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NASA Ball NASA
Procedural
Requirements
NPR 1800.1D
Effective Date: September 11, 2019
Expiration Date: May 13, 2021
COMPLIANCE IS MANDATORY FOR NASA EMPLOYEES
Printable Format (PDF)

(NASA Only)

Subject: NASA Occupational Health Program Procedures

Responsible Office: Office of the Chief Health & Medical Officer


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

Appendix C. Physical Examination Matrix

Exam Regulation
A. Arsenic 29 CFR �§ 1910.1018
B. Asbestos 29 CFR �§ 1910.1001
29 CFR �§ 1926.1101
C. Benzene 29 CFR �§ 1910.1028
D. Beryllium 29 CFR �§ 1910.1024
E. Cadmium 29 CFR �§ 1910.1027
29 CFR �§ 1926.1127
F. Chromium 29 CFR �§ 1910.1026
29 CFR �§ 1926.1126
G. Ethylene Oxide 29 CFR �§ 1910.1047
H. Formaldehyde 29 CFR �§ 1910.1048
I. Hydrazines NIOSH Occupational Safety and
Health Guideline for Hydrazine, 1988
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 �§ 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 Pocket Guide to Chemical Hazards
Q. Polychlorinated Biphenyls (PCB) ATSDR
NIOSH Current Intelligence
Bulletin 45, February 24, 1986
NIOSH Pocket Guide to Chemical Hazards
R. Silica Dust 29 CFR �§ 1910.1053
S. Trichloroethylene NIOSH

A2. 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 OSHA 29 CFR �§�§ 1910.1096, 10 CFR �§ 20.1502
F. Lasers ANSI Z 136.1
G. Noise 29 CFR �§ 1910.95
NPR 1800.1D Chapter 4.8
H. Pesticides NIOSH
I. Spray Painting
J. Water and Sewage NIOSH
K. Welding NIOSH Criteria Document No. 88-110

A3. 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 NASA STD 8719.9
ASME B30.5-2011
49 CFR subpt. E
D. Diver 29 CFR �§ 1910.423
29 CFR �§ 1910.424
E. DOT/Commercial Driver License/Motor Vehicle Certification/Multiple Passenger Van 49 CFR subpt. E
F. Down Range/Shipboard Duty 46 CFR subpts. 10 and 12
G. Firefighter NFPA 1582
H. Food Handler 46 CFR �§ 12.25-20
NPR 1800.1 Chapter 4.10
I. Locomotive Engineer 49 CFR �§ 240.121
J. Motive (Heavy) Equipment Operator 49 CFR subpt. E
K. Occupational Respirator Use 29 CFR �§ 1910.134
29 CFR �§ 1910.134 Appendix A
L. Ordnance Handler NAVMED P-117, 15-107, AFI132-3001
M. Primary Animal Contact
N. Primary Crew Contact JSC 22538
O. Security
P. Self-Contained Atmospheric Protective Ensemble 29 CFR �§ 1910.134
Q. Soldering IPC J-STD-001ES
R. Voluntary Respirator Use 29 CFR �§ 1910.134
29 CFR �§ 1910.134 Appendix A

A4. Flight Activities

Exam Regulation
A. NASA Pilots, Flight Engineers, Other Primary Aircrew, Qualified Non-Crewmember, Unmanned Aircraft System (UAS) Pilots and Observers OCHMO 110902MED, NPR 7900.3, 14 CFR pt. 67
B. Air Traffic Control Specialist (Not Requiring FAA Certification) OPM GS-2152
C. Second Class Airman's Medical Certification (Air Traffic Control Tower Operator) 14 CFR pt. 67 Appendix A

A5. Special Administrative Examinations

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

A6. Voluntary Health Maintenance

Exam Regulation
A. Preventive Health Examination USPSTF
B. Fitness Center Clearance NPR 1800.1

EXAMINATION PROTOCOLS

A1. Surveillance Examinations for Workers with Specific Potentially Hazardous Exposures

A. Arsenic
Reference OSHA 29 CFR �§ 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), annual
2. Discretionary Tests
a. Pulmonary Function
b. 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
Employee Counseling Counseling on exam results and conditions of increased risk
Medical Removal No requirement in standard

