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NASA Ball NASA
Procedural
Requirements
NPR 1800.1C
Effective Date: October 06, 2009
Expiration Date: October 06, 2014
COMPLIANCE IS MANDATORY
Printable Format (PDF)

(NASA Only)

Subject: NASA Occupational Health Program Procedures w/Change 2 (05/17/2013)

Responsible Office: Office of the Chief Health & Medical Officer


| TOC | ChangeLog | Preface | Chapter1 | Chapter2 | Chapter3 | Chapter4 | Chapter5 | Chapter6 | Chapter7 | AppendixA | AppendixB | AppendixC | AppendixD | AppendixE | AppendixF | ALL |

Appendix C. Physical Examination Matrix

1. Specific Potentially Hazardous Exposures

Exam Regulation
A. Arsenic 29 CFR Part 1910.1018
B. Asbestos 29 CFR Part 1910.1001
29 CFR Part 1926.1101
C. Benzene 29 CFR Part 1910.1028
D. Beryllium 10 CFR Part 850 (DOE)
NIOSH
E. Cadmium 29 CFR Part 1910.1027
29 CFR Part 1926.1127
F. Chromium 29 CFR Part 1910.1026
29 CFR Part 1926.1126
G. Ethylene Oxide 29 CFR Part 1910.1047
H. Formaldehyde 29 CFR Part 1910.1048
I. Hydrazines NIOSH
J. Isocyanates NIOSH
K. Lead 29 CFR 1910.1025
29 CFR 1926.62
L. Mercury OSHA CPL 02-02-006
NIOSH, ATSDR
M. Methylene Chloride 29 CFR Part 1910.1052
ATSDR
N. 4,4' Methylenebis (2-chloroaniline) (MOCA, MBOCA) NIOSH, ATSDR, OSHA
O. 4,4' Methylenedianiline (MDA) 29 CFR 1910.19, 1910.1050 and 1926.60
P. Nitrogen Tetroxide (Dioxide) NIOSH
Q. Polychlorinated Biphenyls (PCB) ATSDR
NIOSH Current Intelligence Bulletin 45, February 24, 1986
R. Silica Dust 29 CFR 1910.1000, 29 CFR 1915, OSHA CPL 2-2.7, NIOSH
S. Trichloroethylene NIOSH

2. Hazardous Environments/ Workplace Examinations

Exam Regulation
A. Bloodborne Pathogens 20 CFR 1910.1030
B. Chemistry Laboratory 29 CFR 1910.1450
C. Hazardous Waste Operations and Emergency Response 29 CFR 1910.120
D. Health Care Provider 29 CFR 1910.1030, CDC
E. Ionizing Radiation 10 CFR 20.1502
F. Lasers ANSI Z 136.1
G. Noise 29 CFR 1910.95
NPR 1800.1B Chapter 4.9
H. Pesticides
I. Spray Painting
J. Water and Sewage
K. Welding NIOSH Criteria Document No. 88-110

3. Certification Examinations

Exam Regulation
A. Childcare Workers
B. Confined Space/Tank Entry 29 CFR 1910.134
C. Crane Operator/Ground Floor/Remote-Operation/High/Cabin/Pulpit NS 8719.9
ASME B30.2-2001
D. Diver 29 CFR 1910.423
29 CFR 1910.424
E. DOT/Commercial Driver License/Motor Vehicle Certification/Multiple Passenger Van 49CFR 391.41-49
49 CFR 240.12
F. Down Range/Shipboard Duty 46 CFR Subpart 10 and 12
G. Firefighter NFPA 1582
H. Food Handler 46 CFR 12.25-20
NPR 1800.1B Chapter 4.10
I. Locomotive Engineer 49 CFR 240.121
J. Motive (Heavy) Equipment Operator
K. Occupational Respirator Use 29 CFR 1910.134
29 CFR 1910.134 Appendix A
L. Ordnance Handler
M. Primary Animal Contact
N. Primary Crew Contract JSC 22538
O. Security
P. Self Contained Atmospheric Protective Ensemble 29 CFR 1910.134
Q. Soldering
R. Voluntary Respirator Use 29 CFR 1910.134
29 CFR 1910.134 Appendix A

4. Flight Activities

Exam Regulation
A. First Class Airman's Medical Certificate 14 CFR 67
NPR 7900.3
B. Second Class Airman's Medical Certificate 14 CFR 67
NPR 7900.3
C. Third Class Airman's Medical Certificate 14 CFR 67
D. Air Traffic Control Specialist or Flight Crew OPM GS-2152
E. Qualified Non-Crew Member

5. Special Administrative Examinations

Exam Regulation
A. Fitness for Duty NPR 1800.1B
B. Return to Work NPD 1840.1B
NPR 1800.1B
C. International Travel NPR 1810.1A

6. Voluntary Health Maintenance

Exam Regulation
A. Complete Health Maintenance Examination FEBHP
NPR 1800.1B
B. Annual Health Maintenance Examination FEBHP
NPR 1800.1B
C. Fitness Center Clearance NPR 1800.1B

EXAMINATION PROTOCOLS

1. Surveillance Examinations for Workers with Specific Potentially Hazardous Exposures

A. Arsenic

Reference

OSHA 29 CFR Part 1910.1018

Frequency

  1. Baseline Examination
  2. Annual Exam, if less than 45 years old
  3. Semiannually, if 45 years old or older, or with 10 or more years of exposure
  4. Variable or Exposure-Determined Examination
  5. Exit/Reassignment Examination

Laboratory

  1. Chest X-ray (PA)
  2. Discretionary Tests
    1. Pulmonary Function
    2. Complete Blood Count

Physical Exam

  1. Medical and Occupational History
  2. Physical Examination with focus on peripheral and CNS, GI system, skin including nasal mucosa, respiratory tract, and thyroid
  3. Evaluation of ability to wear respirator may be required, see protocol Section 3 K, Certification Examination. Occupational Respirator Use 

Target Organs

Liver, kidneys, skin, lungs, lymphatic system, CNS, PNS

Written Opinion

Standard Written Medical Opinion

Medical Removal

No requirement in standard


B. Asbestos

Reference

OSHA 29 CFR Part 1910.1001
OSHA 29 CFR Part 1926.1101

Frequency

  1. Baseline Examination
  2. Annual Examination
  3. Variable or Exposure-Determined Examination
  4. Exit/Reassignment Examination

Laboratory (TX)

  1. Chest X-ray (PA) (Must be read by "B reader"):
    1. Baseline
    2. Periodic:
      1. 1-10 years since first exposure:
        1. every 5 years
      2. 10+ years since first exposure, and:
        1. below age 35, every 5 years
        2. age 35-45, every 2 years
        3. age 45+, annually
  2. Pulmonary Function
  3. Discretionary Tests
    1. Hemocult
    2. PPD
    3. Urinalysis (dipstick)

 

Physical Exam

  1. Required Asbestos Questionnaire (Standardized on initial exam, Abbreviated Standardized on annual exam)
  2. Physical Examination with focus on respiratory, CV, and GI systems
  3. Evaluation of ability to wear respirator may be required, see protocol Section 3 K, Certification Examination. Occupational Respirator Use  

Target Organs

Respiratory/lungs, pleural (Mesothelioma), gastrointestinal

Written Opinion

Standard Written Medical Opinion for Asbestos within 30 days, including statement that employee was informed of the increased risk of lung cancer attributable to combined effect of smoking and asbestos.

