupational Safety and Health Administration

Which Employees Must be Offered 

Medical Surveillance

Employers must make an initial or periodic 

medical examination available to employees 

who meet the exposure trigger. The triggers 

for medical surveillance are: 

1. Exposures above the PEL for 30 or more 

days a year from June 23, 2018 through 

June 22, 2020;

2. Exposures at or above the action level 

for 30 or more days a year beginning 

June 23, 2020.

Frequency of Medical Examinations

Employers must offer medical examinations:

■ Within 30 days of initial assignment (the 

day the employee starts working in a job/

task in which he or she will be exposed at 

the trigger point for 30 or more days per 

year), unless the employee has had an 

examination that meets the requirements 

of the silica standard within the last 

three years. 

■ Every three years from the employee’s last 

examination that met the requirements 

of the silica standard, or more frequently 

if recommended by the PLHCP, if the 

employee will continue to perform tasks 

that result in exposures at the trigger for 

30 or more days per year. 

A PLHCP might recommend more frequent 

medical examinations based on factors such 

as high exposure levels or a medical finding, 

such as an X-ray suggesting silicosis. 

Employers must make sure that employees 

receive a dated copy of the PLHCP’s written 

medical opinion for the employer, and the 

employee can present that opinion to a 

new employer as proof of a current medical 

examination. Employers can determine when 

they must offer an employee the next periodic 

medical examination based on the examination 

date on the written medical opinion. 

Tests that Must be Included in the 

Examination

An initial medical examination provided 

under the silica standard must consist of: 

■ A medical and work history that focuses 

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 of respiratory 

disease (for example, shortness of breath, 

cough, wheezing); history of tuberculosis; 

and smoking status and history; 

■ A physical examination that focuses on 

the respiratory system;

■ A digital or film chest X-ray interpreted 

according to the International Labour 

Office (ILO) International Classification 

of Radiographs of Pneumoconioses by a 

National Institute for Occupational Safety 

and Health (NIOSH)-certified B Reader 

(this involves a certified physician reading 

the X-ray according to certain procedures 

to determine if it shows signs of diseases 

such as silicosis);

■ A lung function (spirometry) test that 

includes forced vital capacity (the total 

amount of air that is forcefully blown 

out after taking a full breath), forced 

expiratory volume in one second (the 

amount of air forcefully blown out in the 

first second), and FEV1/FVC ratio (the 

speed of air that is forcefully blown out), 

administered by a spirometry technician 

with a current certificate from a NIOSHapproved spirometry course; 

■ Testing for latent tuberculosis infection; 

■ Any other tests deemed appropriate 

(medically necessary and related to 

respirable crystalline silica exposure) by 

the PLHCP.

Periodic examinations include all these 

tests, with the exception of testing for latent 

tuberculosis, which is required only for the 

initial examination.
Small Entity Compliance Guide for the Respirable Crystalline Silica Standard for General Industry and Maritime 17

Employees who must be offered medical 

surveillance are at risk of developing 

respirable crystalline silica-related diseases, 

and the required tests are the minimum tests 

needed to look for those diseases. More tests 

may also be needed to address an employee’s 

medical complaint or a finding related to 

respirable crystalline silica exposure, such as 

abnormal lung function. The standard gives 

the PLHCP the flexibility to order additional 

tests he or she deems appropriate. Employers 

must make those tests ordered by the PLHCP 

available to the employee. 

Information the Employer Must 

Provide to the PLHCP

The employer must ensure that the 

examining PLHCP has a copy of the standard 

and must provide the PLHCP with: 

■ A description of the employee’s past, 

current, and future duties as they relate to 

respirable crystalline silica exposure; 

■ The employee’s past, current, and 

future levels of 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 or will use 

that equipment; and 

■ Information from records of employmentrelated medical examinations previously 

provided to the employee and currently 

within the control of the employer. 

The PLHCP needs this information to evaluate 

the employee’s health in relation to assigned 

duties and fitness to use personal protective 

equipment, such as respirators. The 

information provided to the PLHCP includes 

only that within the control of the employer; 

the employer is not required to obtain 

information from past employers. 

The PLHCP’s Written Medical Report 

for the Employee

The employer must ensure that the PLHCP 

explains the results of the medical examination 

to the employee and gives the employee a 

written medical report within 30 days of each 

medical examination performed. Only the 

employee receives the written medical report, 

and the employer does not receive a copy of 

this report. The report must contain: 

■ A description of the medical examination 

results, including any medical condition(s) 

that would place the employee at 

increased risk of material impairment 

of health from exposure to respirable 

Medical Evaluation Requirements under 

the Respiratory Protection Standard

Employees who are required to wear respirators 

must receive medical evaluations required by 

the Respiratory Protection standard before they 

are fit tested for a respirator or wear a respirator 

in the workplace. The medical evaluation for 

the Respiratory Protection standard can be 

combined with the medical examination for 

silica, and employers could have the PLHCP 

conduct both the evaluation for respirator use 

and examination for silica at the same time. 

They could also have employees evaluated for 

respirator use before they wear a respirator and 

then offer the silica examination later, according 

to the required time limits of the silica standard. 

Also note that under the Respiratory Protection 

standard, employers are required to provide 

another medical evaluation if employees report 

medical signs or symptoms related to the 

ability to wear a respirator. 

(see 29 CFR 1910.134, Respiratory Protection, 

and OSHA’s Small Entity Compliance Guide 

for the Respiratory Protection Standard, 

Publication #3384). 
18 Occupational Safety and Health Administration

crystalline silica (any health condition 

that might make the employee more 

sensitive to exposure). The report must 

also describe any medical conditions that 

require further evaluation or treatment;

■ Any recommended limitations on the 

employee’s use of respirators;

■ Any recommended limitations on 

respirable crystalline silica exposure; and

■ A statement that the employee should be 

examined by a specialist if the B-reader 

classifies the chest X-ray provided 

under the silica standard as 1/0 or higher 

(X-ray evidence of silicosis in employees 

exposed to respirable crystalline silica), 

or if the PLHCP otherwise recommends 

referral to a specialist. 

The PLHCP’s Written Medical 

Opinion for the Employer

The employer must get a written medical 

opinion from the PLHCP within 30 days of the 

medical examination. The written opinion 

must contain only the following information: 

■ The date of the examination; 

■ A statement that the examination has met 

the requirements of the silica standard; and 

■ Any recommended limitations on the 

employee’s use of respirators. 

If the employee gives written authorization, 

the written medical opinion to the employer 

must also contain one 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 B 

reader classifies the chest X-ray provided 

under the silica standard as 1/0 or higher 

(X-ray evidence of silicosis in employees 

exposed to respirable crystalline silica), 

or if the PLHCP otherwise recommends 

referral to a specialist.

The purpose of the employee written 

authorization requirement is to enhance 

employee privacy and encourage employees 

to participate in medical surveillance 

by minimizing fears about retaliation or 

discrimination based on medical findings.

Employers must make sure that each employee 

receives a copy of the written medical opinion 

within 30 days of each medical examination. 

The PLHCP can give a copy of the opinion 

directly to the employee, so long as the time 

deadline is met. As indicated above, employees 

can show this opinion to future employers as 

proof that medical surveillance requirements 

under the silica standard are current. 

Sample Medical Forms in Appendix B 

of the Standard

Appendix B contains guidelines for PLHCPs 

and blank sample forms for the medical 

report for the employee, the medical opinion 

for the employer, and an authorization form 

to allow limitations on respirable crystalline 

silica exposure or recommendations for 

a specialist examination to be reported to 

the employer. Employers must make sure 

that PLHCPs who will conduct medical 

examinations required by the silica standard 

have a copy of the standard, including 

Appendix B. The purpose of Appendix B 

is to give PLHCPs medical information and 

guidance to help them conduct medical 

examinations that meet the requirements of 

the silica standard. 

Examples of completed forms are included in 

this guide. Sample Form 1 is a sample of the 

written medical report that the PLHCP provides 

to the employee. The employer does not 

receive a copy of the written medical report. 

Sample Form 2 is a sample of the written 

medical opinion that the PLHCP provides to 

the employer. The PLHCP indicates the type 

of examination and recommendations on 

use of a respirator. If the employee signs the 

written authorization (Sample Form 3) allowing 

the PLHCP to release further information 

to the employer, the PLHCP must include 

any recommend limitations on exposure to 

respirable crystalline silica and/or any referral 

to a specialist.
Small Entity Compliance Guide for the Respirable Crystalline Silica Standard for General Industry and Maritime 19

Small Entity Compliance Guide for General Industry and Maritime 

Draft – Do not Quote or Cite 2/22/2017 

25

SAMPLE FORM 1: WRITTEN MEDICAL REPORT FOR EMPLOYEE

EMPLOYEE NAME: Joe Smith DATE OF EXAMINATION: July 1, 2018

TYPE OF EXAMINATION:

[x] Initial examination [ ] Periodic examination [ ] Specialist examination

[ ] Other: _______________________________________________________________________________________

RESULTS OF MEDICAL EXAMINATION:

Physical Examination – [x] Normal [ ] Abnormal (see below) [ ] Not performed

Chest X-Ray – [x] Normal [ ] Abnormal (see below) [ ] Not performed

Breathing Test (Spirometry) – [ ] Normal [x] Abnormal (see below) [ ] Not performed

Test for Tuberculosis – [x] Normal [ ] Abnormal (see below) [ ] Not performed

Other:___________________ [ ] Normal [ ] Abnormal (see below) [ ] Not performed

Results reported as abnormal: Breathing test (Spirometry) shows an obstructive pattern. 

__________________________________________________________________________________________________

[x] Your health may be at increased risk from exposure to respirable crystalline silica due to the following:

Continued unprotected exposure to respirable crystalline silica may further damage your lungs.

RECOMMENDATIONS: 

[ ] No limitations on respirator use

[x] Recommended limitations on use of respirator: A powered air purifying respirator (PAPR) is the only type of

respirator you can safely wear. A PAPR will give you higher protection from silica exposure and will decrease strain on

your heart and lungs.

[x] Recommended limitations on exposure to respirable crystalline silica: Ideally, you may want to consider a position

that doesn’t involve exposure to substances hazardous to your lungs, such as respirable crystalline silica. If that is not

possible, be sure to always wear a respirator when needed to protect your lungs.

Dates for recommended limitations, if applicable: Indefinitely unless otherwise indicated by a specialist.

[x] I recommend that you be examined by a Board Certified Specialist in Pulmonary Disease or Occupational Medicine

[x] Other recommendations*: See your personal physician about the mole on your neck.

__________________________________________________________________________________________________

Your next periodic examination for silica exposure should be in: [ ] 3 years [x] Other: 1 year, July 1, 2019

Examining Provider: Dr. Jones Date: July 1, 2018

 (signature)

Provider Name: Dr. Jones Health Clinic

Office Address: _1111 Main Street, Washington, DC Office Phone: _123-456-7890__________________

*These findings may not be related to respirable crystalline silica exposure or may not be work-related, and therefore

may not be covered by the employer. These findings may necessitate follow-up and treatment by your personal

physician.

Respirable Crystalline Silica standard (§ 1910.1053 or 1926.1153)
20 Occupational Safety and Health Administration

Small Entity Compliance Guide for General Industry and Maritime 

Draft – Do not Quote or Cite 2/22/2017

26

SAMPLE FORM 2: WRITTEN MEDICAL OPINION FOR EMPLOYER

EMPLOYER: _Glass, Inc.___________________________________________

EMPLOYEE NAME: __Joe Smith_________________ DATE OF EXAMINATION: July 1, 2018________

TYPE OF EXAMINATION:

[x] Initial examination [ ] Periodic examination [ ] Specialist examination

[ ] Other: _______________________________________________________________________________________

USE OF RESPIRATOR:

[ ] No limitations on respirator use

[x] Recommended limitations on use of respirator: A powered air purifying respirator (PAPR) is the only type of 

respirator Mr. Smith can safely wear.

Dates for recommended limitations, if applicable: Indefinitely, unless otherwise recommended by specialist

The employee has provided written authorization for disclosure of the following to the employer (if applicable):

[x] This employee should be examined by an American Board Certified Specialist in Pulmonary Disease or Occupational 

Medicine

[ ] Recommended limitations on exposure to respirable crystalline silica:_______________________________________

__________________________________________________________________________________________________

Dates for exposure limitations noted above: _______________ to _______________

 MM/DD/YYYY MM/DD/YYYY

NEXT PERIODIC EVALUATION: [ ] 3 years [x] Other: _1 year, July 1, 2019

 

Examining Provider: __Dr. Jones____________________________ Date: July 1, 2018

 (signature)

Provider Name: _Dr. Jones Health Clinic Provider’s specialty: None, general practitioner

Office Address: _1111 Main Street, Washington, DC________ Office Phone: _123-456-7890_____________

[x] I attest that the results have been explained to the employee.

The following is required to be checked by the Physician or other Licensed Health Care Professional (PLHCP):

[x] I attest that this medical examination has met the requirements of the medical surveillance section of the OSHA 

Respirable Crystalline Silica standard (§ 1910.1053(h) or 1926.1153(h)).
Small Entity Compliance Guide for the Respirable Crystalline Silica Standard for General Industry and Maritime 21

Small Entity Compliance Guide for General Industry and Maritime 

Draft – Do not Quote or Cite 2/22/2017

27

SAMPLE FORM 3: AUTHORIZATION FOR CRYSTALLINE SILICA OPINION TO EMPLOYER

This medical examination for exposure to crystalline silica could reveal a medical condition that results in 

recommendations for (1) limitations on respirator use, (2) limitations on exposure to crystalline silica, or (3) 

examination by a specialist in pulmonary disease or occupational medicine. Recommended limitations on 

respirator use will be included in the written opinion to the employer. If you want your employer to know about 

limitations on crystalline silica exposure or recommendations for a specialist examination, you will need to give 

authorization for the written opinion to the employer to include one or both of those recommendations. 

