United States Department of Agriculture
Research, Education, and Economics
ARS * CSREES * ERS * NASS
Policies and Procedures
Title: | ARS Occupational Medical Surveillance Program |
Number: | 235.0-ARS |
Date: | April 3, 2002 |
Originating Office: | Human Resources Division, AFM |
This Replaces: | |
Distribution: | ARS Headquarters, Areas, and Locations |
This P&P contains ARS policy and responsibilities regarding the medical surveillance of employees potentially exposed to chemical, biological, and/or physical hazards in the work environment. It describes the procedures for establishing and administering a comprehensive Occupational Medical Surveillance Program (OMSP) which replaces the earlier Occupational Health Maintenance Program. |
Table of Contents
1.Applicability
2. Policy
2.Policy
3. Authorities
3.Authorities
4. Coverage
5. Program Description/Procedures
Selection Criteria for Authorized
Employees
Selection of Appropriate Medical
Tests
Recommendations for the
Establishment of Medical Monitoring Services from a Local Provider
Data Submission, Interpretation,
Communication, and the Overall Procedures for Operating the OMSP
6. Summary of Responsibilities
7. Glossary
The contents of this P&P are applicable to all functions under the direction of the
ARS Administrator whether accomplished by ARS personnel, cooperators, or contractors
within ARS. Exceptions to the provisions of this P&P require Office of the Director,
Human Resources Division (HRD) and/or Administrative & Financial Management (AFM)
approval. Waivers must be documented and copies furnished to the next higher management
level. In all instances, however, program coverage consistent with the intent of the
pertinent provision will be provided.
It is ARS policy to provide an Occupational Medical Surveillance Program (OMSP) for
authorized employees considered for assignment or presently assigned to work with
chemical, biological, and/or physical hazards. The OMSP will be established and
administered according to the procedures detailed in this P&P.
Participation in the OMSP is voluntary. Medical evaluations required by OSHA
regulations may be performed in conjunction with the OMSP, however the OMSP should not be
confused with OSHA requirements. The OMSP is a voluntary, broad-based medical surveillance
program, and its purpose is to identify exposures to potentially harmful agents and aid in
the early detection of adverse health effects, if any. OSHA-mandated medical evaluations
are limited and specific to the hazard of work activity in question.
The results of all examinations provided under this program will be safeguarded in
accordance with 5 CFR 293, Subpart E, Employee Medical File System Records.
The OMSP examines authorized employees to establish health-status baselines and detect
work-
related changes in health status. Medical records will document procedures performed,
establish
baselines, and work-related physiological changes (if any) throughout the employee's
career.
This information will be used to establish trends and to determine unusual
susceptibility to
illness from exposures in the work environment, permit identification of harmful effects
of
agents used, and provide medical treatment and advice. It also will be used to plan,
implement,
and evaluate occupational and preventive health programs.
The OMSP is designed for the detection of occupationally significant medical anomalies.
The
limited medical procedures performed are not intended, and should not be
construed, to
substitute for the care provided by the employee's personal physician.
Employees may be provided treatment for occupational injuries and exposures from the
OMSP
Local Provider (the local clinic/examiner providing medical services). However, payment
for
these services resulting from a work-related injury should be administered through the Office
of
Workers' Compensation Program (OWCP) and will be recorded on the location's Occupational
Safety and Health Administration (OSHA) log, if appropriate. In such an instance,
employees must complete the appropriate OWCP forms, e.g., CA-1 or CA-2.
Selection Criteria for Authorized Employees
The selection of eligible enrollees for the OMSP (i.e., the accurate definition of
"Authorized
Employees") is generally determined by the occupational exposures indicated on Form
ARS-182A/B and the employees supervisor. Although it is impossible to establish selection
criteria which provide adequate guidance in all cases, the following rules should apply in
most
instances.
Consult with ARS Safety, Health, and Environmental Management Branch (SHEMB), Area
Safety and Health Manager (ASHM), Cluster Environmental Protection Specialist (CEPS),
and/or your location safety staff for assistance with individual cases that involve more
nebulous
circumstances.
Employees meeting the following criteria may participate in the OMSP:
According to OSHA regulations, ARS is required to perform medical monitoring of
employees
meeting the following criteria:
In as much as the OMSP is a medical surveillance program that is already in place, ARS recommends its use for performing the medical monitoring required under these mandates. (For example, employees who are required to use a respirator when performing their duties must receive an initial medical evaluation.) ARS facilities are free to use other mechanisms to perform the monitoring.