Medical Removal

No requirement in standard


C. Benzene

Reference

OSHA 29 CFR Part 1910.1028

Frequency

  1. Baseline Examination
  2. Annual Examination
  3. Variable or Exposure-Determined Examination

Laboratory

  1. Complete Blood Count (CBC) including a leukocyte count with differential, a quantitative thrombocyte count, hematocrit, hemoglobin, erythrocyte count, and erythrocyte indices (MCV, MCH, MCHC). (Repeat within 2 weeks if abnormal, refer to standard for action level)
  2. Pulmonary Function (if employee wears respirator, initial exam and then every 3 years)
  3. For Emergency Exposures Only:
    1. Urine sample provided at the end of employee's shift for urinary phenol test within 72 hours and urine specific gravity corrected to 1.024.
    2. If urinary phenol test is equal to or greater than 75 mg phenol/L of urine, repeat Complete Blood Count monthly for 3 months.
  4. Discretionary Tests:
    1. Refer to Appendix C of standard for guidance

Physical Exam

  1. Detailed Medical and Occupational History initially, brief update annually
  2. Complete Physical Examination with focus on the blood, skin, CNS, and liver and kidney function
  3. Evaluation of ability to wear respirator may be required, see protocol Section 3 K, Certification Examination. Occupational Respirator Use  

Target Organs

Eyes, respiratory, CNS, skin, blood/bone marrow

Written Opinion

Standard Written Medical Opinion within 15 days

Medical Removal

Required when referred to hematologist/internist


D. Beryllium

Reference

10 CFR Part 850 (DOE rule)

Frequency

  1. Baseline Examination
  2. Annual Examination for beryllium workers
  3. Every 3 years for beryllium associated workers
  4. Variable or Exposure-Determined Examination

Laboratory

  1. Chest X-ray (PA) (Must be read by "B reader"):
    1. Baseline
    2. Every 5 years
  2. Pulmonary Function
  3. Be-LPT (for significant exposure)

Physical Exam

  1. Medical and Occupational History
  2. Physical Examination with focus on skin, eyes, and respiratory tract
  3. Evaluation of ability to wear respirator may be required, see protocol Section 3 K, Certification Examination. Occupational Respirator Use  

Target Organs

Respiratory, kidney, CNS, liver, skin, eyes

Written Opinion

Standard Written Medical Opinion within 14 days of receipt of results

Medical Removal

Required based upon medical recommendation

Multiple Physician Review Process

Required if requested by examinee (see CFR)


E. Cadmium

Reference

OSHA 29 CFR Part 1910.1027
OSHA 29 CFR Part 1926.1127

Frequency

  1. Baseline Examination
  2. Annual Examination 1 year following Baseline Examination
  3. Biennially Examination (see standard for guidance on frequency with abnormal laboratory findings)
  4. Variable or Exposure-Determined Examination
  5. Exit/Reassignment Examination

Laboratory

Annual Laboratory:

  1. Cadmium in urine (CdU) (See Appendix F for protocol for sample handling and laboratory selection)
  2. Beta-2 microglobulin in urine (B(2)-M)
  3. Cadmium in blood (CdB)
  4. BUN and Serum Creatinine
  5. Complete Blood Count (CBC)
  6. Chest X-ray (PA)
    1. Baseline
    2. Exit/Reassignment
  7. Pulmonary Function
  8. Discretionary Tests:
    1. Annual Chest X-ray
    2. PSA (for males 50 years and older)
    3. Urinalysis

Physical Exam

  1. Cadmium Exposure Questionnaire required (Appendix D in CFR)
  2. Complete Physical Examination with focus on blood pressure, respiratory, and urinary systems (refer to health effects Appendix A)
  3. Prostate palpation, males 40 years and older
  4. Evaluation of ability to wear respirator may be required, see protocol Section 3 K, Certification Examination. Occupational Respirator Use 

Written Opinion

Standard Written Medical Opinion for Cadmium

Medical Removal

Required

Multiple Physician Review Process

Required if requested by examinee (see CFR)


F. Chromium

Reference

OSHA 29 CFR 1910.1026, 29 CFR Part 1926.1126

Frequency

  1. Baseline Examination
  2. Annual Examination
  3. Variable or Exposure-Determined Examination
  4. Exit/Reassignment Examination

Laboratory

Discretionary

Physical Exam

  1. Medical and Occupational History
  2. Physical Exam with focus on skin and respiratory tract

Target Organs

Respiratory, liver, kidney, eye, skin

Written Opinion

Standard Written Medical Opinion within 30 days

Medical Removal

No requirement in standard


G. Ethylene Oxide

Reference

OSHA 29 CFR Part 1910.1047

Frequency

  1. Baseline Examination
  2. Annual Examination
  3. Variable or Exposure-Determined Examination
  4. Exit/Reassignment Examination

Laboratory

  1. Complete Blood Count (CBC) with differential
  2. Discretionary Tests:
  3. Pregnancy test
  4. Laboratory evaluation of fertility if requested by examinee and considered appropriate by provider
  5. Blood Chemistry Panel
  6.  Urinalysis

Physical Exam

  1. Medical and Occupational History
  2. Physical Examination with focus on pulmonary, hematologic, neurologic, and reproductive system, and eyes and skin.
  3. Evaluation of ability to wear respirator may be required, see protocol Section 3 K, Certification Examination. Occupational Respirator Use 

Target Organs

Respiratory, blood, CNS, reproductive, eye, skin, liver, kidney

Written Opinion

Standard Written Medical Opinion within 15 days

Medical Removal

No requirement in standard


H. Formaldehyde

Reference

OSHA 29 CFR Part 1910.1048

Frequency

  1. Baseline Examination
  2. Annual Examination (for employees required to wear respirator, others discretionary)
  3. Variable or Exposure-Determined Examination
  4. Exit/Reassignment Examination

Laboratory

  1. Pulmonary Function (for required respirator use)
    1. Baseline
    2. Annual

Physical Exam

  1. Medical and Occupational History (nonmandatory medical disease questionnaire - Appendix D in CFR is recommended)
  2. Physical Examination with focus on eyes, skin, mucous membranes, and allergies and allergic reactions
  3. Evaluation of ability to wear respirator may be required, see protocol Section 3 K, Certification Examination. Occupational Respirator Use  

Target Organs

Respiratory, eyes, skin

Written Opinion

Standard Written Medical Opinion for Formaldehyde within 15 days of results

Medical Removal

Required

Multiple Physician Review Process

Required if requested by examinee (see CFR)


I. Hydrazines

Reference

 

Frequency

  1. Baseline Examination
  2. Annual Examination

Laboratory

  1. Baseline Chest X-ray
  2. Complete Blood Count
  3. Liver Profile
  4. Urinalysis with microscopic
  5. Discretionary:
    1. Pulmonary Function

Physical Exam

  1. Medical and Occupational History
  2. Physical Examination
  3. Evaluation of ability to wear respirator may be required, see protocol Section 3 K, Certification Examination. Occupational Respirator Use 

Target Organs

Eyes, respiratory, skin, CNS, liver, kidneys

Written Opinion

No requirement in standard

Medical Removal

No requirement in standard


J. Isocyanates
(e.g., Methylene Diisocyanate (MDI), Toluene Diisocyanate (TDI).)

Reference

NIOSH 78-215

Frequency

  1. Baseline Examination
  2. Variable or Exposure Determined Examination
  3. Annual Examination

Laboratory

  1. Pulmonary Function
  2. Chest X-ray (PA) at 5-year intervals

Physical Exam

  1. Medical and Occupational History
  2. Physical Examination with focus on respiratory system, skin, and mucous membranes (Isocyanates are potent sensitizers. Acute exposures may cause severe airway obstruction.)
  3. Evaluation of ability to wear respirator may be required, see protocol Section 3 K, Certification Examination. Occupational Respirator Use 

Target Organs

Eyes, respiratory, kidney, liver, skin, CNS

Written Opinion

No requirement in standard

Medical Removal

No requirement in standard


K. Lead

Reference

OSHA 29 CFR 1910.1025
OSHA 29 CFR 1926.62

Frequency

  1. Baseline Examination
  2. Annual Examination for employee's with blood lead over 40ug/100g in the preceding 12 months
  3. Variable or Exposure-Determined Examination
  4. Exit/Reassignment Examination

Laboratory

  1. Blood Lead and ZPP (Baseline and every 6 months)
  2. If Blood Lead is at or above 40ug/100g, repeat every 2 months
  3. Repeat blood lead 2 weeks after any test is at or above 60ug/100g (requires medical removal)
  4. During Medical Removal, Blood Lead and ZPP monthly
  5. Hemoglobin and Hematocrit, red cell indices, and examination of peripheral smear morphology
  6. BUN and Serum Creatinine
  7. Urinalysis with microscopic
  8. Discretionary Tests:
    1. Pregnancy/fertility testing, if employee requests

Physical Exam

  1. Medical and Occupational History
  2. Complete Physical Examination with focus on teeth, gums, hematological, GI, CV, renal, and neurological system.
  3. Blood Pressure
  4. Evaluation of ability to wear respirator may be required, see protocol Section 3 K, Certification Examination. Occupational Respirator Use 

Target Organs

Pulmonary, kidney, blood, reproductive, CNS, gastrointestinal, CV, gums, teeth, eyes

Written Opinion

Standard Written Medical Opinion for all evaluations and employee written notification of blood level results over 40ug/100g within 5 business days

Medical Removal

Required (see CFR for criteria)

Multiple Physician Review Process

Required if requested by examinee (see CFR)


L. Inorganic Mercury

Reference

OSHA CPL 02-02-06

Frequency

  1. Baseline Examination
  2. Annual Interim History
  3. Variable or Exposure-Determined Examination

Laboratory

  1. Complete Blood Count (CBC)
  2. Urinalysis
  3. Voluntary pregnancy test, where appropriate
  4. Urine mercury level (for history of exposure, recommend all employees in given work area be tested at the same time).  If exposed above PEL test every 3 months, if below PEL test every 6 months.