B. Asbestos
Reference OSHA 29 CFR �§ 1910.1001
OSHA 29 CFR �§ 1926.1101
Frequency 1. Baseline Examination
2. Annual Examination
3. Variable or Exposure-Determined Examination
4. Exit/Reassignment Examination
Laboratory (TX) 1. 1. Chest X-ray (PA) (Must be read by "B reader", a board eligible/certified radiologist, or an experienced physician with known expertise in pneumoconiosis.):
a. Baseline
b. Periodic:
i. 1-10 years since first exposure:
1. every 5 years
ii. 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
a. Hemoccult
b. Annual TB Screening
c. 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.
Employee Counseling Exam results and conditions of increased risk including increased risk of lung cancer from combined effects of smoking and asbestos exposure
Medical Removal No requirement in standard

C. Benzene
Reference OSHA 29 CFR �§ 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:
a. 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.
b. 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:
a. 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
Employee Counseling Counseling on exam results and conditions of increased risk
Medical Removal Required when referred to hematologist/internist

D. Beryllium
Reference 29 CFR �§ 1910.1024
Frequency

1. Baseline Examination
2. Every 2 years
3. Termination if last exam was more than 6 months prior to termination

Laboratory

1. Be-LPT or equivalent
2. Pulmonary Function Test
3. Discretionary:
a) Low Dose Computed Tomography (LDCT)
b) Others deemed appropriate by provider

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, skin
Written Opinion Written opinion to employee within 45 days to include explanation of examination results and detection of medical conditions such as chronic beryllium disease (CBD), beryllium sensitization and medical conditions related to airborne exposures that require further evaluation.

Written opinion to the employer within 45 days that examination has met the requirement of the standards,recommendations on limitations for use of protective equipment, including respirators, and that results have been explained to the employee. If employee gives written authorization opinion may include recommendation for medical removal due to confirmed CBD or referral to CBD diagnostic center.

Employee Counseling

Counseling on exam results and conditions, risks related to beryllium exposure that requires further evaluation, treatment or lifestyle modification.

Medical Removal Required based upon medical recommendation
Multiple Physician Review Process

Referral to CBD if recommended by provider.

E. Cadmium
Reference OSHA 29 CFR �§ 1910.1027
OSHA 29 CFR �§ 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)
a. Baseline
b. Exit/Reassignment
7. Pulmonary Function
8. Discretionary Tests:
a. Annual Chest X-ray
b. PSA (for males 50 years and older)
c. 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
Employee Counseling Counseling on exam results and medical conditions related to cadmium exposure requiring further evaluation or treatment or removal.
Medical Removal Required
Multiple Physician Review Process Required if requested by examinee (see CFR)

F. Chromium
Reference OSHA 29 CFR �§1910.1026, 29 CFR �§ 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
Employee Counseling Counseling on exam results and conditions of increased risk
Medical Removal No requirement in standard

G. Ethylene Oxide
Reference OSHA 29 CFR �§ 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:
a. Pregnancy test, if requested by employee
b. Laboratory evaluation of fertility if requested by examinee and considered appropriate by provider
c. Blood Chemistry Panel
d. 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
Employee Counseling Counseling on exam results and conditions of increased risk
Medical Removal No requirement in standard

H. Formaldehyde
Reference OSHA 29 CFR �§ 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)
a. Baseline
b. 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
Employee Counseling Counseling on exam results and conditions of increased risk including whether medical conditions were caused by past or emergency exposures.
Medical Removal Required
Multiple Physician Review Process Required if requested by examinee (see CFR)

I. Hydrazines
Reference NIOSH Occupational Safety and Health Guideline for Hydrazine, 1988
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:
a. 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
Employee counseling Counseling on exam results and conditions of increased risk
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
Employee Counseling Counseling on exam results and conditions of increased risk and delayed effects such as coughing or difficulty breathing at night.
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:
a. 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
Employee Counseling Counseling on exam results and conditions of increased risk including advising of occupational and non-occupational conditions requiring further examination or treatment.
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
Employee Counseling Counseling on exam results and conditions of increased risk and any medical conditions which require further examination or treatment.
Medical Removal No requirement in standard