I hereby authorize the opinion to the employer to contain the following information, if relevant

(please check all that apply): 

Recommendations for limitations on crystalline silica exposure

Recommendation for a specialist examination 

OR

I do not authorize the opinion to the employer to contain anything other than recommended limitations on 

respirator use. 

Please read and initial: 

_X_ I understand that if I do not authorize my employer to receive the recommendation for specialist 

examination, the employer will not be responsible for arranging and covering costs of a specialist 

examination under the OSHA standard for respirable crystalline silica. 

__Joe Smith_______ 

Name (printed)

__Joe Smith______________________________ July 1, 2018______________________

Signature Date

X
2 2 Occupational Safety and Health Administration

Additional Examinations 

by a Specialist

The employer must make the specialist 

examination available within 30 days of 

receiving the written medical opinion that 

includes the PLHCP’s recommendation for 

a specialist examination. The specialists 

must be either an American Board Certified 

Specialist in Pulmonary Disease or an 

American Board Certified Specialist in 

Occupational Medicine.

The employer must ensure the specialist: 

■ Receives the same information that the 

employer is required to provide the PLHCP 

(see above);

■ Explains the results of the medical 

examination to the employee and 

provides each employee with a written 

medical report within 30 days of the 

examination; and 

■ Provides the employer a written medical 

opinion within 30 days of the examination.

The specialist’s written medical report to 

the employee must contain the following 

information: 

■ A description of the medical examination 

results, including any medical condition(s) 

that may make an employee more 

sensitive to respirable crystalline silica 

exposure 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 

respirable crystalline silica exposure.

The specialist’s written medical opinion for 

the employer must include only the following: 

■ The date of the examination; and 

■ Any recommended limitations on the 

employee’s use of respirators. 

If the employee gives written authorization, 

the written opinion to the employer must 

also contain any recommended limitations 

on the employee’s exposure to respirable 

crystalline silica.
Small Entity Compliance Guide for the Respirable Crystalline Silica Standard for General Industry and Maritime 2 3

COMMUNICATION OF HAZARDS – PARAGRAPH (J) OF 

THE STANDARD

Employers must train and inform employees 

covered by the silica standard about 

respirable crystalline silica hazards and the 

methods the employer uses to limit their 

exposures to those hazards. Employers 

must cover the cost of training and must pay 

employees for the time spent in training.

OSHA’s Hazard Communication Standard

Employers must also comply with OSHA’s Hazard Communication standard (HCS) (29 CFR 1910.1200). HCS 

requires employers to inform employees about hazardous chemicals in the workplace, such as respirable 

crystalline silica, through their written hazard communication programs. Written hazard communication 

programs must describe how requirements for container labels, safety data sheets (SDSs), and employee 

training will be met. As part of their hazard communication program for respirable crystalline silica, 

employers must address at least these health hazards: cancer, lung effects, immune system effects, and 

kidney effects. 

Under the HCS, employers must:

 Inform employees about the general requirements of HCS, as well as where and how they can view the 

written hazard communication program, lists of hazardous chemicals, and SDSs.

 Train employees on how the presence or release of hazardous chemicals in the work area is detected; 

in the case of respirable crystalline silica, this could include methods the employer uses to measure 

exposures, such as air sampling or objective data. Employers can train employees to recognize that an 

increase in visible dust is a sign that a control may not be working properly.

 Train employees on the details of the workplace-specific hazard communication program developed 

by the employer, such as container labels, the workplace labeling system, SDSs (including the order in 

which the information is presented), and how employees can get and use hazard information.

See OSHA’s HAZARD COMMUNICATION: Small Entity Compliance Guide for Employers that Use 

Hazardous Chemicals [OSHA Publication # 3695] for more information on preparing a written hazard 

communication program and employer requirements for labeling, SDSs, and training.

Signs at Entrances to 

Regulated Areas

The employer must post a sign at each 

entrance to regulated areas. The sign must 

include the following wording: 

DANGER

RESPIRABLE CRYSTALLINE SILICA

MAY CAUSE CANCER

CAUSES DAMAGE TO LUNGS

WEAR RESPIRATORY PROTECTION IN THIS AREA

AUTHORIZED PERSONNEL ONLY

Training Topics

The employer must ensure that employees 

trained under the silica standard can 

demonstrate knowledge and understanding 

of at least: 

1. Health hazards associated with respirable 

crystalline silica exposure. For respirable 

crystalline silica, the health hazards 

include: cancer, lung effects, immune 

system effects, and kidney effects. 

2. Specific workplace tasks that could expose 

employees to respirable crystalline silica.
24 Occupational Safety and Health Administration

3. Specific measures the employer is 

implementing to protect employees from 

respirable crystalline silica exposure, 

including engineering controls, work 

practices, and respirators to be used. This 

training must be specific for the workplace 

and task that each employee performs. In 

general industry and maritime, training 

subjects would commonly include: 

■ Signs that the controls may not be 

working effectively (e.g., visible dust 

emission).

■ Work practices needed for the controls 

to function effectively (e.g., not opening 

windows near local exhaust sources, 

positioning the local exhaust hood 

directly over the exposure source). 

If employees covered by the general 

industry and maritime standard operate 

equipment with built-in controls that are 

under their control, those employees 

are required to demonstrate knowledge 

and understanding of the full and proper 

implementation of those controls. 

4. The contents of the Respirable Crystalline 

Silica standard. This would involve a 

description of the standard’s requirements.

5. The purpose and a description of the 

medical surveillance program required 

under the standard. Topics that employers 

could communicate to their employees as 

part of this training include: 

■ That employers must offer medical 

examinations to employees who meet 

the exposure trigger for 30 or more 

days a year;

■ That employers must offer medical 

examinations at no cost to the 

employee, including additional silicarelated tests or specialist examinations 

recommended by the PLHCP; 

■ The types of tests included in the 

medical examinations; 

■ Symptoms associated with respirable 

crystalline silica-related diseases;

■ Information that must be included 

in the written medical report for the 

employee versus the written medical 

opinion for the employer;

■ Information that must not be included 

in written medical opinion to the 

employer without written authorization 

from the employee (recommendations 

for limitations on exposures to silica 

and for specialist referrals);

■ The importance of keeping a copy of 

the written medical opinion to the 

employer as proof of a current medical 

examination to avoid unnecessary 

testing; and 

■ That employers cannot retaliate or 

discriminate against employees for 

participating in medical surveillance.

The employer is not required to provide 

all required training if an employee is 

already able to demonstrate knowledge and 

understanding of training topics such as health 

hazards, the contents of the silica standard, or 

medical surveillance requirements. However, 

some site-specific or employer-specific 

training is always necessary, such as training 

on specific tasks that could result in exposures 

in that workplace and specific controls or work 

practices that the employer is using. 

When Employees Must be Trained

Employees must be trained at the time they 

are assigned to a position involving exposure 

to respirable crystalline silica. 

Additional training must be provided as often 

as necessary to ensure that employees know 

and understand respirable crystalline silica 

hazards and the protections available in their 

workplace. Examples of when additional 

training would be required include:

■ When the employer asks an employee to 

perform a task that is new to that employee; 

■ When the employer introduces new 

protections; 

■ When an employee is working in a manner 

that suggests he or she has forgotten what 

was learned in training.
Small Entity Compliance Guide for the Respirable Crystalline Silica Standard for General Industry and Maritime 25

Training Methods

The silica standard does not require the 

employer to use any particular method 

for training employees. Employers could 

use hands-on training, videotapes, slide 

presentations, classroom instruction, 

informal discussions during safety meetings, 

written materials, or any combination of 

these methods to train employees. 

In order for employees to demonstrate 

knowledge and understanding of the training 

subjects, training must be done in a manner 

and language that employees understand. 

This may mean, for example, providing 

materials, instruction, or assistance in Spanish 

rather than English for Spanish-speaking 

employees who do not understand English, 

and using methods other than printed reading 

materials if the employee is not able to read. 

To ensure that employees understand the 

material presented during training, it is 

critical that trainees have the opportunity 

to ask questions and receive answers if 

they do not fully understand the material 

that is presented to them. When videotape 

presentations or computer-based programs 

are used, this requirement may be met by 

having a qualified trainer available to address 

questions after the presentation, or providing 

a telephone hotline so that trainees will have 

direct access to a qualified trainer.

Employers can determine if employees know 

and understand the training topics through 

discussion of the required training subjects, 

written tests, or oral quizzes. 

Making a Copy of the 

Standard Available

Employers must make a copy of the 

Respirable Crystalline Silica standard 

available at no cost to each employee 

covered by the standard. This could simply 

involve allowing employees to view a printed 

or electronic copy in a reasonable location. 

RECORDKEEPING – PARAGRAPH (K) OF THE STANDARD

Records can demonstrate employer 

compliance with the standard, and can assist 

in diagnosing and identifying workplacerelated illnesses. Therefore, employers 

are required to make and keep accurate 

records of air monitoring data and objective 

data used to assess employee exposures 

to respirable crystalline silica under the 

standard, as well as records of medical 

surveillance provided under the standard.

Air Monitoring Data

Employers must make and keep an accurate 

record of all air monitoring performed to comply 

with the standard. The record must indicate:

■ The date of the measurement for each 

sample taken;

■ The task monitored;

■ Sampling and analytical methods used;

■ The number, duration, and results of 

samples taken;

■ The identity of the laboratory that 

performed the analysis;

■ The type of personal protective equipment 

used (e.g., type of respirators worn); and

■ The name, social security number, and job 

classification of all employees represented 

by the monitoring, indicating which 

employees were actually monitored.

Objective Data

When an employer relies on objective data 

to comply with the silica standard, the 

employer must make and keep an accurate 

record of the objective data. The record 

must include at least:

■ The crystalline silica-containing material 

in question;

■ The source of the objective data;

■ The testing protocol and results of testing;

■ A description of the process, task, or activity 

on which the objective data were based; and

■ Any other data relevant to the process, 

task, activity, material, or exposures on 

which the objective data are based.
26 Occupational Safety and Health Administration

Medical Surveillance

The employer must make and keep an 

accurate record for each employee provided 

medical surveillance under the standard. 

The record must include the following 

information about the employee:

■ Name and social security number;

■ A copy of the PLHCPs’ and specialists’ 

written opinions; and

■ A copy of the information that the employer 

is required to provide to the PLHCPs 

and specialists (i.e., a description of the 

employee’s former, current, and anticipated 

duties as they relate to crystalline silica 

exposure; a description of the employee’s 

former, current, and anticipated respirable 

crystalline silica exposure levels; a 

description of the personal protective 

equipment used by the employee; and 

information from previous employmentrelated medical examinations that is 

currently within the control of the employer).

Keeping and Making Medical 

Records Available

Exposure and medical records must be kept 

and made available to employees, their 

representatives, and OSHA in accordance 

with OSHA’s access to employee exposure 

and medical records regulation.

OSHA’s Access to Employee Exposure and Medical Records Regulation

A separate OSHA regulation (29 CFR 1910.1020, Access to Employee Exposure and Medical Records) addresses 

requirements for maintaining exposure and medical records. In general, exposure records (including air 

monitoring and objective data) must be kept for at least 30 years, and medical records must be kept for at 

least the duration of employment plus 30 years. It is necessary to keep these records for extended periods 

because silica-related diseases such as cancer often cannot be detected until several decades after exposure. 

However, if an employee works for an employer for less than one year, the employer does not have to keep the 

medical records after employment ends, as long as the employer gives those records to the employee.

DATES – PARAGRAPH (L) OF THE STANDARD

General industry and maritime employers must 

comply with all requirements of the standard 

by June 23, 2018, except for phase-in dates 

for medical surveillance and for engineering 

controls in the oil and gas industry. 

■ The obligation for employers to offer 

medical surveillance begins on June 23, 

2018 for employees who will be exposed 

above the PEL of 50 μg/m3 for 30 or more 

days per year and on June 23, 2020 for 

employees who will be exposed at or 

above the action level of 25 μg/m3 for 

30 or more days per year. This schedule 

initiates medical surveillance efforts for 

those employees who are at greatest risk 

and provides most employers time to fully 

evaluate installed engineering controls 

and determine which employees meet the 

action level trigger for medical surveillance.

■ The obligation for engineering controls for 

hydraulic fracturing operations in the oil 

and gas industry begins on June 23, 2021. 

In the period between June 23, 2018 and 

June 23, 2021, employers must comply 

with all other requirements of the standard 

for hydraulic fracturing operations, 

including requirements for respiratory 

protection to protect employees exposed 

to respirable crystalline silica at levels that 

exceed the PEL of 50 μg/m3. 

