Procedural
Requirements
Effective Date: March 16, 2023
Expiration Date: March 16, 2028
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NASA Procedural Requirements |
NPR 1800.1E Effective Date: March 16, 2023 Expiration Date: March 16, 2028 |
| | TOC | Preface | Chapter1 | Chapter2 | Chapter3 | Chapter4 | Chapter5 | Chapter6 | Chapter7 | AppendixA | AppendixB | AppendixC | AppendixD | ALL | |
Medical surveillance protocols will be used at all Centers (i.e., Centers, Component Facilities, Technical and Service Support Centers, other NASA installations, JPL and Headquarters). This appendix provides examination procedure basics for most routine and specialty examinations performed at Centers. These physical examination requirements are split into six categories, see Table C-1, Examination Categories. Each category addresses specific requirements for physical examinations based on employee responsibilities, workplace environment, exposures, and health maintenance. Hyperlinks are included throughout this appendix for ease of use.
Table C-1. Examination Categories
| Examination Category | Definition |
|---|---|
| C.1 Surveillance Examinations for Employees with Specific Potentially Hazardous Exposures | Periodic examination for any identified employee designed to detect and monitor potential health effects from a specific hazardous exposure in the workplace to enable early treatment or protective actions. |
| C.2 Surveillance Examinations for Employees who Work in Hazardous Environments and Workplaces Examinations | Periodic examination for any identified employee designed to detect and monitor potential health effects from hazardous exposures or specific occupational conditions to enable early treatment or protective actions. |
| C.3 Surveillance Examinations for Employees who Require a Certification | Periodic examination for any identified employee designed to determine medical qualification for a specified position or duty and the issue of a medical qualification certification. |
| C.4 Surveillance Examinations for Employees who Participate in Flight Activities | Periodic examination for any identified employee designed to determine medical qualification for specified flight duty to ensure safety of flight and mission and the issue of a medical qualification certification. |
| C.5 Surveillance Examinations for Employees who Require Special Administrative Examinations | Periodic examination for any identified employee designed to determine medical qualification for a specified position or duty. |
| C.6 Surveillance Examinations for Employees who Participate in Voluntary Health Maintenance | Periodic examination for any employee who voluntarily opts to participate in health maintenance or preventive health evaluation. |
Table C.1-1. Surveillance Examinations for Employees with Specific Potentially Hazardous Exposures
| Exam | Regulation | |
|---|---|---|
| C.1-2 | Arsenic | Inorganic arsenic, 29 CFR § 1910.1018, App. C |
| C.1-3 | Asbestos | Asbestos, 29 CFR § 1910.1001 Asbestos, 29 CFR § 1926.1101 |
| C.1-4 | Benzene | Benzene, 29 CFR § 1910.1028 |
| C.1-5 | Beryllium | Beryllium, 29 CFR § 1910.1024 |
| C.1-6 | Cadmium | Cadmium, 29 CFR § 1910.1027 Cadmium, 29 CFR § 1926.1127 |
| C.1-7 | Chromium | Chromium (VI), 29 CFR § 1910.1026 Chromium (VI), 29 CFR § 1926.1126 |
| C.1-8 | Ethylene Oxide | Ethylene oxide, 29 CFR § 1910.1047 |
| C.1-9 | Formaldehyde | Formaldehyde, 29 CFR § 1910.1048 |
| C.1-10 | Hydrazines | NIOSH Occupational Safety and Health Guideline for Hydrazine Potential Human Carcinogen, 1988 |
| C.1-11 | Isocyanates | DHHS (NIOSH) Publication Number 78-215, Criteria for a Recommended Standard: Occupational Exposure to Diisocyanates, 1978 |
| C.1-12 | Lead | Lead, 29 CFR § 1910.1025 Lead, 29 CFR § 1926.62 |
| C.1-13 | Mercury (Inorganic) | OSHA Instruction CPL 02-02-006, Inorganic Mercury and Its Compounds NIOSH Agency for Toxic Substances and Disease Registry (ATSDR) |
| C.1-14 | Methylene Chloride (MC) | Methylene chloride, 29 CFR § 1910.1052 ATSDR |
| C.1-15 | 4,4' Methylenebis (2-chloroaniline) (MOCA, MBOCA) | DHHS(NIOSH) Publication Number 78-188, Special Hazard Review with Control Recommendations for 4,4' Methylenebis (2-chloroaniline), 1978 ATSDR OSHA |
| C.1-16 | 4,4' Methylenedianiline (MDA) | Special provisions for air contaminants, 29 CFR § 1910.19 Methylenedianiline, 29 CFR § 1910.1050 Methylenedianiline, 29 CFR § 1926.60 |
