California Code of Regulations › Title 8 - Industrial Relations › Division 1 - Department of Industrial Relations › Chapter 4 - Division of Industrial Safety › Subchapter 18 - Ship Building, Ship Repairing and Ship Breaking Safety Orders › Article 4 - Control of Hazardous Work › Appendix I - 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,
						the following elements in the routine examination are required:
(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, if the employee has not been examined within the past one year
						period.
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.
Note: Authority cited: Section
						  142.3, Labor
						  Code. Reference: Section
						  142.3, Labor
						  Code.