Prior to June 23, 2018, the previous PEL (a 

formula that is approximately equivalent to 

100 μg/m3 of respirable crystalline silica as 

an 8-hour TWA) remains in effect for general 

industry employers. 
Small Entity Compliance Guide for the Respirable Crystalline Silica Standard for General Industry and Maritime 27

APPENDIX I: OSHA RESPIRABLE CRYSTALLINE SILICA 

STANDARD FOR GENERAL INDUSTRY AND MARITIME

§1910.1053 Respirable 

crystalline silica

(a) Scope and application. (1) This section 

applies to all occupational exposures to 

respirable crystalline silica, except:

(i) Construction work as defined in 29 CFR 

1910.12(b) (occupational exposures to 

respirable crystalline silica in construction 

work are covered under 29 CFR 1926.1153);

(ii) Agricultural operations covered under 29 

CFR part 1928; and

(iii) Exposures that result from the processing 

of sorptive clays.

(2) This section does not apply where the 

employer has objective data demonstrating 

that employee exposure to respirable 

crystalline silica will remain below 25 

micrograms per cubic meter of air (25 μg/m3) 

as an 8-hour time-weighted average (TWA) 

under any foreseeable conditions.

(3) This section does not apply if the 

employer complies with 29 CFR 1926.1153 

and:

(i) The task performed is indistinguishable 

from a construction task listed on Table 1 in 

paragraph (c) of 29 CFR 1926.1153; and

(ii) The task will not be performed regularly in 

the same environment and conditions. 

(b) Definitions. For the purposes of this 

section the following definitions apply:

Action level means a concentration of 

airborne respirable crystalline silica of 25 μg/

m3, calculated as an 8-hour TWA.

Assistant Secretary means the Assistant 

Secretary of Labor for Occupational Safety 

and Health, U.S. Department of Labor, or 

designee.

Director means the Director of the National 

Institute for Occupational Safety and Health 

(NIOSH), U.S. Department of Health and 

Human Services, or designee.

Employee exposure means the exposure 

to airborne respirable crystalline silica that 

would occur if the employee were not using a 

respirator.

High-efficiency particulate air [HEPA] filter

means a filter that is at least 99.97 percent 

efficient in removing mono-dispersed 

particles of 0.3 micrometers in diameter.

Objective data means information, such 

as air monitoring data from industrywide surveys or calculations based on the 

composition of a substance, demonstrating 

employee exposure to respirable crystalline 

silica associated with a particular product 

or material or a specific process, task, or 

activity. The data must reflect workplace 

conditions closely resembling or with a 

higher exposure potential than the processes, 

types of material, control methods, work 

practices, and environmental conditions in 

the employer’s current operations.

Physician or other licensed health care 

professional [PLHCP] means an individual 

whose legally permitted scope of practice (i.e., 

license, registration, or certification) allows 

him or her to independently provide or be 

delegated the responsibility to provide some 

or all of the particular health care services 

required by paragraph (i) of this section.

Regulated area means an area, demarcated 

by the employer, where an employee’s 

exposure to airborne concentrations of 

respirable crystalline silica exceeds, or can 

reasonably be expected to exceed, the PEL.

Respirable crystalline silica means quartz, 

cristobalite, and/or tridymite contained in 

airborne particles that are determined to be 
2 8 Occupational Safety and Health Administration

respirable by a sampling device designed 

to meet the characteristics for respirableparticle-size-selective samplers specified 

in the International Organization for 

Standardization (ISO) 7708:1995: Air Quality – 

Particle Size Fraction Definitions for HealthRelated Sampling.

Specialist means an American Board 

Certified Specialist in Pulmonary Disease 

or an American Board Certified Specialist in 

Occupational Medicine.

This section means this respirable crystalline 

silica standard, 29 CFR 1910.1053.

(c) Permissible exposure limit (PEL). The 

employer shall ensure that no employee 

is exposed to an airborne concentration 

of respirable crystalline silica in excess of 

50 μg/m3, calculated as an 8-hour TWA.

(d) Exposure assessment—(1) General. 

The employer shall assess the exposure of 

each employee who is or may reasonably 

be expected to be exposed to respirable 

crystalline silica at or above the action level in 

accordance with either the performance option 

in paragraph (d)(2) or the scheduled monitoring 

option in paragraph (d)(3) of this section.

(2) Performance option. The employer shall 

assess the 8-hour TWA exposure for each 

employee on the basis of any combination 

of air monitoring data or objective data 

sufficient to accurately characterize employee 

exposures to respirable crystalline silica.

(3) Scheduled monitoring option. (i) The 

employer shall perform initial monitoring 

to assess the 8-hour TWA exposure for 

each employee on the basis of one or more 

personal breathing zone air samples that 

reflect the exposures of employees on each 

shift, for each job classification, in each work 

area. Where several employees perform 

the same tasks on the same shift and in the 

same work area, the employer may sample 

a representative fraction of these employees 

in order to meet this requirement. In 

representative sampling, the employer shall 

sample the employee(s) who are expected 

to have the highest exposure to respirable 

crystalline silica. 

(ii) If initial monitoring indicates that employee 

exposures are below the action level, the 

employer may discontinue monitoring for 

those employees whose exposures are 

represented by such monitoring. 

(iii) Where the most recent exposure 

monitoring indicates that employee 

exposures are at or above the action level 

but at or below the PEL, the employer shall 

repeat such monitoring within six months of 

the most recent monitoring.

(iv) Where the most recent exposure 

monitoring indicates that employee 

exposures are above the PEL, the employer 

shall repeat such monitoring within three 

months of the most recent monitoring.

(v) Where the most recent (non-initial) 

exposure monitoring indicates that employee 

exposures are below the action level, the 

employer shall repeat such monitoring within 

six months of the most recent monitoring 

until two consecutive measurements, taken 

7 or more days apart, are below the action 

level, at which time the employer may 

discontinue monitoring for those employees 

whose exposures are represented by such 

monitoring, except as otherwise provided in 

paragraph (d)(4) of this section. 

(4) Reassessment of exposures. The 

employer shall reassess exposures whenever 

a change in the production, process, control 

equipment, personnel, or work practices may 

reasonably be expected to result in new or 

additional exposures at or above the action 

level, or when the employer has any reason 

to believe that new or additional exposures at 

or above the action level have occurred.

(5) Methods of sample analysis. The employer 

shall ensure that all samples taken to satisfy 

the monitoring requirements of paragraph (d) 
Small Entity Compliance Guide for the Respirable Crystalline Silica Standard for General Industry and Maritime 2 9

of this section are evaluated by a laboratory 

that analyzes air samples for respirable 

crystalline silica in accordance with the 

procedures in Appendix A to this section.

(6) Employee notification of assessment 

results. (i) Within 15 working days after 

completing an exposure assessment in 

accordance with paragraph (d) of this section, 

the employer shall individually notify each 

affected employee in writing of the results 

of that assessment or post the results in an 

appropriate location accessible to all affected 

employees.

(ii) Whenever an exposure assessment 

indicates that employee exposure is above 

the PEL, the employer shall describe in the 

written notification the corrective action 

being taken to reduce employee exposure to 

or below the PEL.

(7) Observation of monitoring. (i) Where air 

monitoring is performed to comply with the 

requirements of this section, the employer 

shall provide affected employees or their 

designated representatives an opportunity 

to observe any monitoring of employee 

exposure to respirable crystalline silica.

(ii) When observation of monitoring requires 

entry into an area where the use of protective 

clothing or equipment is required for any 

workplace hazard, the employer shall provide 

the observer with protective clothing and 

equipment at no cost and shall ensure 

that the observer uses such clothing and 

equipment.

(e) Regulated areas—(1) Establishment. The 

employer shall establish a regulated area 

wherever an employee’s exposure to airborne 

concentrations of respirable crystalline silica 

is, or can reasonably be expected to be, in 

excess of the PEL.

(2) Demarcation. (i) The employer shall 

demarcate regulated areas from the rest of 

the workplace in a manner that minimizes the 

number of employees exposed to respirable 

crystalline silica within the regulated area.

(ii) The employer shall post signs at all entrances 

to regulated areas that bear the legend specified 

in paragraph (j)(2) of this section. 

(3) Access. The employer shall limit access to 

regulated areas to:

(A) Persons authorized by the employer and 

required by work duties to be present in the 

regulated area;

(B) Any person entering such an area as a 

designated representative of employees for 

the purpose of exercising the right to observe 

monitoring procedures under paragraph (d) 

of this section; and

(C) Any person authorized by the Occupational 

Safety and Health Act or regulations issued 

under it to be in a regulated area.

(4) Provision of respirators. The employer shall 

provide each employee and the employee’s 

designated representative entering a regulated 

area with an appropriate respirator in 

accordance with paragraph (g) of this section 

and shall require each employee and the 

employee’s designated representative to use 

the respirator while in a regulated area.

(f) Methods of compliance—(1) Engineering 

and work practice controls. The employer 

shall use engineering and work practice 

controls to reduce and maintain employee 

exposure to respirable crystalline silica to 

or below the PEL, unless the employer can 

demonstrate that such controls are not 

feasible. Wherever such feasible engineering 

and work practice controls are not sufficient 

to reduce employee exposure to or below 

the PEL, the employer shall nonetheless use 

them to reduce employee exposure to the 

lowest feasible level and shall supplement 

them with the use of respiratory protection 

that complies with the requirements of 

paragraph (g) of this section.
3 0 Occupational Safety and Health Administration

(2) Written exposure control plan. (i) The 

employer shall establish and implement a 

written exposure control plan that contains at 

least the following elements:

(A) A description of the tasks in the 

workplace that involve exposure to 

respirable crystalline silica;

(B) A description of the engineering controls, 

work practices, and respiratory protection 

used to limit employee exposure to respirable 

crystalline silica for each task; and

(C) A description of the housekeeping 

measures used to limit employee exposure to 

respirable crystalline silica. 

(ii) The employer shall review and evaluate 

the effectiveness of the written exposure 

control plan at least annually and update it 

as necessary.

(iii) The employer shall make the written 

exposure control plan readily available for 

examination and copying, upon request, to 

each employee covered by this section, their 

designated representatives, the Assistant 

Secretary and the Director.

(3) Abrasive blasting. In addition to the 

requirements of paragraph (f)(1) of this 

section, the employer shall comply with other 

OSHA standards, when applicable, such as 

29 CFR 1910.94 (Ventilation), 29 CFR 1915.34 

(Mechanical paint removers), and 29 CFR 1915 

Subpart I (Personal Protective Equipment), 

where abrasive blasting is conducted using 

crystalline silica-containing blasting agents, 

or where abrasive blasting is conducted on 

substrates that contain crystalline silica.

(g) Respiratory protection—(1) General. 

Where respiratory protection is required 

by this section, the employer must provide 

each employee an appropriate respirator 

that complies with the requirements of this 

paragraph and 29 CFR 1910.134. Respiratory 

protection is required: 

(i) Where exposures exceed the PEL during 

periods necessary to install or implement 

feasible engineering and work practice controls;

(ii) Where exposures exceed the PEL during 

tasks, such as certain maintenance and 

repair tasks, for which engineering and work 

practice controls are not feasible;

(iii) During tasks for which an employer has 

implemented all feasible engineering and 

work practice controls and such controls 

are not sufficient to reduce exposures to or 

below the PEL; and

(iv) During periods when the employee is in a 

regulated area.

(2) Respiratory protection program. Where 

respirator use is required by this section, the 

employer shall institute a respiratory protection 

program in accordance with 29 CFR 1910.134. 

(h) Housekeeping. (1) The employer shall not 

allow dry sweeping or dry brushing where 

such activity could contribute to employee 

exposure to respirable crystalline silica unless 

wet sweeping, HEPA-filtered vacuuming or 

other methods that minimize the likelihood of 

exposure are not feasible.

(2) The employer shall not allow compressed 

air to be used to clean clothing or surfaces 

where such activity could contribute to 

employee exposure to respirable crystalline 

silica unless:

(i) The compressed air is used in conjunction 

with a ventilation system that effectively 

captures the dust cloud created by the 

compressed air; or

(ii) No alternative method is feasible.

(i) Medical surveillance—(1) General. (i) The 

employer shall 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 at or above the 

action level for 30 or more days per year. 
Small Entity Compliance Guide for the Respirable Crystalline Silica Standard for General Industry and Maritime 31

(ii) The employer shall ensure that all medical 

examinations and procedures required by 

this section are performed by a PLHCP as 

defined in paragraph (b) of this section. 

(2) Initial examination. The employer shall 

make available an initial (baseline) medical 

examination within 30 days after initial 

assignment, unless the employee has 

received a medical examination that meets 

the requirements of this section within the last 

three years. The examination shall consist of:

(i) 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 of respiratory 

disease (e.g., shortness of breath, cough, 

wheezing); history of tuberculosis; and 

smoking status and history; 

(ii) A physical examination with special 

emphasis on the respiratory system;

(iii) 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) or digital radiography 

systems), interpreted and classified according 

to the International Labour Office (ILO) 

International Classification of Radiographs 

of Pneumoconioses by a NIOSH-certified B 

Reader; 

(iv) A pulmonary function test to include 

forced vital capacity (FVC) and forced 

expiratory volume in one second (FEV1) and 

FEV1/FVC ratio, administered by a spirometry 

technician with a current certificate from a 

NIOSH-approved spirometry course;

(v) Testing for latent tuberculosis infection; and 

(vi) Any other tests deemed appropriate by 

the PLHCP.

(3) Periodic examinations. The employer shall 

make available medical examinations that 

include the procedures described in paragraph 

(i)(2) of this section (except paragraph (i)(2)(v)) 

at least every three years, or more frequently if 

recommended by the PLHCP.