| C.1-17 | Nitrogen Tetroxide (Dioxide) | NIOSH Pocket Guide to Chemical Hazards |
| C.1-18 | Polychlorinated Biphenyls (PCB) | ATSDR DHHS (NIOSH) Publication Number 86-111, Polychlorinated Biphenyls (PCB): Current Intelligence Bulletin 45, 1986 NIOSH Pocket Guide to Chemical Hazards |
| C.1-19 | Silica Dust | Respirable crystalline silica, 29 CFR § 1910.1053 |
| C.1-20 | Trichloroethylene | NIOSH Pocket Guide to Chemical Hazards |
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Table C.1-2. Arsenic
| Arsenic | |
|---|---|
| Reference | 29 CFR § 1910.1018, App C |
| Frequency | 1. Baseline evaluation 2. Annual evaluation, if less than 45 years old and less than 10 years exposure 3. Semiannually, if 45 years old or older or with 10 or more years of exposure 4. Variable or exposure-determined evaluation 5. Exit/reassignment evaluation |
| Laboratory | 1. Chest x-ray (Posteroanterior (PA)), annual 2. Discretionary tests a. Pulmonary function b; Complete Blood Count (CBC) |
| 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 Table C.3-11, Occupational Respirator Use |
| Target Organs | Liver, kidneys, skin, lungs, lymphatic system, Central Nervous System (CNS), Peripheral Nervous System (PNS) |
| Written Opinion | Standard written medical opinion |
| Employee Counseling | Counseling on exam results and conditions of increased risk |
| Medical Removal | No requirement in standard |
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Table C.1-3. Asbestos
| Asbestos | |
|---|---|
| Reference | 29 CFR § 1910.1001 29 CFR § 1926.1101 |
| Frequency | 1. Baseline evaluation 2. Annual evaluation 3. Variable or exposure-determined evaluation 4. Exit/reassignment evaluation |
| Laboratory | 1. Chest x-ray (PA) (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, 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, cardiovascular (CV), and gastrointestinal (GI) systems 3. Evaluation of ability to wear respirator may be required, see Table C.3-11, Occupational Respirator Use |
| Target Organs | Respiratory/lungs, pleural (mesothelioma), GI |
| 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 | Evaluation 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 |
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Table C.1-4. Benzene
| Benzene | |
|---|---|
| Reference | 29 CFR § 1910.1028 |
| Frequency | 1. Baseline evaluation 2. Annual evaluation 3. Variable or exposure-determined evaluation |
| Laboratory | 1. CBC including a leukocyte count with differential, a quantitative thrombocyte count, hematocrit (Hct), hemoglobin (Hgb), erythrocyte count, and erythrocyte indices (Mean Corpuscular Volume (MCV), Mean Corpuscular Hemoglobin (MCH), Mean Corpuscular Hemoglobin Concentration (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 CBC monthly for 3 months. 4. Discretionary tests a. Refer to 29 CFR § 1910.1028, Appendix C for guidance |
| Physical Exam | 1. Detailed medical and occupational history initially, brief update annually 2. Complete baseline physical examination 3. Annual physical examination with focus on blood, skin, CNS, liver and kidney function 4. Evaluation of ability to wear respirator may be required, see Table C.3-11, 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 |
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Table C.1-5. Beryllium
| Beryllium | |
|---|---|
| Reference | 29 CFR § 1910.1024 |
| Frequency | 1. Baseline evaluation 2. Every 2 years 3. Termination if last evaluation was more than 6 months prior to termination |
| Laboratory | 1. Be-LPT or equivalent 2. Pulmonary function test 3. Discretionary tests a. Low Dose Computed Tomography 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 Table C.3-11, Occupational Respirator Use |
| Target Organs | Respiratory, skin |
| Written Opinion | 1. Written opinion to employee within 45 days to include explanation of evaluation 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. 2. Written opinion to employer within 45 days that evaluation 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 evaluation 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 |
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Table C.1-6. Cadmium
| Cadmium | |||||||
|---|---|---|---|---|---|---|---|
| Reference | 29 CFR § 1910.1027 29 CFR § 1926.1127 |
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| Frequency | 1. Baseline evaluation 2. Annual evaluation 1 year following baseline evaluation 3. Biennially evaluation (see standard and tables below for guidance on frequency with abnormal laboratory findings) 4. Variable or exposure-determined evaluation 5. Exit/reassignment evaluation |