M. Methylene Chloride
Reference OSHA 29 CFR �§ 1910.1052
Frequency 1. Baseline Examination
2. Annual Medical and Occupational History Update
3. Examination Frequency Age Determined:
a. Annual, if age 45 or older
b. Every 36 months under age 45
4. Variable or Exposure-Determined Examination
5. Exit/Reassignment Examination
Laboratory 1. Discretionary:
a. Pulmonary Function
b. Hemoglobin and Hematocrit
c. ALT, SGPT
d. Post-shift Carboxyhemoglobin
e. ECG
Physical Exam 1. Methylene Chloride Questionnaire required (annual interim history-CFR Appendix B)
2. Physical Examination focus on employee health status and analysis of questionnaire responses
3. 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:
a. Statement that the physician has informed the employee Methylene Chloride (MC) is a potential carcinogen risk
b. The risk factors for heart disease, and the potential exacerbation of underlying heart disease from MC exposure and its metabolism to carbon monoxide
Employee Counseling Counseling on exam results and that MC is a potential occupational carcinogen, risk factors for heart disease and potential exacerbation of underlying heard disease by exposure to MC through metabolism of 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 (to include LFTs)
3. Urinalysis with microscopic
4. Chest X-ray (discretionary)
Physical Exam 1. Medical and Occupational History
2. Focused Physical Examination
Target Organs Liver, blood, kidneys
Written Opinion No requirement in standard
Employee Counseling Counseling on exam results and conditions of increased risk
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 (to include LFTs)
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
Employee Counseling Counseling on exam results and conditions of increased risk
Medical Removal Required
Multiple Physician Review Process Required if requested by examinee (see CFR)

P. Nitrogen Tetroxide (Dioxide)
Reference NIOSH Pocket Guide to Chemical Hazards-Nitrogen Dioxide
Frequency Baseline Examination
Laboratory 1. Discretionary
a. CBC with diff
b. PFT
c. EKG
d. CXR
Physical Exam 1. Medical and Occupational History
2. Physical Examination with focus on pulmonary system, skin, and eyes
Target Organs Eyes, respiratory, CV
Written Opinion No requirement in standard
Employee Counseling Counseling on exam results and conditions of increased risk
Medical Removal No requirement in standard

Q. Polychlorinated Biphenyls (PCB)
Reference NIOSH Current Intelligence Bulletin 45, February 24, 1986, NIOSH Pocket Guide to Chemical Hazards-Polychlorinated Biphenyls
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:
a. ECG
b. Pulmonary Function
c. 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, eyes, liver, reproductive system
Written Opinion No requirement in standard
Employee Counseling Counseling on exam results and conditions of increased risk
Medical Removal No requirement in standard

R. Silica Dusts
Reference 29 CFR �§ 1910.1053
Frequency

1. Baseline Examination
2. Every 3 years

Laboratory

1. Chest X-ray (Must be read by NIOSH-certified B Reader)
2. Pulmonary Function
3. TB Screening-baseline
4. Discretionary: Tests deemed appropriate by provider.

Physical Exam 1. Medical and Occupational History
2. Physical Examination with focus on respiratory system
3. Evaluation of ability to wear respirator may be required, see protocol Section 3 K, Certification Examination. Occupational Respirator Use
Target Organs Lungs/respiratory
Written Opinion

Written opinion to employee within 30 days including: the results of the examination, conditions that place employee at increased risk due to exposure to silica, conditions that require further evaluation, recommended limitations on respirator use, limitations on exposure to silica and recommendations for referral to a specialist.

Written opinion to employer including statement that examination met the requirements of the standard, recommended limitations of respirator use. If employee gives written authorization opinion may include recommended limitations to exposure to silica and recommended referral to a specialist.

