Written Medical Opinion For Employer (Page 4 of 8) in pdf

Federal Register/Vol. 81, No. 58/Friday, March 25, 2016/Rules and Regulations

16881

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

(FEV

and FEV i/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

(h)(2) of this section (except paragraph

(h)(2)(v)) at least every three years

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

employment-related 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

;

(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 (h)(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)

PUfCP'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;

(BJ A statement that the examination

has met the requirements of this section;

and

(CJ 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;

(Bl A statement that the employee

should be examined by a specialist

(pursuant to paragraph (h)(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 (h)(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 (h)(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 (h)(5) (except paragraph

(h)(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

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

(ii)(B)) of this section.

(i)

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 (i)(2) of this section. The

employer shall ensure that at least the

following hazards are addressed:

Cancer, lung effects, immune system

effects, and kidney

effects.

(2)

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;

(Cl 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;

(DJ The contents of this section;

(El The identity of the competent

person designated by the employer in

accordance with paragraph (g)(4) of this

section; and

(F) The purpose and a description of

the medical surveillance program

required by paragraph (h) of this

section.

(ii) The employer shall make a copy

of this section readily available without

cost to each employee covered by this

section.

(j)

Recordkeeping-(1) Air monitoring

data.

(i)

The employer shall make and

Written Medical Opinion For Employer Page 4

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