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| Laboratory | Annual Laboratory 1. Cadmium in urine (Cdurine) (See 29 CFR § 1910.1027, Appendix F for protocol for sample handling and laboratory selection) 2. Beta-2 microglobulin in urine (β2urine-M) 3. Cadmium in blood (Cdblood) 4. BUN and serum creatinine 5. CBC 6. Urinalysis 7. PSA and/or digital rectal exam at 40 yrs. 8. Chest x-ray (PA) a. Baseline b. Exit/reassignment 9. Pulmonary function 10. Discretionary tests a. Annual chest x-ray |
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| Physical Exam | 1. Cadmium exposure questionnaire required (29 CFR § 1910.1027, Appendix D) 2. Complete physical examination with focus on blood pressure, respiratory, and urinary systems (refer to health effects 29 CFR § 1910.1027, Appendix A) 3. Prostate palpation or other effective diagnostic test(s), males 40 years and older 4. Evaluation of ability to wear respirator may be required, see Table C.3-11, Occupational Respirator Use |
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| Biological Marker | Monitoring Result Category | ||||||
| A | B | C | D | ||||
| Cdurine | ≤3 | >3 and <7 | >7 | >7 | >3 | >3 | |
| and | and/or | or | and | and | |||
| β2urine | ≤300 | >300 and ≤750 | >750 | >750 | >750 | ||
| and | and/or | or | and | and | |||
| Cdblood | ≤5 | >5 and ≤10 | >10 | >5 | >5 | >10 | |
| Cd = cadmium Cdurine = urine Cd, units in μg/g of creatinine β2urine = urine beta-2 microglobulin, units μg/g of creatinine Cdblood = blood Cd, units in μg/liter of whole blood |
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| Required Actions | Monitoring Result Category | ||||||
| A | B | C | D | ||||
| Biological Monitoring | |||||||
| Annual | X | ||||||
| Semiannual | X | ||||||
| Quarterly | X | X | |||||
| Medical Exam | |||||||
| Biennial | X | ||||||
| Annual | X | ||||||
| Semiannual | X | X | |||||
| Within 90 Days | X | X | |||||
| Written Opinion | Standard written medical opinion for cadmium | ||||||
| Employee Counseling | Counseling on evaluation 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 29 CFR § 1910.1027) | ||||||
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Table C.1-7. Chromium
| Chromium | |
|---|---|
| Reference | 29 CFR § 1910.1026 29 CFR § 1926.1126 |
| Frequency | 1. Baseline evaluation 2. Annual evaluation 3. Variable or exposure-determined evaluation\ 4. Exit/reassignment evaluation |
| Laboratory | Discretionary |
| Physical Exam | 1. Medical and Occupational History 2. Physical Examination 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 evaluation results and conditions of increased risk |
| Medical Removal | No requirement in standard |
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Table C.1-8. Ethylene Oxide
| Ethylene Oxide | |
|---|---|
| Reference | 29 CFR § 1910.1047 |
| Frequency | 1. Baseline evaluation 2. Annual evaluation 3. Variable or exposure-determined evaluation 4. Exit/reassignment evaluation |
| Laboratory | 1. 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 (dipstick) |
| 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 Table C.3-11, 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 evaluation results and conditions of increased risk |
| Medical Removal | No requirement in standard |
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Table C.1-9. Formaldehyde
| Formaldehyde | |
|---|---|
| Reference | 29 CFR § 1910.1048 |
| Frequency | 1. Baseline evaluation 2. Annual evaluation (for employees required to wear respirator, others discretionary) 3. Variable or exposure-determined evaluation 4. Exit/reassignment evaluation |
| Laboratory | Pulmonary function (for required respirator use) 1. Baseline 2. Annual |
| Physical Exam | 1. Medical and occupational history (non-mandatory medical disease questionnaire - 29 CFR § 1910.1048, Appendix D 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 Table C.3-11, 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 evaluation 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 29 CFR § 1910.1048) |
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Table C.1-10. Hydrazines
| Hydrazines | |
|---|---|
| Reference | NIOSH Occupational Safety and Health Guideline for Hydrazine |
| Frequency | 1. Baseline evaluation
2. Annual evaluation |
