1910.1048(l)(4)(ii) Laboratory examinations for respirator wearers consisting of baseline and annual pulmonary function tests. As a minimum, these tests shall consist of forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and forced expiratory flow (FEF). 1910.1048(l)(4)(iii) Any other test which the examining physician deems necessary to complete the written opinion. 1910.1048(l)(4)(iv) Counseling of employees having medical conditions that would be directly or indirectly aggravated by exposure to formaldehyde on the increased risk of impairment of their health. 1910.1048(l)(5) Examinations for employees exposed in an emergency. The employer shall make medical examinations available as soon as possible to all employees who have been exposed to formaldehyde in an emergency. 1910.1048(l)(5)(i) The examination shall include a medical and work history with emphasis on any evidence of upper or lower respiratory problems, allergic conditions, skin reaction or hypersensitivity, and any evidence of eye, nose, or throat irritation. 1910.1048(l)(5)(ii) Other examinations shall consist of those elements considered appropriate by the examining physician. 1910.1048(l)(6) Information provided to the physician. The employer shall provide the following information to the examining physician: 1910.1048(l)(6)(i) A copy of this standard and Appendix A, C, D, and E; 1910.1048(l)(6)(ii) A description of the affected employee's job duties as they relate to the employee's exposure to formaldehyde; 1910.1048(l)(6)(iii) The representative exposure level for the employee's job assignment; 1910.1048(l)(6)(iv) Information concerning any personal protective equipment and respiratory protection used or to be used by the employee; and 1910.1048(l)(6)(v) Information from previous medical examinations of the affected employee within the control of the employer. 1910.1048(l)(6)(vi) In the event of a nonroutine examination because of an emergency, the employer shall provide to the physician as soon as possible: a description of how the emergency occurred and the exposure the victim may have received. 1910.1048(l)(7) Physician's written opinion. 1910.1048(l)(7)(i) For each examination required under this standard, the employer shall obtain a written opinion from the examining physician. This written opinion shall contain the results of the medical examination except that it shall not reveal specific findings or diagnoses unrelated to occupational exposure to formaldehyde. The written opinion shall include:
1910.1048(l) Medical surveillance— 1910.1048(l)(1) Employees covered. 1910.1048(l)(1)(i)
The employer shall institute medical surveillance programs for all employees exposed to formaldehyde at concentrations at or exceeding the action level or exceeding the STEL. 1910.1048(l)(1)(ii) The employer shall make medical surveillance available for employees who develop signs and symptoms of overexposure to formaldehyde and for all employees exposed to formaldehyde in emergencies. When determining whether an employee may be experiencing signs and symptoms of possible overexposure to formaldehyde, the employer may rely on the evidence that signs and symptoms associated with formaldehyde exposure will occur only in exceptional circumstances when airborne exposure is less than 0.1 ppm and when formaldehyde is present in material in concentrations less than 0.1 percent. 1910.1048(l)(2) Examination by a physician. All medical procedures, including administration of medical disease questionnaires, shall be performed by or under the supervision of a licensed physician and shall be provided without cost to the employee, without loss of pay, and at a reasonable time and place. 1910.1048(l)(3) Medical disease questionnaire. The employer shall make the following medical surveillance available to employees prior to assignment to a job where formaldehyde exposure is at or above the action level or above the STEL and annually thereafter. The employer shall also make the following medical surveillance available promptly upon determining that an employee is experiencing signs and symptoms indicative of possible overexposure to formaldehyde. 1910.1048(l)(3)(i) Administration of a medical disease questionnaire, such as in Appendix D, which is designed to elicit information on work history, smoking history, any evidence of eye, nose, or throat irritation; chronic airway problems or hyperreactive airway disease: allergic skin conditions or dermatitis; and upper or lower respiratory problems. 1910.1048(l)(3)(ii) A determination by the physician, based on evaluation of the medical disease questionnaire, of whether a medical examination is necessary for employees not required to wear respirators to reduce exposure to formaldehyde. 1910.1048(l)(4) Medical examinations. Medical examinations shall be given to any employee who the physician feels, based on information in the medical disease questionnaire, may be at increased risk from exposure to formaldehyde and at the time of initial assignment and at least annually thereafter to all employees required to wear a respirator to reduce exposure to formaldehyde. The medical examination shall include: 1910.1048(l)(4)(i) A physical examination with emphasis on evidence of irritation or sensitization of the skin and respiratory system, shortness of breath, or irritation of the eyes.
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