Employee Counseling Counseling on exam results and conditions of increased risk and any medical conditions which require further examination or treatment.
Medical Removal No requirement in standard

S. Trichloroethylene
Reference NIOSH Pocket Guide to Chemical Hazards-Trichloroethylene
Frequency 1. Baseline Examination
2. Annual Examination
Laboratory Discretionary
a. LFTs
b. PFTs
c. Urinalysis
d. Blood Chemistry
e. Complete Blood Count
f. Visual acuity
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
Employee Counseling Counseling on exam results and conditions of increased risk
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
a. Victim: HIV test, HepBSAb if not already documented, and HepCAb (other tests per provider)
b. Source (after consent given): HIV test (rapid screen if available), HepB Surface Antigen (HepBSAg), and HepCAb (other tests per provider)
c. 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
Employee Counseling Counseling on exam results and conditions of increased risk.
Post exposure counseling regarding HBV vaccine and follow-up.
Medical Removal No requirement in standard

B. Chemical Laboratory
Reference OSHA 29 CFR �§ 1910.1450
Frequency Variable or Exposure-Determined Examination
Laboratory 1. Discretionary:
a. Blood Chemistry Profile
b. Complete Blood Count (CBC)
c. Chest X-ray
d. Pulmonary Function
e. Urinalysis
f. 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
Employee Counseling Counseling on exam results and conditions of increased risk
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:
a. ECG
b. Exercise Stress Test
c. Pulmonary Function
d. Other based on specific exposure (see Guidance Manual)
e. Chest X-Ray (Follow-up)
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:
a. Statement that the employee has sufficient strength, endurance, and emotional stability to perform the work
b. 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
c. Any limitations in job functions or ability to wear PPE
d. The results of the medical examination and tests were also provided if requested by the employee
Employee Counseling Counseling on exam results and conditions of increased risk.
Medical Removal No requirement in standard
NOTE regarding eligibility Protocol covers the following employees:
a. Potentially exposed to hazardous substances, without regard to the use of respirator, for more than 30 days per year
b. Required to use a respirator more than 30 days per year
c. Injured from exposure of hazardous substances during an emergency incident
d. Members of a HazMat team
Employees Not Covered in Standard:
a. 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. TB Screening required for baseline, periodic testing is discretionary based on risk assessment for the facility
3. Discretionary:
a. Hepatitis Profile
b. Measles, Mumps, Rubella Vaccine
c. Diphtheria, Tetanus, and Pertussis (Td, Tdap)
d. Varicella Vaccine (if no history of chicken pox)
e. 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
Written Opinion No requirement in standard
Employee Counseling Counseling on exam results and conditions of increased risk.
Medical Removal No requirement in standard

E. Ionizing Radiation
Reference OSHA 29 CFR �§ 1910.1096, 10 CFR �§ 20.1502
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
Written Opinion No requirement in standard
Employee Counseling Counseling on exam results and conditions of increased risk.
Medical Removal No requirement in standard

F. Lasers
Reference ANSI Z 136.1 (2014), Required for Class 3B and Class 4 Lasers

NOTE: Baseline examinations are not mandatory but encouraged to serve as a basis for comparison in the event of a mishap. Centers should establish a uniform policy applicable to all employees working with Class 3B and 4 lasers.
Frequency 1. Baseline Examination (per Center Policy)
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. Dilated exam required if abnormalities found.
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
Employee Counseling Counseling on exam results and conditions of increased risk.
Medical Removal No requirement in standard

G. Noise
Reference OSHA 29 CFR �§ 1910.95, NPR 1800.1 Chapter 4.8
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
Employee Counseling Counseling if STS or suspected ear pathology
Medical Removal No requirement in standard

H. Pesticide
Reference NIOSH Pocket Guide the Chemical Hazards
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:
a. Pulmonary Function
b. RBC cholinesterase levels for recent exposure
c. 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
Employee Counseling Counseling on exam results and conditions of increased risk.
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:
a. Blood Chemistry Profile
b. CBC
c. Chest X-ray
d. Urinalysis
e. 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
Target Organs Exposure determined
Employee Counseling Counseling on exam results and conditions of increased risk.
Medical Removal Exposure determined, e.g. lead

J. Water and Sewage
Reference NIOSH Publication 2002-149
Frequency 1. Baseline Examination
2. Annual Examination
3. Variable or Exposure-Determined Examination
Laboratory 1. Immunizations offered:
a. Tetanus Diphtheria (Td) Vaccine
b. Hepatitis A and B Vaccine
2. Discretionary Tests:
a. Blood Chemistry Profile
b. Complete Blood Count (CBC)
c. Chest X-ray
Physical Exam 1. Medical and Occupational History
2. Physical Examination (discretionary)
Target Organs Liver, gastrointestinal, blood
Written Opinion No requirement
Employee Counseling Counseling on exam results and conditions of increased risk.
Medical Removal No requirement