| Laboratory | 1. Baseline chest x-ray 2. CBC 3. Liver profile 4. Urinalysis with microscopic a. Pulmonary Function/td> |
| Physical Exam | 1. Medical and occupational history 2. Physical examination 3. Evaluation of ability to wear respirator may be required, see Table C.3-11, Occupational Respirator Use |
| Target Organs | Eyes, respiratory, skin, CNS, liver, kidneys and hematopoietic |
| Written Opinion | No requirement in standard |
| Employee counseling | Counseling on evaluation results and conditions of increased risk |
| Medical Removal | No requirement in standard |
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Table C.1-11. Isocyanates
| Isocyanates (e.g., Methylene Diisocyanate (MDI), Toluene Diisocyanate (TDI)) |
|
|---|---|
| Reference | DHHS (NIOSH) Publication Number 78-215 |
| Frequency | 1. Baseline evaluation 2. Variable or exposure-determined evaluation 3. Annual evaluation |
| Laboratory | 1. Pulmonary function 2. Chest x-ray (PA) (baseline and 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 Table C.3-11, Occupational Respirator Use |
| Target Organs | Eyes, respiratory, kidney, liver, skin, CNS |
| Written Opinion | No requirement in standard |
| Employee Counseling | Counseling on evaluation results and conditions of increased risk and delayed effects such as coughing or difficulty breathing at night. |
| Medical Removal | No requirement in standard |
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Table C.1-12. Lead
| Lead | |
|---|---|
| Reference | 29 CFR § 1910.1025
29 CFR § 1926.62 |
| Frequency | 1. Baseline evaluation 2. Annual evaluation for employees with blood lead at or above 40ug/100g in the preceding 12 months 3. Variable or exposure-determined evaluation 4. Exit/reassignment evaluation |
| Laboratory | 1. Blood lead and ZPP (Baseline and every 6 months) 2. If blood lead is between 40ug/100g and 60ug/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 Table C.3-11, Occupational Respirator Use |
| Target Organs | Pulmonary, kidney, blood, reproductive, CNS, GI, 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 evaluation results and conditions of increased risk including advising of occupational and non-occupational conditions requiring further evaluation or treatment. |
| Medical Removal | Required (see 29 CFR § 1910.1025 for criteria) |
| Multiple Physician Review Process | Required if requested by examinee (see 29 CFR § 1910.1025 and 29 CFR § 1926.62) |
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Table C.1-13. Mercury (Inorganic)
| Mercury (Inorganic) | |
|---|---|
| Reference | OSHA Instruction CPL 02-02-006 NIOSH ATSDR |
| Frequency | 1. Baseline evaluation 2. Annual interim history 3. Variable or exposure-determined evaluation |
| Laboratory | 1. 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 Table C.3-11, Occupational Respirator Use |
| Target Organs | Liver, kidney, CNS, PNS, lung, eye, mucous membranes |
| Written Opinion | Standard written medical opinion |
| Employee Counseling | Counseling on evaluation results and conditions of increased risk and any medical conditions which require further evaluation or treatment |
| Medical Removal | No requirement in standard |
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Table C.1-14. Methylene Chloride
| Methylene Chloride (MC) | |
|---|---|
| Reference | 29 CFR § 1910.1052 ATSDR |
| Frequency | 1. Baseline evaluation 2. Annual medical and occupational History Update 3. Evaluation frequency age determined: a. Annual, if age 45 or older b. Every 36 months, under age 45 c. Variable or exposure-determined evaluation d. Exit/reassignment evaluation |
| Laboratory | Discretionary 1. Pulmonary function 2. Hemoglobin and hematocrit 3. Alanine Aminotransferase (ALT) or Serum Glutamic-Pyruvic Transaminase (SGPT) 4. Pre and Post-shift carboxyhemoglobin 5. Electrocardiogram (ECG) |
| Physical Exam | 1. MC questionnaire required (annual interim history-29 CFR § 1910.1052, 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 Table C.3-11, Occupational Respirator Use |
| Target Organs | Respiratory, CV, liver, CNS, skin, blood |
| Written Opinion | Standard written medical opinion for MC with the following within 15 days of completion of medical and laboratory findings but not more than 30 days past evaluation including 1. Statement that the physician has informed the employee MC is a potential carcinogen risk 2. 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 evaluation 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 29 CFR § 1910.1052) |