All employees who meet the aforementioned criteria will complete an ARS-182A/B form
identifying their occupational exposures as a tool to determine their participation. The
annual medical occupational examination date will be established based on birth date or
some other recurring date. The frequency of examinations may be altered when supported by
industrial
hygiene data.
Selection of Appropriate Medical Tests
The selection of appropriate medical procedures to identify work-related adverse effects in employee populations is frequently a "best estimate" process which is subject to criteria that are continuously changed or modified. The ARS Medical Matrix identifies minimal test requirements. The Local Provider may add additional tests with prior approval from the Contracting Officer.
The determination of work-related diseases or adverse health effects uncovered by
medical tests is complicated by the fact that occupational related diseases frequently do
not differ in their presentation from diseases of the general population. Although the
diagnosis may be made by the examining physician, the determination of the proximate
cause(s) of the disease/anomalies, and the relationship to potential toxic exposures in
the workplace is considerably more difficult; it is frequently impossible. This
relationship is dependent upon the history of exposure to a particular agent, the degree
and duration of exposure, the efficacy of industrial hygiene controls, and the presence of
compounding factors such as smoking and non-work related exposures. The
determination of work-related diseases or adverse health effects, therefore, cannot be
made with absolute certainty, and must depend upon the interpretation of these factors by
expert occupational medical judgment.
Recommendations for the Establishment of
Medical
Monitoring Services from a Local Provider
Basic medical services vary throughout the nation according to available levels of
expertise and costs. Economical services are most often available through a reimbursable
agreement with a Government affiliated provider, such as a Public Health Service Clinic,
Federal Occupational Health (FOH), a Veteran's Administration Hospital, or a military
complex.
Administration of the medical surveillance services should be under the supervision of a licensed doctor of medicine (MD) or doctor of osteopathy (DO). In addition, at a minimum, the MD/DO should be Board Certified in Occupational Medicine or Board Certified in Internal Medicine. If a person with these credentials is not available, then an MD/DO who is Board Eligible in Occupational Medicine or Internal Medicine would be an acceptable alternative. In either case, a physician with experience and interest in occupational medicine is preferred.
Reimbursement for administrative costs such as postage, duplication, etc., should be included in the Local Provider Agreement. Official postage-and fees-paid envelopes, cards, and labels cannot be used for this purpose. (See P&P 263.1).
To enhance the effectiveness of the Local Provider, the completed ARS Forms 182-A/B and C (or C(2)) should be sent to the physician for review so that lab and other tests are completed prior to the enrollee's medical occupational examination.
A generic Statement of Work is available from the ASHM.
Data Submission, Interpretation,
Communication, and the Overall Procedures for Operating the OMSP
The following sequence of actions provides detailed guidance regarding every step required in the operation of the OMSP:
The Administrator, ARS
Area Directors/Center Directors/Location Coordinators/Research Leaders
Area Administrative Officers/Location Administrative
Officers
Supervisors
All Employees Meeting Section 5 Criteria
Authorized Employees
Director, Human Resources Division (HRD)
ASHM, CEPS, and Location Safety Specialist (as appropriate)
OMS Coordinator (locally assigned personnel)
Local Provider
Reviewing Medical Officer
Action Level. That level of worker exposure, determined by workplace sampling, at
or above
which medical monitoring will be performed. The concentration designated in 29 CFR,
Part 1910 for a specific substance, calculated as an 8-hour time-weighted average,
which initiates certain activities such as exposure monitoring and medical surveillance,
usually one-half the Permissible Exposure Limit (PEL - see definition below). For
substances with an OSHA PEL, the action level is defined and may be one-half of the PEL.
For exposures not regulated by OSHA, other consensus standards may be used for an action
level. One such consensus standard is use of one-half of the Threshold Limit Value (TLV -
see definition below) as an action level.
AD/CD. Area Director/Center Director.
ARS-182A/B. Occupational Medical Surveillance Program -- Occupational Exposures (9/01) (replaces previous edition which is not usable).
ARS-182C. Occupational Medical Surveillance Program -- Occupational/Medical Questionnaire (11/00) (replaces previous edition which is not usable).
ARS-182C(2). Occupational Medical Surveillance Program B Medical History Update Form (9/00).
ARS-182D. Occupational Medical Surveillance Program -- Physical Examination Form (9/00) (replaces previous edition which is not usable).
