California Code of Regulations › Title 8 - Industrial Relations › Division 1 - Department of Industrial Relations › Chapter 4 - Division of Industrial Safety › Subchapter 7 - General Industry Safety Orders › Group 16 - Control of Hazardous Substances › Article 110 - Regulated Carcinogens › Appendix H - Medical Surveillance Guidelines for Asbestos Non-Mandatory

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
I. Route of Entry: Inhalation, Ingestion
II. Toxicology
Clinical evidence of the adverse effects associated
						  with exposure to asbestos is present in the form of several well-conducted
						  epidemiological studies of occupationally exposed workers, family contacts of
						  workers, and persons living near asbestos mines. These studies have shown a
						  definite association between exposure to asbestos and an increased incidence of
						  lung cancer, pleural and peritoneal mesothelioma, gastrointestinal cancer, and
						  asbestosis. The latter is a disabling fibrotic lung disease that is caused only
						  by exposure to asbestos. Exposure to asbestos has also been associated with an
						  increased incidence of esophageal, kidney, laryngeal, pharyngeal, and buccal
						  cavity cancers. As with other known chronic occupational diseases, disease
						  associated with asbestos generally appears about 20 years following the first
						  occurrence of exposure. There are no known acute effects associated with
						  exposure to asbestos.
Epidemiological studies indicate that the risk of lung
						  cancer among exposed workers who smoke cigarettes is greatly increased over the
						  risk of lung cancer among non-exposed smokers or exposed nonsmokers. These
						  studies suggest that cessation of smoking will reduce the risk of lung cancer
						  for a person exposed to asbestos but will not reduce it to the same level of
						  risk as that existing for an exposed worker who has never smoked.
III. Signs and Symptoms of Exposure-Related
						  Disease
The signs and symptoms of lung cancer or
						  gastrointestinal cancer induced by exposure to asbestos are not unique, except
						  that a chest X-ray of an exposed patient with lung cancer may show pleural
						  plaques, pleural calcification, or pleural fibrosis. Symptoms characteristic of
						  mesothelioma include shortness of breath, pain in the walls of the chest, or
						  abdominal pain. Mesothelioma has a much longer latency period compared with
						  lung cancer (40 years versus 15-20 years), and mesothelioma is therefore likely
						  to be found among workers who were first exposed to asbestos at an early age.
						  Mesothelioma is always fatal.
Asbestosis is pulmonary fibrosis caused by the
						  accumulation of asbestos fibers in the lungs. Symptoms include shortness of
						  breath, coughing, fatigue, and vague feelings of sickness. When the fibrosis
						  worsens, shortness of breath occurs even at rest. The diagnosis of asbestosis
						  is based on a history of exposure to asbestos, the presence of characteristic
						  radiologic changes, end inspiratory crackles (rales), and other clinical
						  features of fibrosing lung disease. Pleural plaques and thickening are observed
						  on X-rays taken during the early stages of the disease. Asbestosis is often a
						  progressive disease even in the absence of continued exposure, although this
						  appears to be a highly individualized characteristic. In severe cases, death
						  may be caused by respiratory or cardiac failure.
IV. Surveillance and Preventive Considerations
As noted above, exposure to asbestos has been linked to
						  an increased risk of lung cancer, mesothelioma, gastrointestinal cancer, and
						  asbestosis among occupationally exposed workers. Adequate screening tests to
						  determine an employee's potential for developing serious chronic diseases, such
						  as cancer, from exposure to asbestos do not presently exist. However, some
						  tests, particularly chest X-rays and pulmonary function tests, may indicate
						  that an employee has been overexposed to asbestos, thus increasing his or her
						  risk of developing exposure-related chronic disease. It is important for the
						  physician to become familiar with the operating conditions in which
						  occupational exposure to asbestos is likely to occur. This is particularly
						  important in evaluating medical and work histories and in conducting physical
						  examinations. When an active employee has been identified as having been
						  overexposed to asbestos, measures taken by the employer to eliminate or
						  mitigate further exposure should also lower the risk of serious long-term
						  consequences.
The employer is required to institute a medical
						  surveillance program for all employees who are or will be exposed to asbestos
						  at or above the permissible exposure limit (0.1 fiber per cubic centimeter of
						  air). All examinations and procedures must be performed by or under the
						  supervision of a licensed physician, at a reasonable time and place, and at no
						  cost to the employee.
Although broad latitude is given to the physician in
						  prescribing specific tests to be included in the medical surveillance program,
						  OSHA requires inclusion of the following elements in the routine
						  examination:
(i) Medical and work histories with special emphasis
						  directed to symptoms of the respiratory system, cardiovascular system, and
						  digestive tract.
(ii) Completion of one of the respiratory disease
						  questionnaires contained in Appendix D: Part 1 for the initial examination and
						  part 2 for periodic examinations.
(iii) A physical examination including a chest X-ray
						  (at the discretion of the examining physician for construction work) and
						  pulmonary function testing that includes measurement of the employee's forced
						  vital capacity (FVC) and forced expiratory volume at one second
						  (FEV1).
(iv) Any laboratory or other test that the examining
						  physician deems by sound medical practice to be necessary or
						  appropriate.
The employer is required to make the prescribed tests
						  available at least annually to those employees covered; more often than
						  specified if recommended by the examining physician; and upon termination of
						  employment.
The employer is required to provide the physician with
						  the following information: a copy of this standard and appendices; a
						  description of the employee's work assignments as they relate to asbestos
						  exposure; the employee's representative level of exposure to asbestos; a
						  description of any personal protective and respiratory equipment used; and
						  information from previous medical examinations of the affected employee that is
						  not otherwise available to the physician. Making this information available to
						  the physician will aid in the evaluation of the employee's health in relation
						  to assigned duties and fitness to wear personal protective equipment, if
						  required.
The employer is required to obtain a written opinion
						  from the examining physician containing the results of the medical examination;
						  the physician's opinion as to whether the employee has any detected medical
						  conditions that would place the employee at an increased risk of
						  exposure-related disease; any recommended limitations on the employee or on the
						  use of personal protective equipment; and a statement that the employee has
						  been informed by the physician of the results of the medical examination and of
						  any medical conditions related to asbestos exposure that require further
						  explanation or treatment. This written opinion must not reveal specific
						  findings or diagnoses unrelated to exposure to asbestos, and a copy of the
						  opinion must be provided to the affected employee.
1. New
						  Appendix H to section
						  5208 filed 2-15-91; operative
						  2-15-91 pursuant to Government Code section
						  11346.2(d)
						  (Register 91, No. 19).
2. Editorial correction of HISTORY 1.
						  (Register 91, No. 45).
3. Amendment of appendix and NOTE filed
						  5-3-96; operative 7-3-96 (Register 96, No. 18).
Note: Authority cited: Section
							 142.3, Labor
							 Code. Reference: Section
							 142.3, Labor
							 Code.