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Table C.1-15 4,4'. Methylenebis (2-chloroaniline)
| 4,4' Methylenebis (2-chloroaniline) (MOCA, MBOCA) | |
|---|---|
| Reference | DHHS (NIOSH) Publication Number 78-188 ATSDR OSHA |
| Frequency | 1. Baseline evaluation 2. Annual evaluation 3. Laboratory only every 6 months (employees working directly in production or handling for 10 years or longer) |
| Laboratory | 1. CBC |
| 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 evaluation results and conditions of increased risk |
| Medical Removal | No requirement in standard |
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Table C.1-16 4,4'. Methylenedianiline
| 4,4' Methylenedianiline (MDA) | |
|---|---|
| Reference | 29 CFR § 1910.19 29 CFR § 1910.1050 29 CFR § 1926.60 |
| Frequency | 1. Baseline evaluation 2. Annual evaluation |
| Laboratory | 1. Blood chemistry profile including Liver Function Tests (LFT) 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 Table C.3-11, Occupational Respirator Use |
| Target Organs | Skin, eyes, liver, CV, spleen |
| Written Opinion | Standard written medical opinion required |
| Employee Counseling | Counseling on evaluation results and conditions of increased risk |
| Medical Removal | Required |
| Multiple Physician Review Process | Required if requested by examinee (see 29 CFR § 1910.19, 29 CFR § 1910.1050, and 29 CFR § 1926.60) |
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Table C.1-17. Nitrogen Tetroxide (Dioxide)
| Nitrogen Tetroxide (Dioxide) | |
|---|---|
| Reference | NIOSH Pocket Guide to Chemical Hazards |
| Frequency | Baseline evaluation |
| Laboratory | Discretionary 1. CBC with differential 2. Pulmonary Function Test (PFT) 3. ECG 4. Chest x-ray |
| 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 evaluation results and conditions of increased risk |
| Medical Removal | No requirement in standard |
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Table C.1-18. Polychlorinated Biphenyls
| Polychlorinated Biphenyls (PCB) | |
|---|---|
| Reference | 0DHHS (NIOSH) Publication Number 86-111 NIOSH Pocket Guide to Chemical Hazards ATSDR |
| Frequency | 1. Baseline evaluation 2. Annual evaluation 3. Variable or exposure-determined evaluation 4. Exit/reassignment evaluation |
| Laboratory | 1. Blood chemistry panel 2. CBC 3. Urinalysis (dipstick) 4. Chest x-ray (baseline) 5. LFTs 6. 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 Table C.3-11, Occupational Respirator Use |
| Target Organs | Skin, eyes, liver, reproductive system |
| Written Opinion | No requirement in standard |
| Employee Counseling | Counseling on evaluation results and conditions of increased risk |
| Medical Removal | No requirement in standard |
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Table C.1-19. Silica Dusts
| Silica Dusts | |
|---|---|
| Reference | 29 CFR § 1910.1053 |
| Frequency | 1. Baseline evaluation 2. Every 3 years |
| Laboratory | 1. Chest x-ray (Read by NIOSH-certified B Reader) 2. Pulmonary function 3. TB screening-baseline (Purified Protein Derivative (PPD) or blood test) 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 Table C.3-11, Occupational Respirator Use |
| Target Organs | Lungs/respiratory |
| Written Opinion | 1. Written opinion to employee within 30 days including the results of the evaluation, 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. 2. Written opinion to employer including statement that evaluation 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 evaluation results and conditions of increased risk and any medical conditions which require further evaluation or treatment. |
| Medical Removal | No requirement in standard |
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Table C.1-20. Trichloroethylene
| Trichloroethylene | |
|---|---|
| Reference | NIOSH Pocket Guide to Chemical Hazards |
| Frequency | 1. Baseline evaluation 2. Annual evaluation |
| Laboratory | Discretionary 1. LFTs 2. PFTs 3. Urinalysis (dipstick) 4. Blood chemistry panel 5. CBC 6. 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 Table C.3-11, Occupational Respirator Use |
| Target Organs | Respiratory, CV, kidney, liver, skin, CNS, eyes |
| Written Opinion | No requirement in standard |
| Employee Counseling | Counseling on evaluation results and conditions of increased risk |
| Medical Removal | No requirement in standard |