Physical Exam

  1. Medical and Occupational History (annual interim history)
  2. Physical Examination with focus on central nervous and respiratory systems, kidneys, and skin.
  3. Evaluation of ability to wear respirator may be required, see protocol Section 3 K, Certification Examination. Occupational Respirator Use 

Target Organs

Liver, kidney, CNS, PNS, lung, eye, mucous membranes

Written Opinion

Standard Written Medical Opinion

Medical Removal

No requirement in standard


M. Methylene Chloride

Reference

OSHA 29 CFR Part 1910.1052

Frequency

  1. Baseline Examination
  2. Annual Medical and Occupational History Update
  3. Examination Frequency Age Determined:
    1. Annual, if age 45 or older
    2. Every 36 months under age 45
  4. Variable or Exposure-Determined Examination
  5. Exit/Reassignment Examination

Laboratory

  • Discretionary:
    • Pulmonary Function
    • Hemoglobin and Hematocrit
    • ALT, SGPT
    • Post-shift Carboxyhemoglobin
    • ECG

Physical Exam

  • Methylene Chloride Questionnaire required (annual interim history)
  • Physical Examination focus on employee health status and analysis of questionnaire responses
  • Evaluation of ability to wear respirator may be required, see protocol Section 3 K, Certification Examination. Occupational Respirator Use  

Target Organs

Respiratory, CV, liver, CNS, skin, blood

Written Opinion

Standard Written Medical Opinion for Methylene Chloride with the following within 15 days of completion of medical and laboratory findings but not more than 30 days past examination including:

  • Statement that the physician has informed the employee Methylene Chloride (MC) is a potential carcinogen risk
  • The risk factors for heart disease, and the potential exacerbation of underlying heart disease from MC exposure and its metabolism to carbon monoxide

Medical Removal

Required

Multiple Physician Review Process

Required if requested by examinee (see CFR)


N. 4,4' Methylenebis (2-chloroaniline) (MOCA, MBOCA)

Reference

NIOSH Publication No. 78-188

Frequency

  1. Baseline Examination
  2. Annual Examination
  3. Laboratory only every 6 months (employees working directly in production or handling for 10 years or longer)

Laboratory

  1. Complete Blood Count (CBC)
  2. Blood Chemistry Profile
  3. Urinalysis with microscopic
  4. Chest X-ray

Physical Exam

  1. Medical and Occupational History
  2. Focused Physical Examination

Target Organs

Liver, blood, kidneys

Written Opinion

No requirement in standard

Medical Removal

No requirement in standard


O. 4,4' Methylenenedianiline (MDA)

Reference

OSHA 29 CFR 1910.1050

Frequency

  1. Baseline Examination
  2. Annual Examination

Laboratory

  1. Blood Chemistry Profile
  2. Urinalysis with microscopic

Physical Exam

  1. Medical and Occupational History
  2. Physical Examination with focus on skin disease and liver dysfunction
  3. Evaluation of ability to wear respirator may be required, see protocol Section 3 K, Certification Examination. Occupational Respirator Use 

Target Organs

Skin, eyes, liver, CV, spleen

Written Opinion

Standard Written Medical Opinion required

Medical Removal

Required

Multiple Physician Review Process

Required if requested by examinee (see CFR)


P. Nitrogen Tetroxide (Dioxide)

Reference

 

Frequency

Baseline Examination

Laboratory

Discretionary

Physical Exam

  • Medical and Occupational History
  • Physical Examination with focus on pulmonary system, skin, and eyes

Target Organs

Eyes, respiratory, CV

Written Opinion

No requirement in standard

Medical Removal

No requirement in standard


Q. Polychlorinated Biphenyls (PCB)

Reference

NIOSH Current Intelligence Bulletin 45, February 24, 1986

Frequency

  1. Baseline Examination
  2. Annual Examination
  3. Variable or Exposure-Determined Examination
  4. Exit/Reassignment Examination

Laboratory

  1. Blood Chemistry
  2. Complete Blood Count
  3. Urinalysis
  4. Chest x-ray (baseline)
  5. Discretionary Tests:
    1. ECG
    2. Pulmonary Function
    3. Fecal Occult

Physical Exam

  1. Medical and Occupational History
  2. Physical Examination with focus on the skin, liver, and nervous system.
  3. Evaluation of ability to wear respirator may be required, see protocol Section 3 K, Certification Examination. Occupational Respirator Use  

Target Organs

Skin, liver, CNS

Written Opinion

No requirement in standard

Medical Removal

No requirement in standard


R. Silica Dusts

Reference

NIOSH Publication No. 2002-129, OSHA 29 CFR 1910.1000

Frequency

  • Baseline Examination
  • Annual Examination
  • Variable or Exposure-Determined Examination

Laboratory

  • Chest X-ray (Must be read by "B reader"):
    • Baseline
    • Every 5 years for workers exposed less than 20 years
    • Every 2 years for workers exposed over 20 years
  • Pulmonary Function
  • PPD

Physical Exam

  • Medical and Occupational History
  • Physical Examination with focus on respiratory system
  • Evaluation of ability to wear respirator may be required, see protocol Section 3 K, Certification Examination. Occupational Respirator Use  

Target Organs

Lungs/respiratory, eyes

Written Opinion

Standard Written Medical Opinion including:

  • Signs and symptoms of silica exposure manifested by the employee
  • Report of chest x-ray and pulmonary function test
  • Opinion on whether employee has detected medical condition that may place employee at increased risk of impairment to the employees health from exposure to silica or other substances or would directly or indirectly aggravate any detected medical condition
  • Any recommended limitations upon employee's exposure to silica or other substances or upon use of Personal Protective Equipment (PPE) and respirators
  • Statement employee has been informed by the physician of any medical condition which requires further examination or treatment

Medical Removal

No requirement in standard


S. Trichloroethylene

Reference

 

Frequency

  1. Baseline Examination
  2. Annual Examination

Laboratory

Discretionary

Physical Exam

  1. Medical and Occupational History
  2. Physical Examination with focus on cardiac, pulmonary, liver, and kidneys
  3. Evaluation of ability to wear respirator may be required, see protocol Section 3 K, Certification Examination. Occupational Respirator Use  

Target Organs

Respiratory, CV, kidney, liver, skin, CNS, eyes

Written Opinion

No requirement in standard

Medical Removal

No requirement in standard


2. Hazardous Environments/Workplace Examinations

A. Bloodborne Pathogens

Reference

OSHA 20 CFR 1910.1030

Frequency

  1. Baseline Examination (for occupational groups covered under the standard)
  2. Variable or  Exposure-Determined Examination

Laboratory

  1. Hepatitis B Vaccine
  2. Hepatitis B Surface antibody (HepBSAb)Titer (required one time only after 3rd dose completed)
  3. Declination statement must be signed if Hepatitis B Vaccine declined by employee (Appendix A of OSHA Standard)
  4. Discretionary: Post-exposure
    1. Victim: HIV test, HepBSAb if not already documented, and HepCAb (other tests per provider)
    2. Source (after consent given): HIV test (rapid screen if available), HepB Surface Antigen (HepBSAg), and HepCAb (other tests per provider)
    3. If any HIV test is performed because of a specific occupational exposure, then a confidential ID system and a secure method to receive the test results shall be insured for both victim and source.