ARS Medical Matrix. A list of minimum criteria, including laboratory and ancillary tests which should be performed on individuals reporting exposures to a variety of chemical, physical or biological hazards. It is based on testing criteria which are recommended by the National Institutes of Occupational Safety and Health (NIOSH), OSHA, and published references in the field of Occupational Medicine and Toxicology.
ASHM. Area Safety and Health Manager.
Authorized Employees. Can be any employee, e.g., research scientists, technicians, certified pesticide applicators, maintenance personnel, or other Federal employees who have been specifically trained and assigned by a supervisor to work with or in the vicinity of qualifying hazards. Non-Federal workers, such as those employed by cooperators or contractors, may be authorized OMSP physicals at ARS expense if the task order that specifies the job requirements includes participation in the OMSP. Physical examinations may be provided as part of this program.
CEPS. Cluster Environmental Protection Specialist.
CFR. Code of Federal Regulations.
Chemical, Biological, and/or Physical Hazards. Chemical hazards (e.g., pesticides, solvents, any exposures to chemicals where alteration of health status may occur, etc.); other hazards (e.g., asbestos and any other respiratory hazards); physical hazards (e.g., noise, lasers, radiation, etc.); biological hazards (e.g., rabies, human blood and body fluids, exposure to animals, etiologic agents, etc.).
Emergency Exposure. Any occurrence, such as but not limited to, equipment failure, rupture of containers, or failure of control equipment that may or does result in an unexpected release of and exposure to a hazardous substance or condition.
FD. Facilities Division.
Hearing Conservation Program. Employees exposed to noise levels equal to or exceeding an 8 hour time-weighted average action level of 85 dBA shall be included in a hearing conservation program. The program includes annual audiometric exams and training on the importance, use, and care of hearing protectors. Feasible engineering and administrative controls shall be considered to reduce employee's exposure below 85 dBA so that this program will not be required.
HRD. Human Resources Division.
Industrial Hygiene. The science and art devoted to the recognition, evaluation, and control of those environmental factors or stresses, arising from the workplace which may cause sickness, impaired health and well being, or significant discomfort and inefficiency among employees and/or citizens of the community. LAO/AAO. Location/Area Administrative Officer.
LC. Location Coordinator. Local Provider. A licensed practicing clinician or professional health care provider who will perform the medical occupational examination on the employee. The examining physician should be experienced in the field of Occupational Medicine and Industrial Health or a Board-Certified Internist.
Medical Occupational Examination. Medical examinations performed to prevent work-related health problems by assessing the health status of individuals in relation to their work and making medical recommendations regarding worker placement, accommodation, and exposure controls. An occupational medical examination may include:
OMSP. Occupational Medical Surveillance Program.
OMS Coordinator. The Occupational Medical Surveillance Coordinator is a person who acts as the coordinator for the program at location level.
OSHA. Occupational Safety and Health Administration.
PEL. Permissible Exposure Limit which is the exposure level that is published
and enforced by OSHA as a legal standard. (Table Z-1, Z-2, or Z-3 of OSHA regulation 29
CFR 1910.1000).
Respiratory Protection Program. The employer shall provide a medical evaluation to
determine the employee's ability to use a respirator, before the employee is fit tested or
required to use the respirator in the workplace. The employer may discontinue an
employee's medical evaluations when the employee is no longer required to use a
respirator.
Reviewing Medical Officer (RMO). A licensed MD/DO with Board Certification in Occupational Medicine whose training and experience have led to the development of expertise in the field of occupational medicine. This specialty involves the observation of work practices and toxic exposure potentials in an effort to detect, confirm, and prevent work-related illnesses. The RMO will perform trend analysis and inform the enrollee and the appropriate management officials of any work-related problems through a formalized report of medical findings and determinations. The RMO is currently provided by the Department of Health & Human Services, Division of Federal Occupational Health, through an inter-agency agreement.
SHEMB. Safety, Health, and Environmental Management Branch.
Threshold Limit Value (TLV). Airborne concentrations of substances that represent conditions under which it is believed that nearly all workers may be repeatedly exposed day after day without adverse health effects. TLV's are recommendations from the American Conference of Governmental Industrial Hygienists (ACGIH).
Time-Weighted Average (TWA). Concentrations of stressors or hazards which have been weighted for time duration of the sample. Most commonly expressed as an average concentration for a normal 8-hour workday or 40-hour week.
Workplace. A physical location where the work or operations are performed. Workplaces may be administrative, operational, or industrial.
W. G. HORNER
Deputy Administrator
Administrative and Financial Management