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Table C.2-1. Surveillance Examinations for Employees who Work in Hazardous Environments and Workplaces Examinations
| Exam | Regulation | |
|---|---|---|
| C.2-2 | Bloodborne Pathogens | Bloodborne Pathogens, 20 CFR § 1910.1030 |
| C.2-3 | Chemical Laboratory | Occupational Exposure to Hazardous Chemicals in Laboratories, 29 CFR § 1910.1450 |
| C.2-4 | Hazardous Waste Operations and Emergency Response | Hazardous Waste Operations and Emergency Response, 29 CFR § 1910.120 Occupational Safety and Health Guidance Manual for Hazardous Waste Site Activities, 1985 |
| C.2-5 | Healthcare Provider | 29 CFR § 1910.1030 NIOSH |
| C.2-6 | Ionizing Radiation | Ionizing Radiation, OSHA 29 CFR § 1910.1096 Conditions Requiring Individual Monitoring of External and Internal Occupational Dose, 10 CFR § 20.1502 |
| C.2-7 | Lasers | ANSI Z136.1 App F, Safe Use of Lasers |
| C.2-8 | Noise | Occupational Noise Exposure, 29 CFR § 1910.95 |
| C.2-9 | Pesticides | NIOSH Pocket Guide the Chemical Hazards |
| C.2-10 | Spray Painting | Occupational Health and Environmental Control, 29 CFR pt. 1910 subpt. G Occupational Health and Environmental Controls, 29 CFR pt. 1926 subpt. D |
| C.2-11 | Water and Sewage | DHHS (NIOSH) Publication Number 2002-149, Guidance for Controlling Potential Risks to Workers Exposed to Class B Biosolids |
| C.2-12 | Welding | NIOSH Publication Number 88-110, Criteria for a Recommended Standard: Welding, Brazing, and Thermal Cutting AWS D17.1 Specification for Fusion Welding for Aerospace Applications |
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Table C.2-2. Bloodborne Pathogens
| Bloodborne Pathogens | |
|---|---|
| Reference | 20 CFR § 1910.1030 |
| Frequency | 1. Baseline evaluation (for occupational groups covered under the standard) 2. Variable or exposure-determined evaluation |
| Laboratory | 1. Hepatitis B vaccine 2. Hepatitis B Surface Antibody (HepBSAb) titer (required one time only after 3rd dose completed for HCP or high risk) 3. Declination statement will be signed if Hepatitis B vaccine declined by employee (See 20 CFR § 1910.1030, Appendix A 4. Discretionary: post-exposure a. Victim: Human Immunodeficiency Virus (HIV) test, HepBSAb if not already documented, and Hepatitis C Antibody (HepCAb) (other tests per provider) b. Source (after consent given): HIV test (rapid screen if available), Hepatitis B 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 identification system and a secure method to receive the test results will 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 evaluation results and conditions of increased risk. Post exposure counseling regarding hepatitis B virus vaccine and follow-up. |
| Medical Removal | No requirement in standard |
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Table C.2-3. Chemical Laboratory
| Chemical Laboratory | |
|---|---|
| Reference | 29 CFR § 1910.1450 |
| Frequency | Variable or exposure-determined evaluation |
| Laboratory | Discretionary tests 1. Blood chemistry panel 2. CBC 3. Chest x-ray 4. Pulmonary function 5. Urinalysis (dipstick) 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 Table C.3-11, Occupational Respirator Use |
| Target Organs | Multiple organs, especially eyes, skin, liver |
| Written Opinion | Standard written opinion required |
| Employee Counseling | Counseling on evaluation results and conditions of increased risk |
| Medical Removal | No requirement in standard |
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Table C.2-4. Hazardous Waste Operations and Emergency Response
| Hazardous Waste Operations and Emergency Response | |
|---|---|
| Reference | 29 CFR § 1910.120
Occupational Safety and Health Guidance Manual for Hazardous Waste Site Activities |
| Frequency | 1. Baseline evaluation 2. Annual evaluation 3. Variable or exposure-determined evaluation 4. Exit/reassignment evaluation |
| Laboratory | 1. Audiogram (baseline) 2. Visual acuity, color discrimination, visual fields 3. CBC 4. Blood chemistry panel 5. Urinalysis (dipstick) 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 employee’s fitness, including ability to wear required PPE, back or musculoskeletal problems, heat stress, claustrophobia 3. Evaluation of ability to wear respirator may be required, see Table C.3-11, Occupational Respirator Use 4. Employee may also be covered by 29 CFR § 1910.1030 |