(4) Information provided to the PLHCP. The 

employer shall ensure that the examining 

PLHCP has a copy of this standard, and 

shall provide the PLHCP with the following 

information:

(i) A description of the employee’s former, 

current, and anticipated duties as they relate 

to the employee’s occupational exposure to 

respirable crystalline silica;

(ii) The employee’s former, current, and 

anticipated levels of occupational exposure to 

respirable crystalline silica;

(iii) 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 or will use that 

equipment; and

(iv) Information from records of employmentrelated medical examinations previously 

provided to the employee and currently 

within the control of the employer.

(5) PLHCP’s written medical report for the 

employee. The employer shall 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 shall contain:

(i) 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;

(ii) Any recommended limitations on the 

employee’s use of respirators;
3 2 Occupational Safety and Health Administration

(iii) Any recommended limitations on the 

employee’s exposure to respirable crystalline 

silica; and

(iv) A statement that the employee should 

be examined by a specialist (pursuant to 

paragraph (i)(7) of this section) if the chest 

X-ray provided in accordance with this 

section is classified as 1/0 or higher by 

the B Reader, or if referral to a specialist is 

otherwise deemed appropriate by the PLHCP.

(6) PLHCP’s written medical opinion for the 

employer. (i) The employer shall obtain a 

written medical opinion from the PLHCP within 

30 days of the medical examination. The 

written opinion shall contain only the following:

(A) The date of the examination;

(B) A statement that the examination has met 

the requirements of this section; and

(C) Any recommended limitations on the 

employee’s use of respirators.

(ii) If the employee provides written 

authorization, the written opinion shall also 

contain either or both of the following:

(A) Any recommended limitations on 

the employee’s exposure to respirable 

crystalline silica; 

(B) A statement that the employee should 

be examined by a specialist (pursuant to 

paragraph (i)(7) of this section) if the chest 

X-ray provided in accordance with this 

section is classified as 1/0 or higher by 

the B Reader, or if referral to a specialist is 

otherwise deemed appropriate by the PLHCP.

(iii) The employer shall ensure that each 

employee receives a copy of the written 

medical opinion described in paragraph (i)

(6)(i) and (ii) of this section within 30 days of 

each medical examination performed.

(7) Additional examinations. (i) If the PLHCP’s 

written medical opinion indicates that an 

employee should be examined by a specialist, 

the employer shall make available a medical 

examination by a specialist within 30 days 

after receiving the PLHCP’s written opinion.

(ii) The employer shall ensure that the 

examining specialist is provided with all of 

the information that the employer is obligated 

to provide to the PLHCP in accordance with 

paragraph (i)(4) of this section.

(iii) 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 examination. The 

written report shall meet the requirements of 

paragraph (i)(5) (except paragraph (i)(5)(iv)) of 

this section.

(iv) The employer shall obtain a written 

opinion from the specialist within 30 days of 

the medical examination. The written opinion 

shall meet the requirements of paragraph (i)

(6) (except paragraph (i)(6)(i)(B) and (i)(6)(ii)(B)) 

of this section.

(j) Communication of respirable crystalline 

silica hazards to employees—(1) Hazard 

communication. The employer shall include 

respirable crystalline silica in the program 

established to comply with the hazard 

communication standard (HCS) (29 CFR 

1910.1200). The employer shall ensure that 

each employee has access to labels on 

containers of crystalline silica and safety data 

sheets, and is trained in accordance with the 

provisions of HCS and paragraph (j)(3) of this 

section. The employer shall ensure that at 

least the following hazards are addressed: 

Cancer, lung effects, immune system effects, 

and kidney effects.
Small Entity Compliance Guide for the Respirable Crystalline Silica Standard for General Industry and Maritime 3 3

(2) Signs. The employer shall post signs at 

all entrances to regulated areas that bear the 

following legend:

DANGER

RESPIRABLE CRYSTALLINE SILICA

MAY CAUSE CANCER

CAUSES DAMAGE TO LUNGS 

WEAR RESPIRATORY PROTECTION IN THIS AREA

AUTHORIZED PERSONNEL ONLY

(3) Employee information and training. (i) The 

employer shall ensure that each employee 

covered by this section can demonstrate 

knowledge and understanding of at least the 

following:

(A) The health hazards associated with 

exposure to respirable crystalline silica;

(B) Specific tasks in the workplace that could 

result in exposure to respirable crystalline 

silica;

(C) Specific measures the employer has 

implemented to protect employees from 

exposure to respirable crystalline silica, 

including engineering controls, work 

practices, and respirators to be used; 

(D) The contents of this section; and

(E) The purpose and a description of the 

medical surveillance program required by 

paragraph (i) of this section.

(ii) The employer shall make a copy of this 

section readily available without cost to each 

employee covered by this section.

(k) Recordkeeping—(1) Air monitoring 

data. (i) The employer shall make and 

maintain an accurate record of all exposure 

measurements taken to assess employee 

exposure to respirable crystalline silica, as 

prescribed in paragraph (d) of this section.

(ii) This record shall include at least the 

following information:

(A) The date of measurement for each sample 

taken; 

(B) The task monitored;

(C) Sampling and analytical methods used;

(D) Number, duration, and results of samples 

taken;

(E) Identity of the laboratory that performed 

the analysis;

(F) Type of personal protective equipment, 

such as respirators, worn by the employees 

monitored; and

(G) Name, social security number, and job 

classification of all employees represented by 

the monitoring, indicating which employees 

were actually monitored.

(iii) The employer shall ensure that exposure 

records are maintained and made available in 

accordance with 29 CFR 1910.1020.

(2) Objective data. (i) The employer shall 

make and maintain an accurate record of all 

objective data relied upon to comply with the 

requirements of this section.

(ii) This record shall include at least the 

following information:

(A) The crystalline silica-containing material 

in question;

(B) The source of the objective data;

(C) The testing protocol and results of testing;

(D) A description of the process, task, or 

activity on which the objective data were 

based; and

(E) Other data relevant to the process, task, 

activity, material, or exposures on which the 

objective data were based.

(iii) The employer shall ensure that objective 

data are maintained and made available in 

accordance with 29 CFR 1910.1020.
3 4 Occupational Safety and Health Administration

(3) Medical surveillance. (i) The employer shall 

make and maintain an accurate record for each 

employee covered by medical surveillance 

under paragraph (i) of this section.

(ii) The record shall include the following 

information about the employee:

(A) Name and social security number;

(B) A copy of the PLHCPs’ and specialists’ 

written medical opinions; and

(C) A copy of the information provided to the 

PLHCPs and specialists.

(iii) The employer shall ensure that medical 

records are maintained and made available in 

accordance with 29 CFR 1910.1020.

(l) Dates. (1) This section is effective June 23, 

2016. 

(2) Except as provided for in paragraphs (l)(3) 

and (4) of this section, all obligations of this 

section commence June 23, 2018.

(3) For hydraulic fracturing operations in the 

oil and gas industry:

(i) All obligations of this section, except 

obligations for medical surveillance in 

paragraph (i)(1)(i) and engineering controls 

in paragraph (f)(1) of this section, commence 

June 23, 2018;

(ii) Obligations for engineering controls in 

paragraph (f)(1) of this section commence 

June 23, 2021; and

(iii) Obligations for medical surveillance in 

paragraph (i)(1)(i) commence in accordance 

with paragraph (l)(4) of this section. 

(4) The medical surveillance obligations 

in paragraph (i)(1)(i) commence on June 

23, 2018, for employees who will be 

occupationally exposed to respirable 

crystalline silica above the PEL for 30 or more 

days per year. Those obligations commence 

June 23, 2020, for employees who will 

be occupationally exposed to respirable 

crystalline silica at or above the action level 

for 30 or more days per year.

Appendix A to § 1910.1053 – 

Methods of Sample Analysis.

This appendix specifies the procedures for 

analyzing air samples for respirable crystalline 

silica, as well as the quality control procedures 

that employers must ensure that laboratories 

use when performing an analysis required 

under 29 CFR 1926.1153 (d)(2)(v). Employers 

must ensure that such a laboratory:

1. Evaluates all samples using the procedures 

specified in one of the following analytical 

methods: OSHA ID-142; NMAM 7500; NMAM 

7602; NMAM 7603; MSHA P-2; or MSHA P-7;

2. Is accredited to ANS/ISO/IEC Standard 

17025:2005 with respect to crystalline silica 

analyses by a body that is compliant with ISO/

IEC Standard 17011:2004 for implementation of 

quality assessment programs;

3. Uses the most current National Institute 

of Standards and Technology (NIST) or NIST 

traceable standards for instrument calibration 

or instrument calibration verification;

4. Implements an internal quality control (QC) 

program that evaluates analytical uncertainty 

and provides employers with estimates of 

sampling and analytical error;

5. Characterizes the sample material by 

identifying polymorphs of respirable 

crystalline silica present, identifies the 

presence of any interfering compounds that 

might affect the analysis, and makes any 

corrections necessary in order to obtain 

accurate sample analysis; and

6. Analyzes quantitatively for crystalline 

silica only after confirming that the sample 

matrix is free of uncorrectable analytical 

interferences, corrects for analytical 

interferences, and uses a method that meets 

the following performance specifications:

6.1 Each day that samples are analyzed, 

performs instrument calibration checks 

with standards that bracket the sample 

concentrations;
Small Entity Compliance Guide for the Respirable Crystalline Silica Standard for General Industry and Maritime 3 5

6.2 Uses five or more calibration standard 

levels to prepare calibration curves and 

ensures that standards are distributed 

through the calibration range in a manner 

that accurately reflects the underlying 

calibration curve; and

6.3 Optimizes methods and instruments to 

obtain a quantitative limit of detection that 

represents a value no higher than 25 percent 

of the PEL based on sample air volume.

Appendix B to § 1910.1053 – Medical 

Surveillance Guidelines. 

Introduction

The purpose of this Appendix is to provide 

medical information and recommendations 

to aid physicians and other licensed health 

care professionals (PLHCPs) regarding 

compliance with the medical surveillance 

provisions of the respirable crystalline silica 

standard (29 CFR 1926.1153). Appendix B is 

for informational and guidance purposes 

only and none of the statements in Appendix 

B should be construed as imposing a 

mandatory requirement on employers that is 

not otherwise imposed by the standard. 

Medical screening and surveillance allow for 

early identification of exposure-related health 

effects in individual employee and groups 

of employees, so that actions can be taken 

to both avoid further exposure and prevent 

or address adverse health outcomes. Silicarelated diseases can be fatal, encompass a 

variety of target organs, and may have public 

health consequences when considering the 

increased risk of a latent tuberculosis (TB) 

infection becoming active. Thus, medical 

surveillance of silica-exposed employees 

requires that PLHCPs have a thorough 

knowledge of silica-related health effects. 

This Appendix is divided into seven 

sections. Section 1 reviews silica-related 

diseases, medical responses, and public 

health responses. Section 2 outlines the 

components of the medical surveillance 

program for employees exposed to 

silica. Section 3 describes the roles and 

responsibilities of the PLHCP implementing 

the program and of other medical specialists 

and public health professionals. Section 4 

provides a discussion of considerations, 

including confidentiality. Section 5 provides 

a list of additional resources and Section 6 

lists references. Section 7 provides sample 

forms for the written medical report for the 

employee, the written medical opinion for the 

employer and the written authorization.

1. Recognition of Silica-related Diseases.

1.1. Overview. The term “silica” refers 

specifically to the compound silicon dioxide 

(SiO2). Silica is a major component of 

sand, rock, and mineral ores. Exposure to 

fine (respirable size) particles of crystalline 

forms of silica is associated with adverse 

health effects, such as silicosis, lung 

cancer, chronic obstructive pulmonary 

disease (COPD), and activation of latent TB 

infections. Exposure to respirable crystalline 

silica can occur in industry settings such 

as foundries, abrasive blasting operations, 

paint manufacturing, glass and concrete 

product manufacturing, brick making, china 

and pottery manufacturing, manufacturing 

of plumbing fixtures, and many construction 

activities including highway repair, masonry, 

concrete work, rock drilling, and tuck-pointing. 

New uses of silica continue to emerge. These 

include countertop manufacturing, finishing, 

and installation (Kramer et al. 2012; OSHA 

2015) and hydraulic fracturing in the oil and 

gas industry (OSHA 2012). 

Silicosis is an irreversible, often disabling, 

and sometimes fatal fibrotic lung disease. 

Progression of silicosis can occur despite 

removal from further exposure. Diagnosis of 

silicosis requires a history of exposure to silica 

and radiologic findings characteristic of silica 

exposure. Three different presentations of 

silicosis (chronic, accelerated, and acute) have 

been defined. Accelerated and acute silicosis 

are much less common than chronic silicosis. 
3 6 Occupational Safety and Health Administration

However, it is critical to recognize all cases of 

accelerated and acute silicosis because these 

are life-threatening illnesses and because 

they are caused by substantial overexposures 

to respirable crystalline silica. Although any 

case of silicosis indicates a breakdown in 

prevention, a case of acute or accelerated 

silicosis implies current high exposure and a 

very marked breakdown in prevention.

In addition to silicosis, employees exposed to 

respirable crystalline silica, especially those 

with accelerated or acute silicosis, are at 

increased risks of contracting active TB and 

other infections (ATS 1997; Rees and Murray 

2007). Exposure to respirable crystalline 

silica also increases an employee’s risk of 

developing lung cancer, and the higher the 

cumulative exposure, the higher the risk 

(Steenland et al. 2001; Steenland and Ward 

2014). Symptoms for these diseases and 

other respirable crystalline silica-related 

diseases are discussed below.