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)
Skin exam (burns, chronic damage)

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
Written Opinion No requirement in standard
Employee Counseling Counseling on exam results and conditions of increased risk, including smoking.
Medical Removal Exposure determined, e.g. lead

3. Certification Examinations

. .
A. Childcare Workers
Reference
Frequency 1. Baseline Examination
2. Variable or Exposure-Determined Examination
Laboratory 1. Annual TB Screening
2. Discretionary Vaccines offered:
a. Influenza
b. Measles, Mumps, and Rubella (MMR)
c. Tetanus/Diphtheria (Td)
d. Polio
e. Hepatitis A
f. Chickenpox
g. Hepatitis B
Physical Exam 1. Medical and Occupational/Immunization History
2. Physical Exam with focus on ability to lift and bend repetitively
Target Organs Musculoskeletal
Written Opinion Job Certification with any limitations
Employee Counseling Counseling on exam results and conditions of increased risk

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
Employee Counseling Counseling on exam results and conditions of increased risk.

C. Crane Operators/Riggers
NOTE: Includes ground floor, remote operation, high, cabin, pulpit
Reference National Commission for the Certification of Crane Operators NASA STD 8719.9
49 CFR subpt. E
Frequency 1. Baseline Examination
2. Every 3 years
Laboratory 1. Audiogram: Hearing threshold average in better ear < 40 dB (500, 1000, 2000 Hz)
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:
a. ECG
b. Urinalysis
c. Pulmonary function
d. Hemoglobin (Hgb) and Hematocrit (Hct )
e. HbA1C (discretionary)
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, claustrophobia, 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 additional specialized clinical evaluation or testing

If an employee has Insulin Treated Diabetes Mellitus (ITDM) a Federal Motor Carrier Safety Administration (FMCSA)-compliant waiver is required to obtain a 12-month certification.

Each Center with drivers requiring Department of Transportation (DOT) certification will have a Certified Medical Examiner.

The Center's Certified Medical Examiner, civil service or contractor (per the contractor's contract) will review

1. The FMCSA ITDM Assessment Form MCSA-5870 from the employee's treating physician, per 49 CFR pt. 46.

2. A letter from employee's supervisor stating.

a. The workplace is able to meet requirements to accommodate the employee such as mitigating hypoglycemic symptoms, monitoring glucose levels, and training the employee to recognize hypoglycemic episodes.

b. If the crane has a dead-man switch.

OCHMO will issue certifications for Centers without a Certified Medical Examiner. Occupational health clinic physicians at Centers without a Certified Medical Examiner will submit the information requested in paragraphs 1 and 2 above, along with a waiver recommendation to OCHMO within 30 days of receipt of the required FMCSA ITDM Assessment Form.

Employee Counseling Counseling on exam results and conditions of increased risk.

D. Diver
Reference 29 CFR �§�§ 1910.401-441, subpt. 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. TB Screening
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
Employee Counseling Counseling on exam results and conditions of increased risk.

E. DOT/Commercial Driver License/
Motor Vehicle Certification/Multiple Passenger Van
Reference 49 CFR subpt. E
Frequency 1. Baseline Examination
2. Biennial Exam unless more frequent examination is required by the examining provider (per DOT regulations)
Laboratory 1. Forced whisper voice in better ear at not less than 5 feet with or without hearing aid or Audiogram: Hearing threshold average loss in better ear not > 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:
a. Chest X-ray
b. Complete Blood Count (CBC)
c. Blood Chemistry Profile
d. ECG
e. Exercise Stress Test
f. 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

If an employee has Insulin Treated Diabetes Mellitus (ITDM) a FMCSA-compliant waiver is required to obtain a 12-month certification.

Each Center with drivers requiring Department of Transportation (DOT) certification will have a Certified Medical Examiner.

The Center's Certified Medical Examiner, civil service or contractor (per the contractor's contract) will review

1. The FMCSA ITDM Assessment Form MCSA-5870 from the employee's treating physician, per 49 CFR pt. 46.

2. A letter from employee's supervisor stating the workplace is able to meet requirements to accommodate the employee such as mitigating hypoglycemic symptoms, monitoring glucose levels, and training the employee to recognize hypoglycemic episodes.