| 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. Results of medical evaluation and tests provided if requested by employee |
| Employee Counseling | Counseling on evaluation results and conditions of increased risk. |
| Medical Removal | No requirement in standard |
| Note Regarding Eligibility | 1. 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 d. Members of a hazmat team 2. Employees not covered in standard a. Emergency responders not designated members of HazMat team (e.g., security, firefighters) |
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Table C.2-5. Healthcare Provider
| Healthcare Provider | |
|---|---|
| Reference | 20 CFR § 1910.1030 NIOSH |
| Frequency | 1. Baseline evaluation 2. Variable or exposure-determined evaluation |
| Laboratory | 1. Hepatitis B vaccine (required or declination letter to be completed) or demonstrated immunity 2. TB Screening (PPD or blood) required for baseline; periodic testing is discretionary based on risk assessment for the facility 3. Discretionary a. Hepatitis profile b. Measles, Mumps, Rubella (MMR) vaccine c. Diphtheria, Tetanus, and Pertussis (Td, Tdap) vaccine 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 29 CFR § 1910.1030 |
| Target Organs | Respiratory, blood, liver, skin |
| Written Opinion | No requirement in standard |
| Employee Counseling | Counseling on evaluation results and conditions of increased risk. |
| Medical Removal | No requirement in standard |
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Table C.2-6. Ionizing Radiation
| Ionizing Radiation | |
|---|---|
| Reference | 29 CFR § 1910.1096 10 CFR § 20.1502 |
| Frequency | Variable or exposure-determined evaluation |
| Laboratory | 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 evaluation results and conditions of increased risk. |
| Medical Removal | No requirement in standard |
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Table C.2-7. Lasers
| Lasers | |
|---|---|
| Reference | ANSI Z136.1 App F - Required for actual or suspected laser-induced injury. Note: Baseline evaluations 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 Class 4 lasers. |
| Frequency | 1. Baseline evaluation (per Center policy) 2. Variable or exposure-determined evaluation (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 examination 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 another qualified physician 3. Limited skin examination |
| Target Organs | Eye, skin |
| Written Opinion | No requirement in standard |
| Employee Counseling | Counseling on evaluation results and conditions of increased risk |
| Medical Removal | No requirement in standard |
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Table C.2-8. Noise
| Noise | |
|---|---|
| Reference | 29 CFR § 1910.95 |
| Frequency | 1. Baseline evaluation 2. Annual evaluation 3. Exit/reassignment evaluation |
| 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 including ear canal and tympanic membrane |
| Target Organs | Ears and hearing system |
| Written Opinions | Required within 21 days of 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 |
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Table C.2-9. Pesticides
| Pesticides | |
|---|---|
| Reference | NIOSH Pocket Guide the Chemical Hazards |
| Frequency | 1. Baseline evaluation 2. Annual evaluation 3. Variable or exposure-determined evaluation 4. Exit/reassignment evaluation |
| Laboratory | 1. Baseline (required before occupational exposure) - Plasma and Red Blood Count (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 panel 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 Table C.3-11, Occupational Respirator Use |
| Target Organs | Kidney, liver, CNS, skin, lung |
| Employee Counseling | Counseling on evaluation 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. |
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Table C.2-10. Spray Painting
| Spray Painting | |
|---|---|
| Reference | CFR pt. 1910 subpt. G CFR pt. 1926 subpt. D |
| Frequency | 1. Baseline evaluation 2. Variable or exposure-determined evaluation |
| Laboratory | 1. Discretionary tests a. Blood chemistry panel b. CBC c. Chest x-ray d. Urinalysis (dipstick) e. Pulmonary function |
| Physical Exam | 1. Medical and occupational history 2. Physical examination (discretionary) 3. Evaluation of ability to wear respirator may be required, see Table C.3-11, Occupational Respirator Use 4. Evaluation of other potential exposures, e.g., lead |
| Target Organs | Exposure determined |
