437-002-2034 Medical Surveillance This rule describes the medical monitoring requirements of this subdivision. (1) Make medical surveillance available to each employee: (a) Who is or can be reasonably expected to exposed to beryllium at or above the action level for 30 or more days per year; (b) Who shows signs or symptoms of CBD or other beryllium-related health effects; (c) Who is exposed to beryllium during an emergency. (2) You must also make medical surveillance available to each employee whose most recent written medical opinion required by this rule recommends periodic medical surveillance. NOTE: The medical evaluation requirements of the respiratory protection rule, § 1910.134, still apply for employees wearing respiratory protection. (3) Medical surveillance must be provided at no cost to the employee and at a reasonable time and place. (4) Ensure that all medical examinations and procedures required by this rule are performed by a PLHCP as defined in 437-002-2025. (5) Provide a medical examination: (a) Initially within 30 days for every employee covered by paragraph (1) of this rule, except for any employee who has received a medical examination, provided in accordance with this rule, within the last two years; (b) Every two years for each employee covered by paragraphs (1)(a), (1)(b), and (2) of this rule; and (c) At the termination of employment for each employee who meets any of the criteria of paragraph (1) of (2) of this rule at the time of termination. This requirement does not apply if an examination has been provided in accordance with this rule within six months of the date of termination. (6) Ensure that the PLHCP conducting the examination advises the employee of the risks and benefits of participating in the medical surveillance program and the employee's right to opt out of any or all parts of the medical examination. (7) The examination must include: (a) A medical and work history, with emphasis on past and present airborne exposure to or dermal contact with beryllium, smoking history, and any history of respiratory system dysfunction; (b) A physical examination with emphasis on the respiratory system; (c) A physical examination for skin rashes; (d) Pulmonary function tests, performed in accordance with the guidelines established by the American Thoracic Society including forced vital capacity (FVC) and forced expiratory volume in one second (FEV1); (e) A standardized BeLPT or equivalent test, upon the first examination and at least every two years thereafter, unless the employee is confirmed positive. If the results of the BeLPT are other than normal, a follow-up BeLPT must be offered within 30 days, unless the employee has been confirmed positive. Samples must be analyzed in a laboratory certified under the College of American Pathologists/Clinical Laboratory Improvement Amendments (CLIA) guidelines to perform the BeLPT. (f) A low dose computed tomography (LDCT) scan, when recommended by the PLHCP after considering the employee's history of exposure to beryllium along with other risk factors, such as smoking history, family medical history, sex, age, and presence of existing lung disease; and (g) Any other test deemed appropriate by the PLHCP. (8) Ensure that the examining PLHCP (and the agreed-upon CBD diagnostic center, if an evaluation is required under paragraph (15) of this rule) has a copy of this subdivision and provide the following information, if known: (a) A description of the employee's former and current duties that relate to the employee's airborne exposure to and dermal contact with beryllium; (b) The employee's former and current levels of airborne exposure; (c) A description of any personal protective clothing and equipment, including respirators, used by the employee, including when and for how long the employee has used that personal protective clothing and equipment; and (d) Information from records of employment-related medical examinations previously provided to the employee, currently within the control of the employer, after obtaining written consent from the employee. (9) Ensure that the employee receives a written medical report from the licensed physician within 45 days of the examination (including any follow-up BeLPT required under paragraph (7)(e) of this rule) and that the PLHCP explains the results of the examination to the employee. Ensure the written report contains: (a) A statement indicating the results of the medical examination, including the licensed physician's opinion as to whether the employee has: (A) Any detected medical condition, such as CBD or beryllium sensitization (i.e., the employee is confirmed positive, as defined in OAR 437-002-2025), that may place the employee at increased risk from further airborne exposure, and (B) Any medical conditions related to airborne exposures that require further evaluation or treatment. (b) Any recommendations on: (A) The employee's use of respirators, protective clothing, or equipment; or (B) Limitations on the employee's airborne exposure to beryllium. (c) If the employee is confirmed positive or diagnosed with CBD or if the licensed physician otherwise deems it appropriate, the written report must also contain a referral for an evaluation at a CBD diagnostic center. (d) If the employee is confirmed