OCHMO will issue certifications for Centers without a Certified Medical Examiner. Occupational health clinic physicians at Centers without a Certified Medical Examiner will submit the information requested in paragraphs 1 and 2 above, along with a waiver recommendation to OCHMO within 30 days of receipt of the required FMCSA ITDM Assessment Form.

Employee Counseling Counseling on exam results and conditions of increased risk.

F. Down Range/Shipboard Duty
Reference 46 CFR subpts. 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):
a. Every 5 years for 17 to 24 years of age
b. Every 3 years for 25-49 years of age
c. 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. TB Screening
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:
a. Chest X-ray
b. ECG
c. 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
Employee Counseling Counseling on exam results and conditions of increased risk.

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: Average hearing loss in the unaided better ear less than 40 dB at 500, 1000, 2000, and 3000 Hz.
2. Comprehensive Metabolic Panel (including cholesterol, HDL, LDL, triglycerides, lipid ratios, LFTs)
3. CBC
4. Chest X-Ray:
a. Baseline
b. Every 5 years
5. ECG
6. Pulmonary Function: Ratio of FEV1/FVC must be greater than 0.70 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 if clinically indicated by history or symptoms
11. Mammography: annually age 40 and older
12. Discretionary Tests:
a. TB Screen
b. Hepatitis C screen
c. Immunizations offered:
(i) Hepatitis B Vaccine
(ii) Tetanus/diphtheria (Td) Vaccine
(iii) MMR Vaccine
(iv) Polio Vaccine
(v) Varicella Vaccine
(vi) 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:
a. Statement that the employee has sufficient strength, endurance, and emotional stability to perform the work
b. An opinion the employee would not be a hazard to self or others
c. Any limitations in job functions or ability to wear PPE
Employee Counseling Counseling on exam results and conditions of increased risk.

H. Food Handler
Reference 21 CFR �§ 10.115; 29 CFR �§ 1910.141(h)
Frequency 1. Baseline Examination
2. Annual Examination
Laboratory 1. TB Screening, baseline, then discretionary
2. Hepatitis A (Center may offer)
3. Discretionary Tests:
a. CBC
b. 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.
Employee Counseling Counseling on exam results and conditions of increased risk.
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
Employee Counseling Counseling on exam results and conditions of increased risk.

J. Motive (Heavy) Equipment Operator
NOTE: includes specialized maintenance and construction equipment
such as bulldozers, dump trucks, etc.
Reference 49 CFR subpt. E
Frequency 1. Pre-placement/Baseline Examination
2. Biennial Exam
3. If Commercial Driver License required, refer to DOT/CDL
Laboratory 1. Audiogram: Hearing threshold average in better ear < 40 dB (500, 1000, 2000 Hz)
2. ECG-baseline, and clinically indicated

3. Visual Acuity: 20/40 with or without corrective lenses
4. Gross Visual Fields: 70 degrees in each eye
5. Color: Recognize and distinguish between the colors
6. Urinalysis (dipstick)
7. Discretionary Tests:
a. Chest X-Ray
b. Pulmonary Function
c. Blood Chemistry Profile
d. Complete Blood Count (CBC)
e. HbA1C (discretionary)
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 or referral for additional specialized clinical evaluation or testing

If an employee has Insulin Treated Diabetes Mellitus (ITDM) a FMCSA-compliant waiver is required to obtain a 12-month certification.

Each Center with drivers requiring Department of Transportation (DOT) certification will have a Certified Medical Examiner.

The Center's Certified Medical Examiner, civil service or contractor (per the contractor's contract) will review

1. The FMCSA ITDM Assessment Form MCSA-5870 from the employee's treating physician, per 49 CFR pt. 46.

2. A letter from employee's supervisor stating.

a. The workplace is able to meet requirements to accommodate the employee such as mitigating hypoglycemic symptoms, monitoring glucose levels, and training the employee to recognize hypoglycemic episodes.

b. If the heavy equipment has a dead-man switch.