Physical Exam

  1. Medical and Occupational History
  2. Focused Physical Examination (discretionary)

Target Organs

Multiple organs

Written Opinion

Standard Written Medical Opinion required within 15 days of completion of evaluation including whether Hepatitis B immunization is indicated and if the employee has received such vaccine

Medical Removal

No requirement in standard


B. Chemical Laboratory

Reference

OSHA 29 CFR 1910.1450

Frequency

Variable or Exposure-Determined Examination

Laboratory

  1. Discretionary:
    1. Blood Chemistry Profile
    2. Complete Blood Count (CBC)
    3. Chest X-ray
    4. Pulmonary Function
    5. Urinalysis
    6. Visual Acuity

Physical Exam

  1. Medical and Occupational History
  2. Focused Physical Examination
  3. Evaluation of ability to wear respirator may be required, see protocol Section 3 K, Certification Examination. Occupational Respirator Use  

Target Organs

Multiple organs, especially eyes, skin, liver

Written Opinion

Standard Written Opinion required

Medical Removal

No requirement in standard


C. Hazardous Waste Operations and Emergency Response

Reference

OSHA 29 CFR 1910.120, Occupational Safety and Health Guidance Manual for Hazardous Waste Site Activities

Frequency

  1. Baseline Examination
  2. Annual Examination
  3. Variable or Exposure-Determined Examination
  4. Exit/Reassignment Examination

Laboratory

  1. Audiogram (Baseline)
  2. Visual Acuity, Color Discrimination, Visual Fields
  3. Complete Blood Count (CBC)
  4. Blood Chemistry
  5. Urinalysis
  6. Chest X-Ray (Baseline)
  7. Discretionary Tests:
    1. ECG
    2. Exercise Stress Test
    3. Pulmonary Function
    4. Other based on specific exposure (see Guidance Manual)
    5. Chest X-Ray (Followup)

Physical Exam

  1. Medical and Occupational History
  2. Physical Examination with focus on worker's fitness, including ability to wear any required PPE, back or musculoskeletal problems, heat stress, claustrophobia
  3. Evaluation of ability to wear respirator may be required, see protocol Section 3 K, Certification Examination. Occupational Respirator Use  
  4. Employee may also be covered by Bloodborne Pathogen standard

Target Organs

Multiple organs

Written Opinion

Standard Written Medical Opinion required including:

  1. Statement that the employee has sufficient strength, endurance, and emotional stability to perform the work
  2. Opinion that no medical condition was detected which would place the employee at increased risk of material impairment of the employee's health or would be a hazard to self or others from hazardous waste operations, emergency response, or respirator use
  3. Any limitations in job functions or ability to wear PPE
  4. The results of the medical examination and tests were also provided if requested by the employee

Medical Removal

No requirement in standard

Note regarding eligibility

Protocol covers the following employees:

  1. Potentially exposed to hazardous substances, without regard to the use of respirator, for more than 30 days per year
  2. Required to use a respirator more than 30 days per year
  3. Injured from exposure of hazardous substances during an emergency incident
  4. Members of a HazMat team

Employees Not Covered in Standard:

  1. Emergency responders not designated members of HazMat team (e.g., security, firefighters)

D. Healthcare Provider

Reference

OSHA 20 CFR 1910.1030

Frequency

  1. Baseline Examination
  2. Variable or Exposure-Determined Examination

Laboratory

  1. Hepatitis B Vaccine (required or declination letter shall be completed) or demonstrated immunity
  2. PPD required for baseline, periodic testing is discretionary based on risk assessment for the facility
  3. Discretionary:
    1. Hepatitis Profile
    2. Measles, Mumps, Rubella Vaccine
    3. Diphtheria, Tetanus, and Pertussis (Td, Tdap)
    4. Varicella Vaccine (if no history of chicken pox)
    5. Influenza Vaccine offered annually

Physical Exam

  1. Medical and Occupational History
  2. Focused Physical Examination (discretionary)
  3. Employee also covered by Bloodborne Pathogen Standard

Target Organs

Respiratory, blood, liver, skin


E. Ionizing Radiation

Reference

 

Frequency

Variable or Exposure-Determined Examination

Laboratory

Complete Blood Count (CBC) with Differential

Physical Exam

  1. Medical and Occupational History including exposure
  2. Focused Physical Examination

Target Organs

Exposure determined


F. Lasers

Reference

ANSI Z 136.1 (2007), Required for Class 3B and Class 4 Lasers

Frequency

  1. Baseline Examination (required)
  2. Variable or Exposure-Determined Examination (within 48 hours)

Laboratory

  1. Visual Acuity with refraction corrections to 20/20 (6/6) far and near vision (more extensive examination indicated if this is not met - see standard)
  2. Amsler Grid (or similar pattern to test macular function for vision distortions and scotomas)
  3. Color Vision Discrimination (Ishihara or similar color vision test)
  4. Ocular fundus Examination with Ophthalmoscope or appropriate Fundus Lens at a Slit Lamp if visual acuity, macular function, or color vision is abnormal.

Physical Exam

  1. Medical, Occupational, and Ocular History
  2. Focused Physical Examination performed by or under supervision of ophthalmologist, optometrist, or other qualified physician
  3. Limited skin examination

Target Organs

Eye, skin

Written Opinion

No requirement in standard

Medical Removal

No requirement in standard


G. Noise

Reference

OSHA 29 CFR 1910.95, NPR 1800.1B Chapter 4.9

Frequency

  1. Baseline Examination
  2. Annual Examination
  3. Exit/Reassignment Examination

Laboratory

  1. Baseline Audiogram or within 30 days
  2. Audiogram Annually
  3. Retest (audiogram) within 30 days if there is a STS

Physical Exam

  1. Medical and Occupational History
  2. Focused Physical Examination with focus on external and tympanic membrane

Target Organs

Ears and hearing system

Written Opinions

Required within 21 days of Standard Threshold Shift (STS) determination including statement that STS has occurred, whether further evaluation and testing indicated, and opinion on work relatedness or aggravation by occupational noise exposure, and limitation in use of protective hearing equipment

Medical Removal

No requirement in standard


H. Pesticide Applicator

Reference

 

Frequency

  1. Baseline Examination
  2. Annual Examination
  3. Variable or Exposure-Determined Examination
  4. Exit/Reassignment Examination

Laboratory

  1. Baseline (required before occupational exposure)
    Plasma and RBC cholinesterase baselines should be established by performing each test twice (3 to 7 days between tests) and averaging the result for the baseline for each.
  2. Blood Chemistry
  3. Urinalysis (dipstick)
  4. Discretionary Tests:
    1. Pulmonary Function
    2. RBC cholinesterase levels for recent exposure
    3. Plasma cholinesterase for acute exposure

Physical Exam

  1. Medical and Occupational History
  2. Physical Examination with focus on the skin and nervous system
  3. Evaluation of ability to wear respirator may be required, see protocol Section 3 K, Certification Examination. Occupational Respirator Use  

Target Organs

Kidney, liver, CNS, skin, lung

Medical Removal

If plasma or RBC cholinesterase activity is decreased by 30 percent or greater from baseline the employee should be removed from exposure until follow-up test levels are at least 80 percent of baseline.


I.  Spray Painting

Reference

 

Frequency

  1. Baseline Examination
  2. Variable or Exposure-Determined Examination

Laboratory

Discretionary Tests:

  1. Blood Chemistry Profile
  2. CBC
  3. Chest X-ray
  4. Urinalysis
  5. Pulmonary Function Test

Physical Exam

  1. Medical and Occupational History
  2. Physical Examination (discretionary)
  3. Evaluation of ability to wear respirator may be required, see protocol Section 3 K, Certification Examination. Occupational Respirator Use 
  4. Evaluation of other potential exposures, e.g. lead

J. Water and Sewage

Reference

 

Frequency

  1. Baseline Examination
  2. Annual Examination
  3. Variable or Exposure-Determined Examination

Laboratory

  1. Immunizations offered:
    1. Tetanus Diphtheria (Td) Vaccine
    2. Hepatitis A and B Vaccine
  2. Discretionary Tests:
    1. Blood Chemistry Profile
    2. Complete Blood Count (CBC)
    3. Chest X-ray