1.2. Chronic Silicosis. Chronic silicosis is 

the most common presentation of silicosis 

and usually occurs after at least 10 years of 

exposure to respirable crystalline silica. The 

clinical presentation of chronic silicosis is:

1.2.1. Symptoms - shortness of breath 

and cough, although employees may not 

notice any symptoms early in the disease. 

Constitutional symptoms, such as fever, loss 

of appetite and fatigue, may indicate other 

diseases associated with silica exposure, 

such as TB infection or lung cancer. 

Employees with these symptoms should 

immediately receive further evaluation and 

treatment.

1.2.2. Physical Examination - may be normal 

or disclose dry rales or rhonchi on lung 

auscultation.

1.2.3. Spirometry - may be normal or may 

show only a mild restrictive or obstructive 

pattern. 

1.2.4. Chest X-ray - classic findings are small, 

rounded opacities in the upper lung fields 

bilaterally. However, small irregular opacities 

and opacities in other lung areas can also 

occur. Rarely, “eggshell calcifications” in the 

hilar and mediastinal lymph nodes are seen.

1.2.5. Clinical Course - chronic silicosis in most 

cases is a slowly progressive disease. Under 

the respirable crystalline silica standard, the 

PLHCP is to recommend that employees 

with a 1/0 category X-ray be referred to 

an American Board Certified Specialist in 

Pulmonary Disease or Occupational Medicine. 

The PLHCP and/or Specialist should counsel 

employees regarding work practices and 

personal habits that could affect employees’ 

respiratory health.

1.3. Accelerated Silicosis. Accelerated silicosis 

generally occurs within 5-10 years of exposure 

and results from high levels of exposure 

to respirable crystalline silica. The clinical 

presentation of accelerated silicosis is: 

1.3.1. Symptoms - shortness of breath, cough, 

and sometimes sputum production. Employees 

with exposure to respirable crystalline silica, 

and especially those with accelerated silicosis, 

are at high risk for activation of TB infections, 

atypical mycobacterial infections, and fungal 

superinfections. Constitutional symptoms, such 

as fever, weight loss, hemoptysis (coughing 

up blood), and fatigue may herald one of these 

infections or the onset of lung cancer. 

1.3.2. Physical Examination - rales, rhonchi, 

or other abnormal lung findings in relation to 

illnesses present. Clubbing of the digits, signs 

of heart failure, and cor pulmonale may be 

present in severe lung disease.

1.3.3. Spirometry - restrictive or mixed 

restrictive/obstructive pattern.

1.3.4. Chest X-ray - small rounded and/

or irregular opacities bilaterally. Large 

opacities and lung abscesses may indicate 

infections, lung cancer, or progression 

to complicated silicosis, also termed 

progressive massive fibrosis.
Small Entity Compliance Guide for the Respirable Crystalline Silica Standard for General Industry and Maritime 37

1.3.5. Clinical Course - accelerated silicosis 

has a rapid, severe course. Under the 

respirable crystalline silica standard, the 

PLHCP can recommend referral to a Board 

Certified Specialist in either Pulmonary 

Disease or Occupational Medicine, as 

deemed appropriate, and referral to a 

Specialist is recommended whenever the 

diagnosis of accelerated silicosis is being 

considered. 

1.4. Acute Silicosis. Acute silicosis is a rare 

disease caused by inhalation of extremely 

high levels of respirable crystalline silica 

particles. The pathology is similar to alveolar 

proteinosis with lipoproteinaceous material 

accumulating in the alveoli. Acute silicosis 

develops rapidly, often, within a few months 

to less than 2 years of exposure, and is 

almost always fatal. The clinical presentation 

of acute silicosis is as follows: 

1.4.1. Symptoms - sudden, progressive, and 

severe shortness of breath. Constitutional 

symptoms are frequently present and 

include fever, weight loss, fatigue, productive 

cough, hemoptysis (coughing up blood), and 

pleuritic chest pain. 

1.4.2. Physical Examination - dyspnea at rest, 

cyanosis, decreased breath sounds, inspiratory 

rales, clubbing of the digits, and fever. 

1.4.3. Spirometry - restrictive or mixed 

restrictive/obstructive pattern. 

1.4.4. Chest X-ray - diffuse haziness of the 

lungs bilaterally early in the disease. As 

the disease progresses, the “ground glass” 

appearance of interstitial fibrosis will appear. 

1.4.5. Clinical Course - employees with acute 

silicosis are at especially high risk of TB 

activation, nontuberculous mycobacterial 

infections, and fungal superinfections. Acute 

silicosis is immediately life-threatening. The 

employee should be urgently referred to 

a Board Certified Specialist in Pulmonary 

Disease or Occupational Medicine for 

evaluation and treatment. Although any 

case of silicosis indicates a breakdown in 

prevention, a case of acute or accelerated 

silicosis implies a profoundly high level 

of silica exposure and may mean that 

other employees are currently exposed to 

dangerous levels of silica. 

1.5. COPD. COPD, including chronic bronchitis 

and emphysema, has been documented in 

silica-exposed employees, including those who 

do not develop silicosis. Periodic spirometry 

tests are performed to evaluate each employee 

for progressive changes consistent with 

the development of COPD. In addition to 

evaluating spirometry results of individual 

employees over time, PLHCPs may want to 

be aware of general trends in spirometry 

results for groups of employees from the same 

workplace to identify possible problems that 

might exist at that workplace. (See Section 

2 of this Appendix on Medical Surveillance 

for further discussion.) Heart disease may 

develop secondary to lung diseases such as 

COPD. A recent study by Liu et al. 2014 noted a 

significant exposure-response trend between 

cumulative silica exposure and heart disease 

deaths, primarily due to pulmonary heart 

disease, such as cor pulmonale.

1.6. Renal and Immune System. Silica 

exposure has been associated with 

several types of kidney disease, including 

glomerulonephritis, nephrotic syndrome, and 

end stage renal disease requiring dialysis. 

Silica exposure has also been associated 

with other autoimmune conditions, including 

progressive systemic sclerosis, systemic 

lupus erythematosus, and rheumatoid 

arthritis. Studies note an association between 

employees with silicosis and serologic 

markers for autoimmune diseases, including 

antinuclear antibodies, rheumatoid factor, 

and immune complexes (Jalloul and Banks 

2007; Shtraichman et al. 2015).
3 8 Occupational Safety and Health Administration

1.7. TB and Other Infections. Silica-exposed 

employees with latent TB are 3 to 30 times 

more likely to develop active pulmonary 

TB infection (ATS 1997; Rees and Murray 

2007). Although respirable crystalline silica 

exposure does not cause TB infection, 

individuals with latent TB infection are 

at increased risk for activation of disease 

if they have higher levels of respirable 

crystalline silica exposure, greater profusion 

of radiographic abnormalities, or a diagnosis 

of silicosis. Demographic characteristics, 

such as immigration from some countries, 

are associated with increased rates of latent 

TB infection. PLHCPs can review the latest 

Centers for Disease Control and Prevention 

(CDC) information on TB incidence rates and 

high risk populations online (See Section 

5 of this Appendix). Additionally, silicaexposed employees are at increased risk for 

contracting nontuberculous mycobacterial 

infections, including Mycobacterium aviumintracellulare and Mycobacterium kansaii.

1.8. Lung Cancer. The National Toxicology 

Program has listed respirable crystalline 

silica as a known human carcinogen since 

2000 (NTP 2014). The International Agency 

for Research on Cancer (2012) has also 

classified silica as Group 1 (carcinogenic 

to humans). Several studies have indicated 

that the risk of lung cancer from exposure to 

respirable crystalline silica and smoking is 

greater than additive (Brown 2009; Liu et al. 

2013). Employees should be counseled on 

smoking cessation.

2. Medical Surveillance.

PLHCPs who manage silica medical 

surveillance programs should have a thorough 

understanding of the many silica-related 

diseases and health effects outlined in Section 

1 of this Appendix. At each clinical encounter, 

the PLHCP should consider silica-related 

health outcomes, with particular vigilance 

for acute and accelerated silicosis. In this 

Section, the required components of medical 

surveillance under the respirable crystalline 

silica standard are reviewed, along with 

additional guidance and recommendations 

for PLHCPs performing medical surveillance 

examinations for silica-exposed employees.

2.1. History.

2.1.1. The respirable crystalline silica standard 

requires the following: 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 of respiratory disease (e.g., 

shortness of breath, cough, wheezing); history 

of TB; and smoking status and history.

2.1.2. Further, the employer must provide the 

PLHCP with the following information: 

2.1.2.1. A description of the employee’s 

former, current, and anticipated duties as 

they relate to the employee’s occupational 

exposure to respirable crystalline silica;

2.1.2.2. The employee’s former, current, and 

anticipated levels of occupational exposure to 

respirable crystalline silica;

2.1.2.3. 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 or will use that equipment; and
Small Entity Compliance Guide for the Respirable Crystalline Silica Standard for General Industry and Maritime 3 9

2.1.2.4. Information from records of 

employment-related medical examinations 

previously provided to the employee and 

currently within the control of the employer.

2.1.3. Additional guidance and 

recommendations: A history is particularly 

important both in the initial evaluation and in 

periodic examinations. Information on past 

and current medical conditions (particularly 

a history of kidney disease, cardiac disease, 

connective tissue disease, and other immune 

diseases), medications, hospitalizations and 

surgeries may uncover health risks, such 

as immune suppression, that could put 

an employee at increased health risk from 

exposure to silica. This information is important 

when counseling the employee on risks and 

safe work practices related to silica exposure.

2.2. Physical Examination. 

2.2.1. The respirable crystalline silica 

standard requires the following: A physical 

examination, with special emphasis on the 

respiratory system. The physical examination 

must be performed at the initial examination 

and every three years thereafter. 

2.2.2. Additional guidance and 

recommendations: Elements of the physical 

examination that can assist the PHLCP include: 

an examination of the cardiac system, an 

extremity examination (for clubbing, cyanosis, 

edema, or joint abnormalities), and an 

examination of other pertinent organ systems 

identified during the history.

2.3. TB Testing. 

2.3.1. The respirable crystalline silica standard 

requires the following: Baseline testing for TB 

on initial examination.

2.3.2. Additional guidance and 

recommendations:

2.3.2.1. Current CDC guidelines (See Section 

5 of this Appendix) should be followed for the 

application and interpretation of Tuberculin 

skin tests (TST). The interpretation and 

documentation of TST reactions should 

be performed within 48 to 72 hours of 

administration by trained PLHCPs. 

2.3.2.2. PLHCPs may use alternative TB tests, 

such as interferon-release assays (IGRAs), if 

sensitivity and specificity are comparable to 

TST (Mazurek et al. 2010; Slater et al. 2013). 

PLHCPs can consult the current CDC guidelines 

for acceptable tests for latent TB infection. 

2.3.2.3. The silica standard allows the PLHCP 

to order additional tests or test at a greater 

frequency than required by the standard, 

if deemed appropriate. Therefore, PLHCPs 

might perform periodic (e.g., annual) TB 

testing as appropriate, based on employees’ 

risk factors. For example, according to 

the American Thoracic Society (ATS), the 

diagnosis of silicosis or exposure to silica for 

25 years or more are indications for annual 

TB testing (ATS 1997). PLHCPs should consult 

the current CDC guidance on risk factors for 

TB (See Section 5 of this Appendix).

2.3.2.4. Employees with positive TB tests and 

those with indeterminate test results should 

be referred to the appropriate agency or 

specialist, depending on the test results and 

clinical picture. Agencies, such as local public 

health departments, or specialists, such as a 

pulmonary or infectious disease specialist, 

may be the appropriate referral. Active TB is a 

nationally notifiable disease. PLHCPs should 

be aware of the reporting requirements 

for their region. All States have TB Control 

Offices that can be contacted for further 

information. (See Section 5 of this Appendix 

for links to CDC’s TB resources and State TB 

Control Offices.)

2.3.2.5. The following public health principles 

are key to TB control in the U.S. (ATS-CDCIDSA 2005):

(1) Prompt detection and reporting of persons 

who have contracted active TB;
4 0 Occupational Safety and Health Administration

(2) Prevention of TB spread to close contacts 

of active TB cases;

(3) Prevention of active TB in people with 

latent TB through targeted testing and 

treatment; and

(4) Identification of settings at high risk for TB 

transmission so that appropriate infectioncontrol measures can be implemented.

2.4. Pulmonary Function Testing. 

2.4.1. The respirable crystalline silica 

standard requires the following: Pulmonary 

function testing must be performed on the 

initial examination and every three years 

thereafter. The required pulmonary function 

test is spirometry and must include forced 

vital capacity (FVC), forced expiratory 

volume in one second (FEV1), and FEV1/

FVC ratio. Testing must be administered 

by a spirometry technician with a current 

certificate from a National Institute for 

Occupational Health and Safety (NIOSH)-

approved spirometry course.

2.4.2. Additional guidance and 

recommendations: Spirometry provides 

information about individual respiratory 

status and can be used to track an 

employee’s respiratory status over time or 

as a surveillance tool to follow individual 

and group respiratory function. For quality 

results, the ATS and the American College of 

Occupational and Environmental Medicine 

(ACOEM) recommend use of the third National 

Health and Nutrition Examination Survey 

(NHANES III) values, and ATS publishes 

recommendations for spirometry equipment 

(Miller et al. 2005; Townsend 2011; Redlich 

et al. 2014). OSHA’s publication, Spirometry 

Testing in Occupational Health Programs: 

Best Practices for Healthcare Professionals, 

provides helpful guidance (See Section 5 of 

this Appendix). Abnormal spirometry results 

may warrant further clinical evaluation and 

possible recommendations for limitations 

on the employee’s exposure to respirable 

crystalline silica.