OCHMO will issue certifications for Centers without a Certified Medical Examiner. Occupational health clinic physicians at Centers without a Certified Medical Examiner will submit the information requested in paragraphs 1 and 2 above, along with a waiver recommendation to OCHMO within 30 days of receipt of the required FMCSA ITDM Assessment Form.

Employee Counseling Counseling on exam results and conditions of increased risk.

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: 29 CFR �§ 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:
a. Chest X-ray
b. Pulmonary Function (spirometry)
Written Opinion Required Standard Written Medical Opinion including:
a. 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
b. The need for any medical follow-up
c. A statement that employee has been given a copy of the written opinion
d. 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
Employee Counseling Counseling on exam results, conditions of increased risk and copy of written opinion provided to employer.
Medical Removal No requirement in standard

1. Medical and Occupational History to ascertain any condition that may cause
L. Ordnance Handler
Reference
Frequency 1. Baseline Examination
2. Every 2 years
Laboratory 1. Audiogram
2. Visual Acuity
3. Depth Perception
4. Color Perception (as related to specific job requirements)
5. Urinalysis (dipstick)
6. Discretionary Tests:
a. ECG
b. Complete Blood Count (CBC)
c. Blood Chemistry Profile
d. Chest X-ray
e. Pulmonary Function
Physical Exam 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
Employee Counseling Counseling on exam results and conditions of increased risk.

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. TB Screening
5. Tetanus every 10 years
6. Discretionary:
a. Serum Sample (10 mL) for storage
b. Rabies Titer
c. Rubeola Titer
d. Hepatitis A and B
e. 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
Employee Counseling Counseling on exam results and conditions of increased risk.

N. Primary Crew Contact
Reference Flight Crew Health Stabilization Program JSC 22538
Frequency 1. Mission specific: No earlier than L-21 every scheduled manned launch
2. Permanent Primary Contacts: Annual
3. Food Depot: Every 6 months
Laboratory Required for Food Depot only:
(a) CBC
(b) Urinalysis
(c) Blood Chemistry Panel and Cholesterol Panel
(d) TB screening (annual)
(e) Hepatitis A and Influenza Vaccine (offered)
Discretionary Tests for all others:
(f) WBC count with differential
(g) Urinalysis
(h) Other serological or bacteriological testing
(i) 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)
Employee Counseling Counseling on exam results and conditions of increased risk.

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. TB Screening
6. Discretionary Tests:
a. Pulmonary Function
b. 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:
a. Certification statement that the employee has emotional stability to perform the work
b. 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
c. Any limitations in job functions
Employee Counseling Counseling on exam results and conditions of increased risk.

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 ≤ 40 dB average hearing loss at 500, 1000, 2000, and 3000 Hz in the "Better Ear"
6. Visual Acuity:
a. 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
b. Near vision correctable to 20/40 (Snellen equivalent) bilaterally
7. Color perception
8. Depth perception
9. Gross visual fields intact
10. Discretionary Tests:
a. Annual Chest X-ray
b Urinalysis with microscopic
c. 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:
a. 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
b. Any need for medical follow-up
c. Statement that employer/employee has been given a copy of the written opinion
Employee Counseling Counseling on exam results, conditions of increased risk and copy of written opinion provided to employer.
Medical Removal No requirement in standard

Q. Soldering
Reference IPC J-STD-001ES, Space Applications Electronic Hardware
Addendum to JPC J-STD-001E
Frequency 1. Baseline Examination
2. Biennial
3. Variable or Exposure-Determined
Laboratory 1. Pulmonary Function (Baseline only)
2. Visual Acuity, 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
Written Opinion
Employee Counseling Counseling on exam results and conditions of increased risk.

R. Voluntary Respirator Use
Reference OSHA 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: 29 CFR �§ 1910.134 Appendix A)
Written Opinion Required:
a. Any limitations in job functions or ability to wear PPE
Employee Counseling Counseling on exam results and conditions of increased risk.

4. Flight Activities

A. Pilots, Flight Engineers, Other Primary Aircrew, Qualified Non-Crewmember, Unmanned Aircraft System (UAS) Pilots and Observers
NOTE: Refer to Section 2.2 of OCHMO 110902MED; NPR 7900.3 Aircraft Operation Management Manual; 14 CFR pt. 67 Medical Standards and Certification for certification examination requirements.