Physical Exam

  1. Medical and Occupational History
  2. Physical Examination (discretionary)

Target Organs

Liver, gastrointestinal, blood


K.  Welding

Reference

NIOSH Criteria Document No. 88-110

Frequency

  1. Baseline Examination
  2. Annual Examination
  3. Variable or Exposure-Determined Examination

Laboratory

  1. Pulmonary Function (Base only)
  2. Blood Chemistry Profile
  3. Complete Blood Count (CBC)
  4. Urinalysis
  5. Visual Acuity, Depth Perception, and Color Discrimination
  6. Chest X-ray (Baseline)
  7. Discretionary

      a. Skin Cancer Screening

Physical Exam

  1. Medical and Occupational History
  2. Physical Examination with focus on skin, respiratory, macular, cornea, fundus, and any condition that may interfere with ability to perform duties
  3. Evaluation of ability to wear respirator may be required, see protocol Section 3 K, Certification Examination Occupational Respirator Use 
  4. Evaluation of other potential exposures, e.g. metals, flux, compounds

Target Organs

Respiratory, eyes, varies with exposure type


3. Certification Examinations

A. Childcare Workers

Reference

 

Frequency

  1. Baseline Examination
  2. Variable or Exposure-Determined Examination

Laboratory

  1. PPD every 2 years
  2. Discretionary Vaccines offered:
    1. Influenza
    2. Measles, Mumps, and Rubella (MMR)
    3. Tetanus/Diphtheria (Td)
    4. Polio
    5. Hepatitis A
    6. Chickenpox
    7. Hepatitis B

Physical Exam

  1. Medical and Occupational/Immunization History
  2. Physical Exam with focus on ability to lift and bend repetitively

 

Written Opinion

Job Certification with any limitations.


B. Permit-Entry Confined Space/Tank Entry

Reference

29 CFR 1910.134

Frequency

  1. Variable or Exposure-Determined Examination

Laboratory

  1. Audiogram
  2. Visual Acuity, Depth Perception, and Color Vision (or demonstration of employee's ability to see and hear warnings, such as flashing lights, buzzers, and sirens)
  3. Discretionary Tests:

a.  ECG 
b.  Chest X-ray (Baseline)
c.  Urinalysis  (dipstick)
d.  Pulmonary Function

Physical Exam

  1. Medical and Occupational History
  2. Physical Examination with focus on employee's ability to carry out assigned duties and detection of any disease or abnormality that would make it difficult to work within confined spaces
  3. Evaluation of ability to wear respirator may be required, see protocol Section 3 K, Certification Examination. Occupational Respirator Use 
  4. Evaluation of other exposures may be required

Written Opinion

Job Certification with any limitations


C. Crane Operators/Riggers
Note: Includes ground floor, remote operation, high, cabin, ulpit

Reference

 

Frequency

  1. Baseline Examination
  2. Biennial

Laboratory

  1. Audiogram: No hearing loss in better ear greater than 40 dB at 500, 1,000, 2,000, 3,000, and 4,000 Hz with or without a hearing aid
  2. Visual Acuity: Minimum of 20/40 Snellen in each eye without correction or separately corrected to 20/40 Snellen in both eyes with or without corrective lenses
  3. Depth Perception
  4. Field of vision at least 70 degrees in the horizontal median in each eye
  5. Color Vision
  6. Discretionary Tests:
    1. ECG 
    2. Urinalysis
    3. Pulmonary function
    4. Hemoglobin (Hgb) and Hematocrit (Hct )
  7. Contact the Drug-Free Workplace (DFW) coordinator to arrange testing

Physical Exam

Complete examination:

  1. History to ascertain any condition that may cause any sudden incapacitation or inability to perform duties
  2. Evaluation for reaction time, manual dexterity, and coordination
  3. No tendencies to seizures, dizziness, laustrophobia, sudden incapacitation, loss of physical control, or similar undesirable conditions such as insulin controlled diabetes
  4. No evidence of physical defects, or emotional instability, that in the opinion of the examiner, would present a hazard to self or others

Written Opinion

Job Certification with any limitations or referral for further testing


D. Diver

Reference

 29 CFR 1910.401-441, Subpart T

Frequency

  1. Baseline Examination
  2. Annual Exam

Laboratory

  1. Audiogram
  2. Baseline and Annual ECG
  3. Baseline Chest X-ray (PA and lateral)
  4. Pulmonary Function (Vital Capacity)
  5. Urinalysis (dipstick)
  6. Blood Chemistry
  7. Complete Blood Count (CBC)
  8. PPD
  9. Visual Acuity and Color Discrimination
  10. Discretionary Tests:

a.  Exercise Stress Test

Physical Exam

  1. Medical and Occupational History to include predisposition to unconsciousness, vomiting, cardiac arrest, impairment of oxygen transport, serious blood loss, or anything that interferes with effective underwater work
  2. Physical Examination

Written Opinion

Job Certification with any limitations, or recommend further specialized clinical evaluation or testing


E. DOT/Commercial Driver License/
Motor Vehicle Certification/Multiple Passenger Van

Reference

 49 CFR 391.41-49

Frequency

  1. Baseline Examination
  2. Biennial Exam unless more frequent examination is required by the examining provider (per DOT regulations)

Laboratory

  1. Audiogram: Hearing thresholds in better ear < 40 dB at 500, 1,000, 2,000 Hz with or without hearing aid
  2. Visual Acuity: At least 20/40 (Snellen) in each eye without corrective lenses or visual acuity separately corrected to 20/40 or better with corrective lenses, distant binocular acuity of at least 20/40 in both eyes with or without corrective lenses
    
            
  3. Depth perception
  4. Gross field of vision: 70 degrees in each eye
  5. Traffic signal color perception
  6. Urinalysis (dipstick)
  7. Discretionary Tests:
    1. Chest X-ray
    2. Complete Blood Count (CBC)
    3. Blood Chemistry Profile
    4. ECG
    5. Exercise Stress Test
    6. Pulmonary Function

Physical Exam

  1. Medical and Occupational History
  2. Physical Examination with focus on any condition that may cause any sudden incapacitation or inability to perform duties, tendencies to seizures, dizziness, claustrophobia, loss of physical control, or similar undesirable conditions

(Cannot qualify if diabetic on insulin or if currently on medication for seizure disorder/epilepsy)

Written Opinion

Job Certification with any limitations, or referral for additional specialized clinical evaluation or testing


F.  Down Range/Shipboard Duty

Reference

46 CFR Subpart 10.205; 12.02-27; 12.25

Frequency

  1. Baseline Examination (temporary assignment to ships, submarines, or NASA Test Range shipboard)
  2. Annual Examination (for Masters, Chief Mates, Chief Engineers, 1st Assistant Engineer, Food Handlers, or anyone 60 years and up, or temporary assignments)
  3. Variable (if none of the above):
    1. Every 5 years for 17 to 24 years of age
    2. Every 3 years for 25-49 years of age
    3. Every 2 years for 50 to 59 years of age

Laboratory

  1. Audiogram
  2. Visual Acuity: 20/200 correctable to 20/40 (Snellen) for deck responsibility; correctable to 20/50 for engineering responsibility
  3. PPD
  4. Gross Visual Fields: If otherwise qualified, may have lost vision in one eye if remaining good eye's vision is passing
  5. Color Perception (Pseudoisochromatic Plates or Eldridge--Green Color Perception Lantern)
    
            
  6. Discretionary Tests:
    1. Chest X-ray
    2. ECG
    3. Travel Immunizations (offered)

Physical Exam

  1. Medical and Occupational History
  2. Physical Examination
  3. Shipboard food handlers must abide by the Food Handler protocol

Written Opinion

Job Certification with limitations


G. Fire Fighter

Reference

National Fire Protection Association (NFPA) 1582

Frequency

  1. Baseline Examination
  2. Annual Examination, if 40 or older
  3. Biennial Examination, if between ages 30-39
  4. Triennial Examination, if 29 or younger

Laboratory

  1. Audiogram: Requires less than 40 dB average hearing loss at 500, 1000, 2000, and 3000 Hz in the "Better ear."
  2. Full Blood Chemistry (including cholesterol, HDL, LDL, triglycerides, lipid ratios)
  3. CBC
  4. Chest X-Ray:
    1. Baseline
    2. Every 5 years
  5. ECG
  6. Pulmonary Function: Ratio of FEV1/FVC must be greater than 0.75 if both FEV1 and FVC are below normal
  7. Urinalysis (dipstick)
  8. Visual Acuity: Far (Snellen) at least 20/40 binocular corrected  and at least 20/100 binocular uncorrected for those routinely using corrective lenses.
  9. Color Perception
  10. Stress test (age determined): Graded Exercise Test (GXT) with diagnostic symptom limit (95% PAAMHR) "if clinically indicated by history or symptoms"  offered annually after 50 years of age
  11. Discretionary Tests:

a.  PPD screen
b.   Hepatitis C ab titer
c.   Immunizations offered:

  • Hepatitis B Vaccine
  • Tetanus/diphtheria (Td) Vaccine
  •  MMR Vaccine
  •  Polio Vaccine
  •  Varicella Vaccine
  •  Influenza Vaccine

d.  HIV screen
e.  Depth perception
f.  Gross visual fields

Physical Exam

  1. Medical and Occupational History
  2. Physical Examination with focus on any condition that may cause any sudden incapacitation or inability to perform duties, tendencies to seizures, dizziness, claustrophobia, loss of physical control, or similar undesirable conditions
  3. Evaluation of ability to wear respirator may be required, see protocol Section 3 K, Certification Examination. Occupational Respirator Use 

Written Opinion

Job Certification with:

  1. Statement that the employee has sufficient strength, endurance, and emotional stability to perform the work
  2. An opinion the employee would not be a hazard to self or others
  3. Any limitations in job functions or ability to wear PPE

H. Food Handler

Reference

21 CFR 10.115; 29 CFR 1910.141(h)

Frequency

  1. Baseline Examination
  2. Annual Examination

Laboratory

  1. PPD
  2. Hepatitis A (offered)
  3. Discretionary Tests:
    1. CBC
    2. Chest X-Ray

Physical Exam

  1. Medical and Occupational History focusing upon transmittable infectious diseases
  2. Focused Physical Examination
  3. Examiner should provide counseling regarding hygiene and prevention of cross contamination/fecal-oral diseases

Written Opinion

Job Certification with statement that employee is medically cleared as indicated in the Food Safety section of this document.

Note:

For Crew Food Handler, refer to Primary Crew Contact Physical


I. Locomotive Engineer

Reference

49 CFR 240.121 and Appendix F

Frequency

  1. Baseline Examination
  2. Triennial Examination

Laboratory

  1. Audiogram: Hearing loss in better ear < 40 dB at 500, 1,000, 2,000 Hz with or without hearing aid
  2. Visual Acuity: 20/40 with or without corrective lenses
  3. Visual Fields: at least 70 degrees in each eye
  4. Color: Recognize and distinguish between the colors of railroad signals

Physical Exam

  1. Medical and Occupational History
  2. Focused Physical Examination with focus on assessing any condition affecting vision and/or hearing that may cause any sudden incapacitation or inability to perform duties, tendencies to seizures, loss of physical control, or similar undesirable conditions

Written Opinion

Job Certification with any limitations


J. Motive (Heavy) Equipment Operator
Note: includes specialized maintenance and construction equipment
such as bulldozers, dump trucks, etc.

Reference

 

Frequency

1. Pre-placement/Baseline Examination
2. Biennial Exam

Laboratory

1. Audiogram: Hearing threshold in better ear < 40 dB (500, 1000, 2000 Hz)
2. ECG
3. Pulmonary Function
4.  Visual Acuity: 20/40 with or without corrective lenses
5.  Gross Visual Fields: 70 degrees in each eye
6.  Color:  Recognize and distinguish between the colors
7.  Urinalysis (dipstick)
8.  Discretionary Tests:

  1. Chest X-Ray
  2. Blood Chemistry Profile
  3. Complete Blood Count (CBC)
  4. Stress Test (age determined)  

Physical Exam

  1. Occupational and Medical History
  2. Physical Examination with focus on assessing any condition affecting vision and/or hearing that may cause any sudden incapacitation or inability to perform duties, tendencies to seizures, loss of physical control, or similar undesirable conditions

Written Opinion

Job Certification with any limitations


K. Occupational Respirator Use

Reference

OHSA 29 CFR 1910.134, and 29 CFR 1910.134 Appendices  A, B1, B2 , C

Frequency

  1. Baseline Examination
  2. Baseline and annual respirator questionnaire
  3. Variable or Exposure-Determined Examination

Laboratory

  1. Discretionary

Physical Exam

  1. OSHA Respirator Medical Evaluation Questionnaire (Mandatory: 1910.134 Appendix A) annually
  2. Focused Physical Examination with a focus on employee's ability to use a respirator for baseline
  3. Annual Focused Physical Examinations required only if positive responses to Questions 1-8, Section 2, Part A of Appendix C, or at the discretion of the physician
  4. Discretionary Tests:
    1. Chest X-ray
    2. Pulmonary Function (spirometry)

Written Opinion

Required Standard Written Medical Opinion including:

  1. Statement employee is medically able to use the respirator, or any limitations on respirator use related to a medical condition or related to workplace conditions in which respirator will be used
  2. The need for any medical followup
  3. A statement that employee has been given a copy of the written opinion
  4. If the respirator is a negative pressure respirator and the PLHCP finds a medical condition that may place the employee's health at increased risk if the respirator is used, the employer shall provide a PAPR if the medical evaluation finds that the employee can use such a respirator; if a subsequent medical evaluation finds that the employee is medically able to use a negative pressure respirator, then the employer is no longer required to provide a PAPR

L. Ordnance Handler

Reference

Frequency

  1. Baseline Examination
  2. Annual Examination

Laboratory

  1.  Audiogram
  2.  Visual Acuity
  3.  Depth Perception
  4.  Color Perception (as related to specific job requirements)
  5.  Urinalysis (dipstick)
  6. Discretionary Tests:
    1. ECG
    2. Complete Blood Count (CBC)
    3. Blood Chemistry Profile
    4. Chest X-ray
    5. Pulmonary Function

Physical Exam

  1. Medical and Occupational History to ascertain any condition that may cause any sudden incapacitation or inability to perform duties, tendencies to seizures, dizziness, claustrophobia, loss of physical control, or similar undesirable conditions
  2. Physical Examination focusing on strength, endurance, agility, coordination, adequate visual acuity and hearing, and emotional stability

Written Opinion

Job Certification with any limitations


M. Primary Animal Contact
Note: May have to be modified to cover the
animal species and specific agents being used.

Reference

 

Frequency

  1. Baseline Examination
  2. Annual Examination
  3. Variable or Exposure-Determined Examination

Laboratory

Baseline only:

  1. Complete Blood Count (CBC)
  2. Blood Chemistry Profile
  3. Pulmonary Function
  4. PPD
  5. Tetanus every 10 years
  6. Discretionary:
    1. Serum Sample (10 mL) for storage
    2. Rabies Titer
    3. Rubeola Titer
    4. Hepatitis A and B
    5. Offer Rabies Vaccine

Physical Exam

  1. Medical and Occupational History (annual interim history)
  2. Physical Examination with focus on immunization history, conditions with suppression of the immune system, allergies to animals, and prior illnesses from animal
  3. Evaluation of ability to wear respirator may be required, see protocol Section 3 K, Certification Examination. Occupational Respirator Use 

Written Opinion

Job Certification with any limitations


N. Primary Crew Contact

Reference

Flight Crew Health Stabilization Program JSC 22538

Frequency

  1. Mission specific: No earlier than L-21 every scheduled Space Shuttle launch
  2. Permanent Primary Contacts: Annual
  3. Food Depot: Every 6 months

Laboratory

Required for Food Depot only:

  1. CBC
  2. Urinalysis
  3. Blood Chemistry Panel and Cholesterol Panel
  4. TB screening (annual)
  5. Hepatitis A and Influenza Vaccine (offered)

Discretionary Tests for all others:

  1. WBC count with differential
  2. Urinalysis
  3. Other serological or bacteriological testing   
  4. TB screening

Physical Exam

Focused Physical Examination with focus on detection of infectious disease

Written Opinion

Certification status (JSC Form 270, KSC Form 13-116)


O.  Security

Reference

 

Frequency

  1. Baseline Examination
  2. Annual Examination

Laboratory

  1. Audiogram
  2. Visual Acuity, Color Vision, Visual Field
  3. ECG
  4. Urinalysis (dipstick)
  5. PPD
  6. Discretionary Tests:
    1. Pulmonary Function
    2.  Exercise Stress Test

Physical Exam

  1. Medical and Occupational History
  2. Physical Examination with focus on ability to perform the essential functions of the job and maintain emotional stability

Written Opinion

Required:

  1. Certification statement that the employee has emotional stability to perform the work
  2. In the opinion of the examiner that no medical condition was detected which would place the employee at increased risk of material impairment of the employee's health or would be a hazard to self or others
  3. Any limitations in job functions

P. Self Contained Atmospheric Protective Ensemble (SCAPE)

Reference

29 CFR 1910.134

Frequency

  1. Baseline Examination
  2. Annual Examination

Laboratory

  1. Blood Chemistry Profile
  2. Complete Blood count (CBC)
  3. Baseline Chest X-ray
  4. Pulmonary Function
  5. Audiogram: Hearing threshold less than 40 dB average hearing loss at 500, 1000, 2000, and 3000 Hz in the "Better Ear"
  6. Visual Acuity:
    1. Far (Snellen) at least 20/70 in one eye and 20/100 in the other eye corrected to 20/20 in one eye and 20/40 in the other eye 
    2. Near vision correctable to 20/40 (Snellen equivalent) bilaterally
  7. Color perception
  8. Depth perception
  9. Gross visual fields intact
  10. Discretionary Tests:
    1. Annual Chest X-ray
    2. Urinalysis with microscopic
    3. ECG

Physical Exam

  1. OSHA Respirator Medical Evaluation Questionnaire (Mandatory: 29 CFR 1910.134, Appendix A)
  2. Physical Examination with focus on employee's ability to use a respirator under the conditions of use (i.e., temperature extremes)
  3. Have sufficient strength, endurance, agility, coordination, and emotional stability to avoid interference with performance

Written Opinion

Required:

  1. Statement that the employee is medically able to use the Self Contained Atmospheric Protective Ensemble (SCAPE), or any limitations on SCAPE use related to a medical condition or related to workplace conditions in which the SCAPE will be used 
  2. Any need for medical followup
  3. Statement that employer/employee has been given a copy of the written opinion

Q.  Soldering

Reference

NASA STD 8739.3, Soldered Electrical Connections

Frequency

  1. Baseline Examination
  2. Annual
  3. Variable or Exposure-Determined

Laboratory

  1. Pulmonary Function (Baseline only)
  2. Visual Acuity, Depth Perception, and Color Discrimination

Physical Exam

  1. Medical and Occupational History
  2. Physical Examination with focus on skin and respiratory tract.
  3. Evaluation of ability to wear respirator may be required, see protocol Section 3 K, Certification Examination. Occupational Respirator Use 
  4. Evaluation of other potential exposures, e.g. lead

Target Organs

Respiratory, skin, varies with type of solder used


R.  Voluntary Respirator Use
Note:  For employees requesting elastomeric respirator

Reference

OHSA 29 CFR 1910.134 Appendix A ,B1, B2, C, D

Frequency

  1. Baseline Examination

Physical Exam

  1. Focused physical evaluation
  2. History to ascertain any condition that may cause any sudden incapacitation, inability to perform duties.
  3. Evaluation of ability to wear respirator under expected use conditions (i.e., temperature extremes).
  4. OSHA Respirator Medical Evaluation Questionnaire (Mandatory: 1910.134 Appendix A)

Written Opinion

Required:

  1. Any limitations in job functions or ability to wear PPE

4. Flight Activities

A. First Class Airman's Medical Certificate (Airline Transport Pilot)

Reference

14 CFR 67, NPR 7900.3 Aircraft Operations Management w/Interim Revision to Chapter 3, Appendix A, Aviation Medical Program Certification For NASA Pilots 

Frequency

  1. Baseline Examination (high performance aircraft requires a NASA medical evaluation in addition to the FAA certificate, see NPR 7900.3, Appendix A)
  2. Every 6 months

Laboratory

  1. Audiogram (see standard for other acceptable means of testing hearing) with results no worse than:

 

500 Hz

1000 Hz

2000 Hz

3000 Hz

Better ear (dB)

35

30

30

40

Poorer ear (dB)

35

50

50

60

  1. Visual Acuity:
    1. Distant: 20/20 in each eye with or without correction
    2. Near: 20/40, Snellen equivalent at 16 inches, or better in each eye with or without correction
    3. Near at age 50 or older: 20/40, Snellen equivalent at 16 and 32 inches, or better in each eye with or without correction
    4. Intermediate: 20/40 or better in each eye with or without correction at age 50 and over
  1. Visual Fields: Normal
  2. Color Perception
  3. ECG (transmitted to FAA): First examination after 35 years of age and annually after 40 years of age
  4. Discretionary Tests:
    1. Blood Chemistry Profile (can include fasting blood sugar and blood lipid profile).
    2. Complete Blood Count (CBC)
    3. Chest X-ray
    4. Pulmonary Function
    5. Urinalysis (dipstick)
    6. Exercise Stress Test

Physical Exam

  1. FAA Medical History Form 8500-8
  2. Physical Examination by FAA certified physician with focus on any condition that may cause any sudden incapacitation or inability to perform duties, tendencies to seizures, dizziness, claustrophobia, loss of physical control, or similar undesirable conditions
  3. Average BP should not exceed 155mm/95mm
  4. Check references above for acceptable standards, equipment, and requirements

Written Opinion

  1. Certification with any limitations, or referral to Aerospace Medical Certification Division, or Regional Flight Surgeon for possible further specialized clinical evaluation or testing.
  2. For waivers refer to NPR 7900.3 Appendix A
  3. Examinations conducted by non-NASA Aircrew Medical Examiners (AME) will require a records review by a NASA Occupational Health Clinic physician prior to recommendation to the Center Director.
  4. See 14 CFR 67 for Pilot Medical Standards

B. Second Class Airman's Medical Certificate (Commercial Pilot, Flight Engineer, Flight Navigator, and Air Traffic Control Tower Operator)

Reference

14 CFR 67 Appendix A

Frequency

  1. Baseline Examination
  2. Annual Examination

Laboratory

  1. Audiogram See FAA I
  2. Visual Testing and Requirements: See FAA I
  3. ECG (transmitted to FAA): First examination after 35 years of age, and annually after 40 years of age
  4. Discretionary Tests:
    1. Blood Chemistry Profile (can include fasting blood sugar and blood lipid profile)
    2. Complete Blood Count (CBC)
    3. Chest X-ray
    4. Pulmonary Function
    5. Urinalysis (dipstick)
    6. Exercise Stress Test

Physical Exam

  1. Medical and Occupational History
  2. Physical Examination by FAA certified physician with focus on any condition that may cause any sudden incapacitation or inability to perform duties, tendencies to seizures, dizziness, claustrophobia, loss of physical control, or similar undesirable conditions
  3. Average BP should not exceed 155mm/95mm
  4. Check references above for acceptable standards, equipment, and requirements.

Written Opinion

  1. Certification with any limitations, or referral to Aerospace Medical Certification Division, or Regional Flight Surgeon for possible further specialized clinical evaluation or testing.
  2. See 14 CFR 67 for Pilot Medical Standards

C. Third Class Airman's Medical Certificate (Private Pilot, Recreational Pilot, Student Pilot)

Reference

14 CFR 67 Appendix A

Frequency

  1. Baseline Examination
  2. Every 2 years, if 40 years of age or older
  3. Every 3 years, if under 40 years of age

Laboratory

  1. Audiogram: See FAA I
  2. Visual Acuity:
    1. Distant: 20/40 or better in each eye with or without correction
    2. Near: 20/40, Snellen equivalent, or better in each eye at 16 inches with or without corrective lens
    3. Intermediate: No requirement
  3. Visual Fields and Color: see FAA I
  4. Discretionary Tests:
    1. Blood Chemistry Profile (can include Fasting Blood Sugar and Blood Lipid Profile).
    2. CBC
    3. Chest X-Ray
    4. Pulmonary Function
    5. Urinalysis (dipstick)
    6. ECG
    7. Exercise Stress Test

Physical Exam

  1. Medical and Occupational History
  2. Physical Examination by FAA certified physician with focus on any condition that may cause any sudden incapacitation or inability to perform duties, tendencies to seizures, dizziness, claustrophobia, loss of physical control, or similar undesirable conditions
  3. Average BP should not exceed 155mm/95mm
  4. Check references above for acceptable standards, equipment, and requirements

Written Opinion

  1. Certification with any limitations, or referral to Aerospace Medical Certification Division or Regional Flight Surgeon for possible further specialized clinical evaluation or testing
  2. See 14 CFR 67 for Pilot Medical Standards