2.5. Chest X-ray. 

2.5.1. The respirable crystalline silica 

standard requires the following: A single 

posteroanterior (PA) 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) or 

digital radiography systems. A chest X-ray 

must be performed on the initial examination 

and every three years thereafter. The chest 

X-ray must be interpreted and classified 

according to the International Labour 

Office (ILO) International Classification 

of Radiographs of Pneumoconioses by a 

NIOSH-certified B Reader.

Chest radiography is necessary to diagnose 

silicosis, monitor the progression of silicosis, 

and identify associated conditions such as 

TB. If the B reading indicates small opacities 

in a profusion of 1/0 or higher, the employee 

is to receive a recommendation for referral 

to a Board Certified Specialist in Pulmonary 

Disease or Occupational Medicine. 

2.5.2. Additional guidance and 

recommendations: Medical imaging has 

largely transitioned from conventional filmbased radiography to digital radiography 

systems. The ILO Guidelines for the 

Classification of Pneumoconioses has 

historically provided film-based chest 

radiography as a referent standard for 

comparison to individual exams. However, 

in 2011, the ILO revised the guidelines to 

include a digital set of referent standards 

that were derived from the prior filmbased standards. To assist in assuring that 

digitally-acquired radiographs are at least 

as safe and effective as film radiographs, 

NIOSH has prepared guidelines, based 

upon accepted contemporary professional 

recommendations (See Section 5 of this 

Appendix). Current research from Laney et al. 

2011 and Halldin et al. 2014 validate the use of 

the ILO digital referent images. Both studies 

conclude that the results of pneumoconiosis 

classification using digital references are 
Small Entity Compliance Guide for the Respirable Crystalline Silica Standard for General Industry and Maritime 41

comparable to film-based ILO classifications. 

Current ILO guidance on radiography for 

pneumoconioses and B-reading should 

be reviewed by the PLHCP periodically, as 

needed, on the ILO or NIOSH websites (See 

Section 5 of this Appendix).

2.6. Other Testing. Under the respirable 

crystalline silica standards, the PLHCP has 

the option of ordering additional testing he 

or she deems appropriate. Additional tests 

can be ordered on a case-by-case basis 

depending on individual signs or symptoms 

and clinical judgment. For example, if an 

employee reports a history of abnormal 

kidney function tests, the PLHCP may want 

to order a baseline renal function tests (e.g., 

serum creatinine and urinalysis). As indicated 

above, the PLHCP may order annual TB 

testing for silica-exposed employees who are 

at high risk of developing active TB infections. 

Additional tests that PLHCPs may order based 

on findings of medical examinations include, 

but is not limited to, chest computerized 

tomography (CT) scan for lung cancer or 

COPD, testing for immunologic diseases, and 

cardiac testing for pulmonary-related heart 

disease, such as cor pulmonale.

3. Roles and Responsibilities.

3.1. PLHCP. The PLHCP designation refers 

to “an individual whose legally permitted 

scope of practice (i.e., license, registration, 

or certification) allows him or her to 

independently provide or be delegated the 

responsibility to provide some or all of the 

particular health care services required” by 

the respirable crystalline silica standard. The 

legally permitted scope of practice for the 

PLHCP is determined by each State. PLHCPs 

who perform clinical services for a silica 

medical surveillance program should have a 

thorough knowledge of respirable crystalline 

silica-related diseases and symptoms. 

Suspected cases of silicosis, advanced COPD, 

or other respiratory conditions causing 

impairment should be promptly referred to 

a Board Certified Specialist in Pulmonary 

Disease or Occupational Medicine. 

Once the medical surveillance examination 

is completed, the employer must ensure 

that the PLHCP explains to the employee 

the results of the medical examination and 

provides the employee with a written medical 

report within 30 days of the examination. 

The written medical 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. In 

addition, the PLHCP’s written medical report 

must include 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 Board Certified Specialist in 

Pulmonary Disease or Occupational medicine 

if the chest X-ray is classified as 1/0 or higher 

by the B Reader, or if referral to a Specialist is 

otherwise deemed appropriate by the PLHCP.

The PLHCP should discuss all findings and test 

results and any recommendations regarding 

the employee’s health, worksite safety and 

health practices, and medical referrals for 

further evaluation, if indicated. In addition, it 

is suggested that the PLHCP offer to provide 

the employee with a complete copy of 

their examination and test results, as some 

employees may want this information for their 

own records or to provide to their personal 

physician or a future PLHCP. Employees are 

entitled to access their medical records. 

Under the respirable crystalline silica 

standard, the employer must ensure that 

the PLHCP provides the employer with a 

written medical opinion within 30 days of 

the employee examination, and that the 

employee also gets a copy of the written 

medical opinion for the employer within 

30 days. The PLHCP may choose to directly 

provide the employee a copy of the written 

medical opinion. This can be particularly 
42 Occupational Safety and Health Administration

helpful to employees, such as construction 

employees, who may change employers 

frequently. The written medical opinion can 

be used by the employee as proof of upto-date medical surveillance. The following 

lists the elements of the written medical 

report for the employee and written medical 

opinion for the employer. (Sample forms for 

the written medical report for the employee, 

the written medical opinion for the employer, 

and the written authorization are provided in 

Section 7 of this Appendix.)

3.1.1. The written medical report for the 

employee must include the following 

information:

3.1.1.1. 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; 

3.1.1.2. Any recommended limitations upon 

the employee’s use of a respirator;

3.1.1.3. Any recommended limitations on the 

employee’s exposure to respirable crystalline 

silica; and

3.1.1.4. A statement that the employee should 

be examined by a Board Certified Specialist 

in Pulmonary Disease or Occupational 

Medicine, where the standard requires or 

where the PLHCP has determined such a 

referral is necessary. The standard requires 

referral to a Board Certified Specialist in 

Pulmonary Disease or Occupational Medicine 

for a chest X-ray B reading indicating small 

opacities in a profusion of 1/0 or higher, or 

if the PHLCP determines that referral to a 

Specialist is necessary for other silica-related 

findings.

3.1.2. The PLHCP’s written medical opinion 

for the employer must include only the 

following information:

3.1.2.1. The date of the examination;

3.1.2.2. A statement that the examination has 

met the requirements of this section; and

3.1.2.3. Any recommended limitations on the 

employee’s use of respirators.

3.1.2.4. If the employee provides the PLHCP 

with written authorization, the written 

opinion for the employer shall also contain 

either or both of the following:

(1) Any recommended limitations on the 

employee’s exposure to respirable crystalline 

silica; and

(2) A statement that the employee should be 

examined by a Board Certified Specialist in 

Pulmonary Disease or Occupational Medicine 

if the chest X-ray provided in accordance with 

this section is classified as 1/0 or higher by 

the B Reader, or if referral to a Specialist is 

otherwise deemed appropriate.

3.1.2.5. In addition to the above referral for 

abnormal chest X-ray, the PLHCP may refer 

an employee to a Board Certified Specialist in 

Pulmonary Disease or Occupational Medicine 

for other findings of concern during the medical 

surveillance examination if these findings are 

potentially related to silica exposure.

3.1.2.6. Although the respirable crystalline 

silica standard requires the employer to 

ensure that the PLHCP explains the results of 

the medical examination to the employee, the 

standard does not mandate how this should 

be done. The written medical opinion for 

the employer could contain a statement that 

the PLHCP has explained the results of the 

medical examination to the employee. 

3.2. Medical Specialists. The silica standard 

requires that all employees with chest X-ray B 

readings of 1/0 or higher be referred to a Board 

Certified Specialist in Pulmonary Disease or 

Occupational Medicine. If the employee has 

given written authorization for the employer 

to be informed, then the employer shall 

make available a medical examination by a 

Specialist within 30 days after receiving the 

PLHCP’s written medical opinion.
Small Entity Compliance Guide for the Respirable Crystalline Silica Standard for General Industry and Maritime 4 3

3.2.1. The employer must provide the 

following information to the Board Certified 

Specialist in Pulmonary Disease or 

Occupational Medicine: 

3.2.1.1. A description of the employee’s 

former, current, and anticipated duties as 

they relate to the employee’s occupational 

exposure to respirable crystalline silica;

3.2.1.2. The employee’s former, current, and 

anticipated levels of occupational exposure to 

respirable crystalline silica;

3.2.1.3. 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 or will use that 

equipment; and

3.2.1.4. Information from records of 

employment-related medical examinations 

previously provided to the employee and 

currently within the control of the employer.

3.2.2. The PLHCP should make certain that, 

with written authorization from the employee, 

the Board Certified Specialist in Pulmonary 

Disease or Occupational Medicine has any 

other pertinent medical and occupational 

information necessary for the specialist’s 

evaluation of the employee’s condition. 

3.2.3. Once the Board Certified Specialist in 

Pulmonary Disease or Occupational Medicine 

has evaluated the employee, the employer 

must ensure that the Specialist explains 

to the employee the results of the medical 

examination and provides the employee with 

a written medical report within 30 days of the 

examination. The employer must also ensure 

that the Specialist provides the employer with 

a written medical opinion within 30 days of 

the employee examination. (Sample forms for 

the written medical report for the employee, 

the written medical opinion for the employer 

and the written authorization are provided in 

Section 7 of this Appendix.)

3.2.4. The Specialist’s written medical report

for the employee must include the following 

information:

3.2.4.1. 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; 

3.2.4.2. Any recommended limitations upon 

the employee’s use of a respirator; and

3.2.4.3. Any recommended limitations on the 

employee’s exposure to respirable crystalline 

silica.

3.2.5. The Specialist’s written medical 

opinion for the employer must include the 

following information:

3.2.5.1. The date of the examination; and

3.2.5.2. Any recommended limitations on the 

employee’s use of respirators.

3.2.5.3. If the employee provides the Board 

Certified Specialist in Pulmonary Disease 

or Occupational Medicine with written 

authorization, the written medical opinion 

for the employer shall also contain any 

recommended limitations on the employee’s 

exposure to respirable crystalline silica.

3.2.5.4. Although the respirable crystalline 

silica standard requires the employer to 

ensure that the Board Certified Specialist 

in Pulmonary Disease or Occupational 

Medicine explains the results of the medical 

examination to the employee, the standard 

does not mandate how this should be done. 

The written medical opinion for the employer 

could contain a statement that the Specialist 

has explained the results of the medical 

examination to the employee. 
4 4 Occupational Safety and Health Administration

3.2.6. After evaluating the employee, the 

Board Certified Specialist in Pulmonary 

Disease or Occupational Medicine 

should provide feedback to the PLHCP as 

appropriate, depending on the reason for 

the referral. OSHA believes that because 

the PLHCP has the primary relationship with 

the employer and employee, the Specialist 

may want to communicate his or her 

findings to the PLHCP and have the PLHCP 

simply update the original medical report 

for the employee and medical opinion for 

the employer. This is permitted under the 

standard, so long as all requirements and 

time deadlines are met.

3.3. Public Health Professionals. PLHCPs 

might refer employees or consult with 

public health professionals as a result of 

silica medical surveillance. For instance, if 

individual cases of active TB are identified, 

public health professionals from state 

or local health departments may assist 

in diagnosis and treatment of individual 

cases and may evaluate other potentially 

affected persons, including coworkers. 

Because silica-exposed employees are at 

increased risk of progression from latent 

to active TB, treatment of latent infection 

is recommended. The diagnosis of active 

TB, acute or accelerated silicosis, or other 

silica-related diseases and infections should 

serve as sentinel events suggesting high 

levels of exposure to silica and may require 

consultation with the appropriate public 

health agencies to investigate potentially 

similarly exposed coworkers to assess for 

disease clusters. These agencies include 

local or state health departments or OSHA. 

In addition, NIOSH can provide assistance 

upon request through their Health Hazard 

Evaluation program. (See Section 5 of this 

Appendix)

4. Confidentiality and Other Considerations.

The information that is provided from the 

PLHCP to the employee and employer 

under the medical surveillance section of 

OSHA’s respirable crystalline silica standard 

differs from that of medical surveillance 

requirements in previous OSHA standards. 

The standard requires two separate written 

communications, a written medical report 

for the employee and a written medical 

opinion for the employer. The confidentiality 

requirements for the written medical opinion 

are more stringent than in past standards. For 

example, the information the PLHCP can (and 

must) include in his or her written medical 

opinion for the employer is limited to: the 

date of the examination, a statement that the 

examination has met the requirements of this 

section, and any recommended limitations 

on the employee’s use of respirators. If the 

employee provides written authorization 

for the disclosure of any limitations on the 

employee’s exposure to respirable crystalline 

silica, then the PLHCP can (and must) include 

that information in the written medical 

opinion for the employer as well. Likewise, 

with the employee’s written authorization, the 

PLHCP can (and must) disclose the PLHCP’s 

referral recommendation (if any) as part of 

the written medical opinion for the employer. 

However, the opinion to the employer 

must not include information regarding 

recommended limitations on the employee’s 

exposure to respirable crystalline silica or 

any referral recommendations without the 

employee’s written authorization. 

The standard also places limitations on the 

information that the Board Certified Specialist 

in Pulmonary Disease or Occupational 

Medicine can provide to the employer 

without the employee’s written authorization. 