positive or diagnosed with CBD the written report must also contain a recommendation for continued periodic medical surveillance. (e) If the employee is confirmed positive or diagnosed with CBD the written report must also contain a recommendation for medical removal from airborne exposure to beryllium, as described in OAR 437-002-2035. (10) Obtain a written medical opinion from the licensed physician within 45 days of the medical examination (including any follow-up BeLPT required by this rule). The written opinion must contain only the following: (a) The date of the examination; (b) A statement that the examination has met the requirements of this rule; and (c) Any recommended limitations on the employee’s use of respirators, protective clothing, or equipment; and (d) A statement that the PLHCP has explained the results of the medical examination to the employee, including any tests conducted, any medical conditions related to airborne exposure that require further evaluation or treatment, and any special provisions for use of personal protective clothing or equipment. (11) If the employee provides written authorization, the written opinion must also contain any recommended limitations on the employee's airborne exposure to beryllium. (12) If the employee is confirmed positive or diagnosed with CBD or if the licensed physician otherwise deems it appropriate, and the employee provides written authorization, the written opinion must also contain a referral for an evaluation at a CBD diagnostic center. (13) If the employee is confirmed positive or diagnosed with CBD and the employee provides written authorization, the written opinion must also contain a recommendation for continued periodic medical surveillance. (14) If the employee is confirmed positive or diagnosed with CBD and the employee provides written authorization, the written opinion must also contain a recommendation for medical removal from airborne exposure to beryllium, as described in 437-002-2035. (15) When a physician's written medical report indicates that the employee has been confirmed positive or diagnosed with CBD, or recommends referral to a CBD diagnostic center, provide an evaluation to the employee at a CBD diagnostic center that is mutually agreed upon by the employer and the employee. This evaluation must be provided within 30 days of receiving the written opinion, and at no cost to the employee. (a) Ensure the employee receives a written medical report within 30 days of the medical examination from the CBD diagnostic center that includes: (A) A statement indicating the results of the medical examination, including the licensed physician's opinion as to whether the employee has: (i) Any detected medical condition, such as CBD or beryllium sensitization (i.e., the employee is confirmed positive, as defined in OAR 437-002-2025), that may place the employee at increased risk from further airborne exposure, and (ii) Any medical conditions related to airborne exposure that require further evaluation or treatment. (B) Any recommendations on: (i) The employee's use of respirators, protective clothing, or equipment; or (ii) Limitations on the employee's airborne exposure to beryllium. (b) If the employee is confirmed positive or diagnosed with CBD the written report must also contain a recommendation for continued periodic medical surveillance. (c) If the employee is confirmed positive or diagnosed with CBD the written report must also contain a recommendation for medical removal from airborne exposure to beryllium, as described in OAR 437-002-2035. (16) Obtain a written medical opinion from CBD diagnostic center within 30 days of the medical examination. The written opinion must contain only the following: (a) The date of the examination; (b) A statement that the examination has met the requirements of this rule; and (c) Any recommended limitations on the employee’s use of respirators, protective clothing, or equipment; and (d) A statement that the PLHCP has explained the results of the medical examination to the employee, including any tests conducted, any medical conditions related to airborne exposure that require further evaluation or treatment, and any special provisions for use of personal protective clothing or equipment. (e) If the employee provides written authorization, the written opinion must also contain: (A) Any recommended limitations on the employee's airborne exposure to beryllium (B) A recommendation for continued periodic medical surveillance if the employee is confirmed positive or diagnosed with CBD; (C) A recommendation for medical removal from airborne exposure to beryllium, as described in 437-002-2035, if the employee is confirmed positive or diagnosed with CBD. (17) After an employee has received the initial clinical evaluation at a CBD diagnostic center, the employee may choose to have any subsequent medical examinations for which the employee is eligible performed at a CBD diagnostic center mutually agreed upon by the employer and the employee. Provide such examinations at no cost to the employee. Statutory/Other Authority: ORS 654.025(2) & 656.726(4) Statutes/Other Implemented: ORS 654.001 – 654.295 History: OSHA 1-2018, amend filed 03/12/2018, effective 03/12/2018 OSHA 3-2017, f. 7-7-17, cert. ef. 3-12-18