D. Air Traffic Control Specialist or Flight Crew (Not requiring FAA Certification)

Reference

Office of Personnel Management (OPM) GS-2152

Frequency

  1. Baseline Examination
  2. Annual Examination

Laboratory

  1. Audiogram or demonstrate ability to hear normal conversation in a quiet room, using both ears, at a distance of 6 feet with the examiner's back turned
  2. Visual Acuity:
    1. Distant 20/20 in at least one eye with or without correction
    2. Near vision 20/20, Snellen equivalent, with or without correction
  3. Visual Fields: Normal
  4. Color Vision
  5. Tonometry
  6. ECG
  7. Exercise Stress Test
  8. Chest X-ray
  9. Discretionary Tests:
    1. Blood Chemistry (can include fasting blood sugar and blood lipid profile).
    2. Complete Blood Count (CBC)
    3. Chest X-ray
    4. Pulmonary Functions
    5. Urinalysis (dipstick)

Physical Exam

  1. Medical and Occupational History
  2. Physical Examination (see OPM qualifications on age based blood pressure values) with focus on cardiovascular, neurological, musculoskeletal, general medical, psychiatric, and substance dependency

Written Opinion

Certification with any limitations


E. Qualified Non-Crew Member

Reference

 

Frequency

  1. Baseline Examination
  2. Biennial Examination

Laboratory

  1. Audiogram
  2. Visual Acuity
  3. Gross Visual Fields
  4. Discretionary Tests:
    1. Color Perception
    2. Blood Chemistry Profile as in C above
    3. Complete Blood Count (CBC)
    4. Chest X-Ray
    5. ECG
    6. Pulmonary Function
    7. Urinalysis (dipstick)
    8. Exercise Stress Test

Physical Exam

  1. Medical and Occupational History
  2. Physical Examination with focus on assessing any condition that may cause any sudden incapacitation or inability to perform duties, tendencies to seizures, dizziness, claustrophobia, loss of physical control, or similar undesirable conditions and emotional stability to avoid interference with performance, or in the opinion of the examiner could render a hazard to self or others

Written Opinion

Certification: Opinion that the employee has no physical limitation or medical condition which would prevent employee from performing their ordinary duties or be a hazard to self or others


5. Special Administrative Examinations

A. Fitness For Duty (FFD)

Defined

Fitness for Duty (FFD) examinations are performed at the request of management when a change in work performance, productivity, or health is observed or suspected.  NPR 1800.1B

Frequency

Variable upon an unexpected change in behavior or performance.  The examination should be completed as soon as possible after a written request through management has been made

Scope

The physician should evaluate whether there is a medical or psychological condition impacting work performance.  A job description with the physical requirements and essential job functions is an integral part of this evaluation.  Cooperation and coordination with the treating physician(s), as well as other services such as the Employee Assistance Program (EAP) can be of help to an affected employee 

Managers Responsibilities

The supervisor/manager requesting the FFD examination should notify the employee and have their consent, provide documentation to the physician and a copy of the employee's job description. 
Managers must also decide if there is a "For Cause" need for drug testing based upon performance.  Since this testing is not a medical test, the manager must contact the Drug Free Workplace (DFW) coordinator to arrange testing

Laboratory

Discretionary

Confidentiality

Confidentiality is of utmost importance and all recommendations and reports must be limited to work-related matters, e.g., work limitation, modifications, or accommodations.  No non-work related medical diagnosis should be released in the written opinion

Written Opinion

Required return to duty status for the employee's manager, including recommendations for work limitations or accommodations


B. Return to Work (RTW)

Defined

RTW evaluations are usually performed when employees are returning to work after an illness or injury of greater than 3 business days 

Frequency

Variable or Exposure-Determined Examination

Scope

  1. Vital signs
  2. The evaluation should focus on the employee's ability to perform the essential job functions with or without work limitations, modifications, or accommodations.  The information from the employee's physician is reviewed, and a decision is made whether a focused physical and/or tests are necessary   

Managers Responsibilities

The manager requesting the RTW examination must provide a copy of the employee's job description that includes the functional and physical requirements

Laboratory

Focused laboratory based upon the prior condition/problem of the employee 

Confidentiality

Confidentiality is of utmost importance and all recommendations and reports must be limited to work-related matters, e.g., work limitation, modifications, or accommodations 

Written Opinion

A RTW certificate for the employee's manager should indicate:

  1. A statement of work limitations (including modifications and duration)
  2. A statement of any Personal Protective Equipment (PPE) needed or limitations in use of PPE
  3. For an occupational related issue, safety, and health should receive a copy of the RTW statement

C. International Traveler

Reference

 

Frequency

  1. Variable or Exposure-Determined Examination
  2. Note: Medical clearance required for NASA civil service employees traveling outside the United States or its possessions, with special emphasis for those traveling to Russia or the former nations under the Soviet Union, TAL site, or any developing or medically under-served country 

Laboratory

Immunizations offered based on recommended WHO and CDC country requirements

Physical Evaluation

  1. Medical Record Review
  2. Medical and Occupational History
  3. Physical Examination (discretionary)
  4. Offer HRA
  5. Provide education based on health risk assessment with emphasis on food and water precautions and other specific issues related to travel destination

Written Opinion (Clearance)

International Travel Worksheet, NASA Form 1711

 

6. Voluntary Health Maintenance

A. Complete Health Maintenance Examination

Reference

 

Frequency

  1. Offer every 3 years to civil servants
  2. Offer at retirement to civil servants

Laboratory

  1. Vital signs (weight, blood pressure, pulse rate, rhythm)
  2. Offer total body skin examination
  3. Skin fold or BMI
  4. Baseline and when medically indicated:
    1. Visual Acuity
    2. Audiogram
    3. Pulmonary Function
    4. Exercise Stress Test
  5. ECG
  6. Mammograms every 1-2 years age 40 to 49, annually for age 50 to 70
  7. Colonoscopy every 10 years after age 50, earlier with family history (refer to private MD)
  8. Tonometry (if available)
  9. Menopause counseling for females age 45 and older
  10. Breast self-examination education
  11. Breast examination
  12. PAP smear annually (every 3 years if negative consecutively x 3)
  13. PSA test for men age 50 and older
  14. Digital Rectal and Testicular examination offered to men age 40 and older
  15. Complete Blood Chemistry (CBC)
  16. Blood Chemistry Profile
  17. Urinalysis
  18. Hemocult

Physical Exam

  1. Medical and Family History, if history of smoking?offer smoking cessation
  2. Complete Physical Examination
  3. Offer Health Risk Assessment (HRA)

 

Target Organs

Multiple Organs

Written Opinion

A summary of examination and laboratory results sent to the employee


B. Annual Health Maintenance Examination

Reference

 

Frequency

Offer annually to civil servants

Laboratory

  1. Vital signs (weight, blood pressure, pulse rate, rhythm)
  2. Mammograms every 1-2 years age 40 to 49, annually for age 50 to 70
  3. PAP smear annually (every 3 years if negative consecutively x 3)
  4. PSA men age 50 and older
  5. Digital Rectal and Testicular Examination offered to men age 40 and older
  6. Complete Blood Count (CBC)
  7. Blood Chemistry Profile
  8. Urinalysis
  9. Hemocult

Physical Exam

  1. Medical and Family History, if history of smoking?offer smoking cessation
  2. Focused Physical Examination
  3. Offer Health Risk Assessment (HRA)

Target Organs

Multiple Organs

Written Opinion

A summary of examination and laboratory results sent to the employee


C. Fitness Center Clearance

Reference

 

Frequency

Every 3 years

Laboratory

Discretionary

Physical Exam

  1. Review of Physical Activity Readiness Questionnaire (PARQ)
  2. Vital signs (blood pressure, pulse)
  3. Refer to NASA Occupational Medicine Clinic for clearance if PARQ responses are positive or vital signs are abnormal
  4. Physical examination and appropriate testing required if referred by Occupational Medicine Clinic or employees healthcare provider. Documentation must be received from personal healthcare provider and reviewed by Medical Director.  Medical Director responsible for final decision on fitness center clearance 

Written Opinion (Clearance)

Medical clearance may specify any limitations in clearance duration (i.e., 1-year) or Fitness Center activity



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