The Specialist’s written medical opinion 

for the employer, like the PLHCP’s opinion, 

is limited to (and must contain): the date 

of the examination and any recommended 

limitations on the employee’s use of 

respirators. If the employee provides written 

authorization, the written medical opinion 

can (and must) also contain any limitations 

on the employee’s exposure to respirable 

crystalline silica. 
Small Entity Compliance Guide for the Respirable Crystalline Silica Standard for General Industry and Maritime 4 5

The PLHCP should discuss the implication of 

signing or not signing the authorization with 

the employee (in a manner and language that 

he or she understands) so that the employee 

can make an informed decision regarding the 

written authorization and its consequences. 

The discussion should include the risk of 

ongoing silica exposure, personal risk factors, 

risk of disease progression, and possible 

health and economic consequences. For 

instance, written authorization is required 

for a PLHCP to advise an employer that an 

employee should be referred to a Board 

Certified Specialist in Pulmonary Disease 

or Occupational Medicine for evaluation of 

an abnormal chest X-ray (B-reading 1/0 or 

greater). If an employee does not sign an 

authorization, then the employer will not 

know and cannot facilitate the referral to a 

Specialist and is not required to pay for the 

Specialist’s examination. In the rare case 

where an employee is diagnosed with acute 

or accelerated silicosis, co-workers are likely 

to be at significant risk of developing those 

diseases as a result of inadequate controls in 

the workplace. In this case, the PLHCP and/or 

Specialist should explain this concern to the 

affected employee and make a determined 

effort to obtain written authorization from the 

employee so that the PLHCP and/or Specialist 

can contact the employer. 

Finally, without written authorization from 

the employee, the PLHCP and/or Board 

Certified Specialist in Pulmonary Disease 

or Occupational Medicine cannot provide 

feedback to an employer regarding control of 

workplace silica exposure, at least in relation 

to an individual employee. However, the 

regulation does not prohibit a PLHCP and/

or Specialist from providing an employer 

with general recommendations regarding 

exposure controls and prevention programs 

in relation to silica exposure and silicarelated illnesses, based on the information 

that the PLHCP receives from the employer 

such as employees’ duties and exposure 

levels. Recommendations may include 

increased frequency of medical surveillance 

examinations, additional medical surveillance 

components, engineering and work practice 

controls, exposure monitoring and personal 

protective equipment. For instance, more 

frequent medical surveillance examinations 

may be a recommendation to employers 

for employees who do abrasive blasting 

with silica because of the high exposures 

associated with that operation. 

ACOEM’s Code of Ethics and discussion is a 

good resource to guide PLHCPs regarding the 

issues discussed in this section (See Section 

5 of this Appendix).

5. Resources.

5.1. American College of Occupational and 

Environmental Medicine (ACOEM): 

ACOEM Code of Ethics. Accessed at: http://

www.acoem.org/codeofconduct.aspx

Raymond, L.W. and Wintermeyer, S. (2006) 

ACOEM evidenced-based statement on 

medical surveillance of silica-exposed 

workers: medical surveillance of workers 

exposed to crystalline silica. J Occup Environ 

Med, 48, 95-101.

5.2. Center for Disease Control and 

Prevention (CDC) 

Tuberculosis webpage: http://www.cdc.gov/

tb/default.htm

State TB Control Offices web page: http://

www.cdc.gov/tb/links/tboffices.htm

Tuberculosis Laws and Policies webpage: 

http://www.cdc.gov/tb/programs/laws/

default.htm

CDC. (2013). Latent Tuberculosis Infection: 

A Guide for Primary Health Care Providers. 

Accessed at: http://www.cdc.gov/tb/

publications/ltbi/pdf/targetedltbi.pdf
4 6 Occupational Safety and Health Administration

5.3. International Labour Organization

International Labour Office (ILO). 

(2011) Guidelines for the use of the ILO 

International Classification of Radiographs 

of Pneumoconioses, Revised edition 2011. 

Occupational Safety and Health Series No. 22: 

http://www.ilo.org/safework/info/publications/

WCMS_168260/lang--en/index.htm

5.4. National Institute of Occupational Safety 

and Health (NIOSH)

NIOSH B Reader Program webpage. 

(Information on interpretation of X-rays for 

silicosis and a list of certified B-readers). 

Accessed at: http://www.cdc.gov/niosh/

topics/chestradiography/breader-info.html

NIOSH Guideline (2011). Application of 

Digital Radiography for the Detection and 

Classification of Pneumoconiosis. NIOSH 

publication number 2011-198. Accessed at: 

http://www.cdc.gov/niosh/docs/2011-198/

NIOSH Hazard Review (2002), Health Effects 

of Occupational Exposure to Respirable 

Crystalline Silica. NIOSH publication number 

2002-129: Accessed at http://www.cdc.gov/

niosh/docs/2002-129/

NIOSH Health Hazard Evaluations Programs. 

(Information on the NIOSH Health Hazard 

Evaluation (HHE) program, how to request 

an HHE and how to look up an HHE report). 

Accessed at: http://www.cdc.gov/niosh/hhe/

5.5. National Industrial Sand Association:

Occupational Health Program for Exposure 

to Crystalline Silica in the Industrial 

Sand Industry. National Industrial Sand 

Association, 2nd ed. 2010. Can be ordered 

at: http://www.sand.org/silica-occupationalhealth-program

5.6. Occupational Safety and Health 

Administration (OSHA)

Contacting OSHA: http://www.osha.gov/html/

Feed_Back.html

OSHA’s Clinicians webpage. (OSHA 

resources, regulations and links to help 

clinicians navigate OSHA’s web site and aid 

clinicians in caring for workers.) Accessed 

at: http://www.osha.gov/dts/oom/clinicians/

index.html

OSHA’s Safety and Health Topics webpage 

on Silica. Accessed at: http://www.osha.gov/

dsg/topics/silicacrystalline/index.html

OSHA (2013). Spirometry Testing in 

Occupational Health Programs: Best Practices 

for Healthcare Professionals. (OSHA 3637-

03 2013). Accessed at: http://www.osha.gov/

Publications/OSHA3637.pdf

OSHA/NIOSH (2011). Spirometry: OSHA/

NIOSH Spirometry InfoSheet (OSHA 3415-

1-11). (Provides guidance to employers). 

Accessed at http://www.osha.gov/

Publications/osha3415.pdf

OSHA/NIOSH (2011) Spirometry: OSHA/

NIOSH Spirometry Worker Info. (OSHA 

3418-3-11). Accessed at http://www.osha.gov/

Publications/osha3418.pdf

5.7. Other 

Steenland, K. and Ward E. (2014). Silica: A 

lung carcinogen. CA Cancer J Clin, 64, 63-69. 

(This article reviews not only silica and lung 

cancer but also all the known silica-related 

health effects. Further, the authors provide 

guidance to clinicians on medical surveillance 

of silica-exposed workers and worker 

counselling on safety practices to minimize 

silica exposure.)

6. References.

American Thoracic Society (ATS). Medical 

Section of the American Lung Association 

(1997). Adverse effects of crystalline silica 

exposure. Am J Respir Crit Care Med, 155, 

761-765.

American Thoracic Society (ATS), Centers for 

Disease Control (CDC), Infectious Diseases 

Society of America (IDSA) (2005). Controlling 

Tuberculosis in the United States. Morbidity 
Small Entity Compliance Guide for the Respirable Crystalline Silica Standard for General Industry and Maritime 47

and Mortality Weekly Report (MMWR), 

54(RR12), 1-81. Accessed at: http://www.cdc.

gov/mmwr/preview/mmwrhtml/rr5412a1.htm

Brown, T. (2009). Silica exposure, smoking, 

silicosis and lung cancer – complex 

interactions. Occupational Medicine, 59, 89-95.

Halldin, C. N., Petsonk, E. L., and Laney, 

A. S. (2014). Validation of the International 

Labour Office digitized standard images for 

recognition and classification of radiographs 

of pneumoconiosis. Acad Radiol, 21,305-311. 

International Agency for Research on 

Cancer. (2012). Monographs on the 

evaluation of carcinogenic risks to humans: 

Arsenic, Metals, Fibers, and Dusts Silica 

Dust, Crystalline, in the Form of Quartz 

or Cristobalite. A Review of Human 

Carcinogens. Volume 100 C. Geneva, 

Switzerland: World Health Organization.

Jalloul, A. S. and Banks D. E. (2007). Chapter 

23. The health effects of silica exposure. 

In: Rom, W. N. and Markowitz, S. B. (Eds). 

Environmental and Occupational Medicine, 

4th edition. Lippincott, Williams and Wilkins, 

Philadelphia, 365-387.

Kramer, M. R., Blanc, P. D., Fireman, E., 

Amital, A., Guber, A., Rahman, N. A., and 

Shitrit, D. (2012). Artifical stone silicosis: 

disease resurgence among artificial stone 

workers. Chest, 142, 419-424.

Laney, A. S., Petsonk, E. L., and Attfield, M. 

D. (2011). Intramodality and intermodality 

comparisons of storage phosphor computed 

radiography and conventional filmscreen radiography in the recognition of 

small pneumonconiotic opacities. Chest, 

140,1574-1580. 

Liu, Y., Steenland, K., Rong, Y., Hnizdo, E., 

Huang, X., Zhang, H., Shi, T., Sun, Y., Wu, 

T., and Chen, W. (2013). Exposure-response 

analysis and risk assessment for lung cancer 

in relationship to silica exposure: a 44-year 

cohort study of 34,018 workers. Am J Epi, 

178,1424-1433.

Liu, Y., Rong, Y., Steenland, K., Christiani, D. 

C., Huang, X., Wu, T., and Chen, W. (2014). 

Long-term exposure to crystalline silica and 

risk of heart disease mortality. Epidemiology, 

25, 689-696.

Mazurek, G. H., Jereb, J., Vernon, A., LoBue, 

P., Goldberg, S., Castro, K. (2010). Updated 

guidelines for using interferon gamma 

release assays to detect Mycobacterium

tuberculosis infection – United States. 

Morbidity and Mortality Weekly Report 

(MMWR), 59(RR05), 1-25.

Miller, M. R., Hankinson, J., Brusasco, V., 

Burgos, F., Casaburi, R., Coates, A., Crapo, R., 

Enright, P., van der Grinten, C. P., Gustafsson, 

P., Jensen, R., Johnson, D. C., MacIntyre, 

N., McKay, R., Navajas, D., Pedersen, O. F., 

Pellegrino, R., Viegi, G., and Wanger, J. (2005). 

American Thoracic Society/European 

Respiratory Society (ATS/ERS) Task Force: 

Standardisation of Spirometry. Eur Respir J, 

26, 319-338.

National Toxicology Program (NTP) (2014). 

Report on Carcinogens, Thirteenth Edition. 

Silica, Crystalline (respirable Size). Research 

Triangle Park, NC: U.S. Department of Health 

and Human Services, Public Health Service. 

http://ntp.niehs.nih.gov/ntp/roc/content/

profiles/silica.pdf

Occupational Safety and Health 

Administration/National Institute for 

Occupational Safety and Health (OSHA/

NIOSH) (2012). Hazard Alert. Worker exposure 

to silica during hydraulic fracturing. 

Occupational Safety and Health Administration/

National Institute for Occupational Safety and 

Health (OSHA/NIOSH) (2015). Hazard alert. 

Worker exposure to silica during countertop 

manufacturing, finishing, and installation. 

(OSHA- HA-3768-2015). 

Redlich, C. A., Tarlo, S. M., Hankinson, J. L., 

Townsend, M. C, Eschenbacher, W. L., Von 

Essen, S. G., Sigsgaard, T., Weissman, D. N. 

(2014). Official American Thoracic Society 
4 8 Occupational Safety and Health Administration

technical standards: spirometry in the 

occupational setting. Am J Respir Crit Care 

Med; 189, 984-994.

Rees, D. and Murray, J. (2007). Silica, silicosis 

and tuberculosis. Int J Tuberc Lung Dis, 11(5), 

474-484.

Shtraichman, O., Blanc, P. D., Ollech, J. E., 

Fridel, L., Fuks, L., Fireman, E., and Kramer, 

M. R. (2015). Outbreak of autoimmune 

disease in silicosis linked to artificial stone. 

Occup Med, 65, 444-450.

Slater, M. L., Welland, G., Pai, M., Parsonnet, 

J., and Banaei, N. (2013). Challenges with 

QuantiFERON-TB gold assay for large-scale, 

routine screening of U.S. healthcare workers. 

Am J Respir Crit Care Med, 188,1005-1010. 

Steenland, K., Mannetje, A., Boffetta, P., 

Stayner, L., Attfield, M., Chen, J., Dosemeci, 

M., DeKlerk, N., Hnizdo, E., Koskela, R., and 

Checkoway, H. (2001). International Agency 

for Research on Cancer. Pooled exposureresponse analyses and risk assessment for 

lung cancer in 10 cohorts of silica-exposed 

workers: an IARC multicentre study. Cancer 

Causes Control,12(9):773-84. 

Steenland, K. and Ward E. (2014). Silica: A 

lung carcinogen. CA Cancer J Clin, 64, 63-69. 

Townsend, M. C. ACOEM Guidance 

Statement. (2011). Spirometry in the 

occupational health setting – 2011 Update. J 

Occup Environ Med, 53, 569-584.