B. Air Traffic Control Specialist (Not requiring FAA Certification)
Reference Office of Personnel Management (OPM) GS-2152
Frequency 1. Baseline Examination
2. Annual Examination
Laboratory 1. Audiogram: No hearing loss in either ear of more than 25 decibels at 500, 1000, or 2000 Hz. No hearing loss in these ranges of more than 20 decibels in the better ear.
2. Visual Acuity:
a. Distant 20/20 in at least one eye with or without correction
b. Near vision 20/20, Snellen equivalent, with or without correction
3. Visual Fields: Normal
4. Color Vision
5. Tonometry
6. ECG
7.
8.
9. Discretionary Tests:
a. Blood Chemistry (can include fasting blood sugar and blood lipid profile).
b. Complete Blood Count (CBC)
c. Chest X-ray
d. Pulmonary Functions
e. Urinalysis (dipstick)
f. Exercise Stress Test
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

C. Second Class Airman's Medical Certificate (Air Traffic Control Tower Operator)
Reference 14 CFR pt. 67 Appendix A
Frequency 1. Baseline Examination
2. Annual Examination
Laboratory 1. Audiogram See FAA II
2. Visual Testing and Requirements: See FAA II
3. ECG (transmitted to FAA): First examination after 35
years of age, and annually after 40 years of age
4. Discretionary Tests:
a. Blood Chemistry Profile (can include fasting blood sugar and blood lipid profile)
b. Complete Blood Count (CBC)
c. Chest X-ray
d. Pulmonary Function
e. Urinalysis (dipstick)
f. 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 a. Certification with any limitations, or referral to Aerospace Medical Certification Division, or Regional Flight Surgeon for possible further specialized clinical evaluation or testing.
b. See 14 CFR pt. 67 for Pilot Medical Standards

5. Special Administrative Examinations

A. Fitness For Duty (FFD)
Regulation
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.
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)
Regulation
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:
a. A statement of work limitations (including modifications and duration)
b. A statement of any Personal Protective Equipment (PPE) needed or limitations in use of PPE
c. For an occupational related issue, safety, and health should receive a copy of the RTW statement

C. International Traveler
Reference CDC
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) As required by Center policy

6. Voluntary Health Maintenance

A. Preventive Health Examination
Reference U.S. Preventive Services Task Force
Frequency 1. Offer annually to NASA employees
2. Offer at retirement to NASA employees if not previously done
Laboratory 1. Vital signs
2. Total body skin examination: baseline and at providers discretion
3. BMI
4. Baseline and at providers discretion:
a. Visual Acuity
b. Audiogram
c. Pulmonary Function
d. ECG
5. Breast examination
6. PAP smear (at clinical discretion)
7. PSA test (at clinical discretion)
8. Digital Rectal examination offered to men age 40 and older
9. Complete Blood Count (CBC)
10. Blood Chemistry Profile (includes fasting blood glucose)
11. Lipid profile
12. Urinalysis
13. High Sensitivity Fecal Occult Blood
Physical Exam 1. Medical and Family History, if history of smoking -- offer smoking cessation
2. Physical Examination Complete baseline then focused as clinically indicated
Counseling/ Education 1. Tobacco cessation, if indicated
2. Healthful diet and physical activity
3. Risk factors based on age, history and examination
3. Breast or testicular self-examination
4. Mammograms every 1-2 years age 40 to 49, every 2 years for age 50 to 74
5. Colonoscopy every 10 years after age 50, earlier with family history (refer to private MD)
Target Organs Multiple Organs
Written Opinion A summary of examination and laboratory results provided to the employee along with individualized preventive health recommendations


B. Fitness Center Clearance
Reference
Frequency Per Center or component facility policy
Laboratory Discretionary
Physical Exam 1. Review of Physical Activity Readiness Questionnaire (PARQ), if applicable
2. Vital signs (blood pressure, pulse)
3. Physical examination and testing as clinically indicated. Refer to primary care provider as appropriate for additional testing/documentation. Medical Director must review documentation provided by primary care provider.
Written Opinion (Clearance) Medical clearance may specify any limitations in clearance duration (i.e., 1-year) or Fitness Center activity

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