7. Sample Forms.

Three sample forms are provided. The first 

is a sample written medical report for the 

employee. The second is a sample written 

medical opinion for the employer. And 

the third is a sample written authorization 

form that employees sign to clarify what 

information the employee is authorizing to be 

released to the employer. 
Small Entity Compliance Guide for the Respirable Crystalline Silica Standard for General Industry and Maritime 4 9

57

WRITTEN MEDICAL REPORT FOR EMPLOYEE 

EMPLOYEE NAME: ____________________________________ DATE OF EXAMINATION: _______________ 

TYPE OF EXAMINATION: 

[ ] Initial examination [ ] Periodic examination [ ] Specialist examination 

[ ] Other: _______________________________________________________________________________________ 

RESULTS OF MEDICAL EXAMINATION: 

Physical Examination – [ ] Normal [ ] Abnormal (see below) [ ] Not performed 

Chest X-Ray – [ ] Normal [ ] Abnormal (see below) [ ] Not performed 

Breathing Test (Spirometry) – [ ] Normal [ ] Abnormal (see below) [ ] Not performed 

Test for Tuberculosis – [ ] Normal [ ] Abnormal (see below) [ ] Not performed 

Other:___________________ [ ] Normal [ ] Abnormal (see below) [ ] Not performed 

Results reported as abnormal: ____________________________________________________________________ 

__________________________________________________________________________________________________ 

[ ] Your health may be at increased risk from exposure to respirable crystalline silica due to the following: 

_________________________________________________________________________________________________ 

RECOMMENDATIONS: 

[ ] No limitations on respirator use 

[ ] Recommended limitations on use of respirator: ________________________________________________________ 

[ ] Recommended limitations on exposure to respirable crystalline silica: ______________________________________ 

_________________________________________________________________________________________________ 

Dates for recommended limitations, if applicable: _______________ to _____________ 

 MM/DD/YYYY MM/DD/YYYY

[ ] I recommend that you be examined by a Board Certified Specialist in Pulmonary Disease or Occupational Medicine 

[ ] Other recommendations*: 

__________________________________________________________________________ 

__________________________________________________________________________________________________ 

Your next periodic examination for silica exposure should be in: [ ] 3 years [ ] Other: ___________________ 

 MM/DD/YYYY 

Examining Provider: ________________________________________ Date: _____________________ 

 (signature) 

Provider Name: ___________________________________________ 

Office Address: ____________________________________________ Office Phone: ___________________ 

*These findings may not be related to respirable crystalline silica exposure or may not be work-related, and therefore

may not be covered by the employer. These findings may necessitate follow-up and treatment by your personal

physician.

Respirable Crystalline Silica standard (§ 1910.1053 or 1926.1153) 
5 0 Occupational Safety and Health Administration

Small Entity Compliance Guide for Construction 

Draft – Do not Quote or Cite 2/22/2017

58

WRITTEN MEDICAL OPINION FOR EMPLOYER

EMPLOYER: ____________________________________________

EMPLOYEE NAME: _______________________________________ DATE OF EXAMINATION: _______________

TYPE OF EXAMINATION:

[ ] Initial examination [ ] Periodic examination [ ] Specialist examination

[ ] Other: _______________________________________________________________________________________

USE OF RESPIRATOR:

[ ] No limitations on respirator use

[ ] Recommended limitations on use of respirator:_________________________________________________________

Dates for recommended limitations, if applicable: _______________ to _______________

 MM/DD/YYYY MM/DD/YYYY

The employee has provided written authorization for disclosure of the following to the employer (if applicable):

[ ] This employee should be examined by an American Board Certified Specialist in Pulmonary Disease or Occupational 

Medicine

[ ] Recommended limitations on exposure to respirable crystalline silica:_______________________________________

__________________________________________________________________________________________________

Dates for exposure limitations noted above: _______________ to _______________

 MM/DD/YYYY MM/DD/YYYY

NEXT PERIODIC EVALUATION: [ ] 3 years [ ] Other: ______________

 MM/DD/YYYY

Examining Provider: ______________________________________ Date: ___________

 (signature)

Provider Name: _________________________________________ Provider’s specialty:_______________________

Office Address: _________________________________________ Office Phone: ______________

[ ] I attest that the results have been explained to the employee.

The following is required to be checked by the Physician or other Licensed Health Care Professional (PLHCP):

[ ] I attest that this medical examination has met the requirements of the medical surveillance section of the OSHA 

Respirable Crystalline Silica standard (§ 1910.1053(h) or 1926.1153(h)).
Small Entity Compliance Guide for the Respirable Crystalline Silica Standard for General Industry and Maritime 51

Small Entity Compliance Guide for Construction 

Draft – Do not Quote or Cite 2/22/2017

59

AUTHORIZATION FOR CRYSTALLINE SILICA OPINION TO EMPLOYER

This medical examination for exposure to crystalline silica could reveal a medical condition that 

results in recommendations for (1) limitations on respirator use, (2) limitations on exposure to 

crystalline silica, or (3) examination by a specialist in pulmonary disease or occupational 

medicine. Recommended limitations on respirator use will be included in the written opinion to 

the employer. If you want your employer to know about limitations on crystalline silica exposure 

or recommendations for a specialist examination, you will need to give authorization for the 

written opinion to the employer to include one or both of those recommendations. 

I hereby authorize the opinion to the employer to contain the following information, if relevant

(please check all that apply): 

Recommendations for limitations on crystalline silica exposure

Recommendation for a specialist examination

OR

I do not authorize the opinion to the employer to contain anything other than recommended 

limitations on respirator use. 

Please read and initial: 

___ I understand that if I do not authorize my employer to receive the recommendation for 

specialist examination, the employer will not be responsible for arranging and covering 

costs of a specialist examination. 

________________________________ 

Name (printed)

________________________________ ______________________

Signature Date
5 2 Occupational Safety and Health Administration

WORKERS’ RIGHTS

Workers have the right to:

■ Working conditions that do not pose a risk 

of serious harm.

■ Receive information and training (in a 

language and vocabulary the worker 

understands) about workplace hazards, 

methods to prevent them, and the OSHA 

standards that apply to their workplace.

■ Review records of work-related injuries 

and illnesses.

■ File a complaint asking OSHA to inspect 

their workplace if they believe there is a 

serious hazard or that their employer is 

not following OSHA’s rules. OSHA will 

keep all identities confidential.

■ Exercise their rights under the law without 

retaliation, including reporting an injury or 

raising health and safety concerns with their 

employer or OSHA. If a worker has been 

retaliated against for using their rights, they 

must file a complaint with OSHA as soon as 

possible, but no later than 30 days.

For additional information, see OSHA’s 

Workers page (www.osha.gov/workers).

OSHA ASSISTANCE, SERVICES AND PROGRAMS 

OSHA has a great deal of information to 

assist employers in complying with their 

responsibilities under OSHA law. Several 

OSHA programs and services can help 

employers identify and correct job hazards, 

as well as improve their safety and 

health program.

Establishing a Safety and 

Health Program

Safety and health programs are systems that 

can substantially reduce the number and 

severity of workplace injuries and illnesses, 

while reducing costs to employers. 

Visit www.osha.gov/safety-management for 

more information.

Compliance Assistance Specialists

OSHA compliance assistance specialists 

can provide information to employers and 

workers about OSHA standards, short 

educational programs on specific hazards 

or OSHA rights and responsibilities, and 

information on additional compliance 

assistance resources. 

Visit www.osha.gov/complianceassistance/

cas or call 1-800-321-OSHA (6742) to contact 

your local OSHA office.

No-Cost On-Site Safety and Health 

Consultation Services for Small 

Business

OSHA’s On-Site Consultation Program offers 

no‐cost and confidential advice to small and 

medium-sized businesses in all states, with 

priority given to high-hazard worksites. OnSite consultation services are separate from 

enforcement and do not result in penalties 

or citations. 

For more information or to find the local OnSite Consultation office in your state, visit 

www.osha.gov/consultation, or call 1-800-

321-OSHA (6742).

Under the consultation program, certain 

exemplary employers may request 

participation in OSHA’s Safety and Health 

Achievement Recognition Program 

(SHARP). Worksites that receive SHARP 

recognition are exempt from programmed 

inspections during the period that the 

SHARP certification is valid.
Small Entity Compliance Guide for the Respirable Crystalline Silica Standard for General Industry and Maritime 5 3

Cooperative Programs

OSHA offers cooperative programs under 

which businesses, labor groups and other 

organizations can work cooperatively with 

OSHA. To find out more about any of the 

following programs, visit www.osha.gov/

cooperativeprograms.

Strategic Partnerships and Alliances

The OSHA Strategic Partnerships (OSP) 

provide the opportunity for OSHA to partner 

with employers, workers, professional or 

trade associations, labor organizations, and/

or other interested stakeholders. Through 

the Alliance Program, OSHA works with 

groups to develop compliance assistance 

tools and resources to share with workers 

and employers, and educate workers 

and employers about their rights and 

responsibilities.

Voluntary Protection Programs (VPP)

The VPP recognize employers and workers 

in the private sector and federal agencies 

who have implemented effective safety and 

health programs and maintain injury and 

illness rates below the national average for 

their respective industries.

Occupational Safety and 

Health Training

OSHA partners with more than 25 OSHA 

Training Institute Education Centers at 

multiple locations throughout the United 

States to deliver courses on OSHA standards 

and occupational safety and health topics 

to thousands of students a year. For more 

information on training courses, visit 

www.osha.gov/otiec.

OSHA Educational Materials

OSHA has many types of educational 

materials to assist employers and workers in 

finding and preventing workplace hazards. 

All OSHA publications are free at 

www.osha.gov/publications and 

www.osha.gov/ebooks. You can also 

call 1-800-321-OSHA (6742) to 

order publications.

Employers and safety and health 

professionals can sign-up for QuickTakes, 

OSHA’s free, twice-monthly online 

newsletter with the latest news about OSHA 

initiatives and products to assist in finding 

and preventing workplace hazards. To sign 

up, visit www.osha.gov/quicktakes.
5 4 Occupational Safety and Health Administration

OSHA REGIONAL OFFICES

Region 1

Boston Regional Office

(CT*, ME*, MA*, NH, RI, VT*)

JFK Federal Building

25 New Sudbury Street, Room E340 

Boston, MA 02203

(617) 565-9860 (617) 565-9827 Fax 

Region 2

New York Regional Office

(NJ*, NY*, PR*, VI*)

Federal Building

201 Varick Street, Room 670

New York, NY 10014

(212) 337-2378 (212) 337-2371 Fax

Region 3

Philadelphia Regional Office

(DE, DC, MD*, PA, VA*, WV)

1835 Market Street 

Mailstop OSHA-RO/19

Philadelphia, PA 19103

(215) 861-4900 (215) 861-4904 Fax

Region 4 

Atlanta Regional Office

(AL, FL, GA, KY*, MS, NC*, SC*, TN*)

Sam Nunn Atlanta Federal Center

61 Forsyth Street, SW, Room 6T50

Atlanta, GA 30303

(678) 237-0400 (678) 237-0447 Fax

Region 5

Chicago Regional Office

(IL*, IN*, MI*, MN*, OH, WI)

John C. Kluczynski Federal Building 

230 South Dearborn Street, Room 3244

Chicago, IL 60604

(312) 353-2220 (312) 353-7774 Fax

Region 6

Dallas Regional Office

(AR, LA, NM*, OK, TX)

A. Maceo Smith Federal Building 

525 Griffin Street, Room 602

Dallas, TX 75202

(972) 850-4145 (972) 850-4149 Fax

Region 7

Kansas City Regional Office

(IA*, KS, MO, NE)

Two Pershing Square Building

2300 Main Street, Suite 1010

Kansas City, MO 64108-2416

(816) 283-8745 (816) 283-0547 Fax

Region 8

Denver Regional Office

(CO, MT, ND, SD, UT*, WY*)

Cesar Chavez Memorial Building

1244 Speer Boulevard, Suite 551

Denver, CO 80204

(720) 264-6550 (720) 264-6585 Fax

Region 9 

San Francisco Regional Office

(AZ*, CA*, HI*, NV*, and American Samoa, 

Guam and the Northern Mariana Islands)

San Francisco Federal Building 

90 7th Street, Suite 2-650

San Francisco, CA 94103

(415) 625-2547 (415) 625-2534 Fax

Region 10

Seattle Regional Office

(AK*, ID, OR*, WA*)

909 1st Ave, Suite 201A

Seattle, WA 98104 

Mailing address:

20425 72nd Ave South, Suite 150A 

Kent, WA 98032-2388

(206) 757-6700 (206) 757-6705 Fax

*These states and territories operate their own OSHAapproved job safety and health plans and cover state 

and local government employees as well as private 

sector employees. The Connecticut, Illinois, Maine, 

Massachusetts, New Jersey, New York and Virgin 

Islands programs cover public employees only. 

(Private sector workers in these states are covered 

by Federal OSHA). States with approved programs 

must have standards that are identical to, or at least as 

effective as, the Federal OSHA standards.

Note: To get contact information for OSHA area 

offices, OSHA-approved State Plans and OSHA 

consultation projects, please visit us online at 

www.osha.gov or call us at 1-800-321-OSHA (6742).
HOW TO CONTACT OSHA

Under the Occupational Safety and Health Act of 1970, employers 

are responsible for providing safe and healthful workplaces for their 

employees. OSHA’s role is to help ensure these conditions for America’s 

workers by setting and enforcing standards, and providing training, 

education and assistance. For more information, visit www.osha.gov or 

call OSHA at 1-800-321-OSHA (6742), TTY 1-877-889-5627.

For assistance, contact us.

We are OSHA. We can help.
For more information:

Occupational 

Safety and Health

Administration

www.osha.gov (800) 321-OSHA (6742)

U.S. Department of Labor