| Employee Counseling | Counseling on evaluation results and conditions of increased risk. |
| Medical Removal | Exposure determined, e.g., lead |
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Table C.2-11. Water and Sewage
| Water and Sewage | |
|---|---|
| Reference | DHHS (NIOSH) Publication Number 2002-149 |
| Frequency | 1. Baseline evaluation 2. Annual evaluation 3. Variable or exposure-determined evaluation |
| Laboratory | 1. Immunizations offered a. Td vaccine b. Hepatitis A and B vaccine 2. Discretionary tests a. Blood chemistry panel b. CBC c. Chest x-ray |
| Physical Exam | 1. Medical and occupational history 2. Physical examination (discretionary) |
| Target Organs | Liver, GI, blood |
| Written Opinion | No requirement |
| Employee Counseling | Counseling on evaluation results and conditions of increased risk |
| Medical Removal | No requirement |
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Table C.2-12. Welding
| Welding | |
|---|---|
| Reference | NIOSH Publication Number. 88-110 AWS D17.1 |
| Frequency | 1. Baseline evaluation 2. Annual evaluation 3. Variable or exposure-determined evaluation |
| Laboratory | 1. Pulmonary function (Base only) 2. Blood chemistry panel 3. CBC 4. Urinalysis (dipstick) 5. Visual acuity: near vision: Jaeger 2, far vision:20/30 in either eye with or without correction 6. Depth perception and color discrimination 7. Chest x-ray (baseline) 8. Skin examination (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 Table C.3-11, 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 evaluation results and conditions of increased risk, including smoking. |
| Medical Removal | Exposure determined, e.g., lead |
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Table C.3-1. Surveillance Examinations for Employees who Require a Certification
| Exam | Regulation | |
|---|---|---|
| C.3-2 | Childcare Employee | Caring for Our Children: National Health and Safety Performance Standards, https://nrckids.org/CFOC. |
| C.3-3 | Permit Entry Confined Space/Tank Entry | DHHS (NIOSH) Publication Number 80-106, Criteria for a Recommended Standard: Working in Confined Spaces Respiratory Protection, 29 CFR § 1910.134 Permit-Required Confined Spaces, 29 CFR § 1910.146 |
| C.3-4 | Crane Operator/Rigger | NASA STD 8719.9, Lifting Standard ASME B30.3, Tower Cranes ASME B30.5, Mobile and Locomotive Cranes Operator Training, Certification, and Evaluation, 49 CFR § 1926.1427 Powered Industrial Trucks, 29 CFR § 1910.178 |
| C.3-5 | Diver | Examples of Conditions Which May Restrict or Limit Exposure to Hyperbaric Conditions, 29 CFR pt. 1910 subpt. T, Appendix A International Consensus Standards for Commercial Diving and Underwater Operations, Association of Diving Contractors International |
| C.3-6 | DOT/Commercial Driver License/Motor Vehicle Certification/Multiple Passenger Van | Commercial Driver’s License Standards; Requirements and Penalties, 49 CFR pt. 383 |
| C.3-7 | Down Range/Shipboard Duty | Medical Certification, 46 CFR pt. 10 Subpt. C |
| C.3-8 | Fire Fighter | National Fire Protection Association (NFPA) 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments |
| C.3-9 | Locomotive Engineer | Criteria for Vision and Hearing Acuity Data, 49 CFR § 240.121 |
| C.3-10 | Motive (Heavy) Equipment Operator | 29 CFR pt. 1926 subpt. O, Motor Vehicles, Mechanized Equipment, and Marine Operations |
| C.3-11 | Occupational Respirator Use | 29 CFR § 1910.134 Fit Testing Procedures (Mandatory), 29 CFR § 1910.134, Appendix A User Seal Check Procedures (Mandatory), 29 CFR § 1910.134, Appendix B-1 Respiratory Cleaning Procedures (Mandatory), 29 CFR § 1910.134, Appendix B-2 OSHA Respiratory Medical Evaluation Questionnaire (Mandatory), 29 CFR § 1910.134, Appendix C |
| C.3-12 | Ordnance Handler | NAVMED P-117, Manual of the Medical Department (MANMED), section 15-107, Explosives Motor Vehicle Operator and Explosives Handler Examinations and Standards ANSI/AIAA G-095, Guide to Safety of Hydrogen and Hydrogen Systems 29 CFR § 1910.119, Process Safety Management of Highly Hazardous Chemicals |
| C.3-13 | Primary Animal or Animal Product Contact | The Guide for the Care and Use of Laboratory Animals Occupational Health and Safety in the Care and Use of Research Animals |
| C.3-14 | Health Stabilization Program | CDC Immunization Schedules |
| C.3-15 | Crew Food Handler/Technician | FDA Food Code |
| C.3-16 | Security | OPM Policy, Data, Oversight Classification & Qualifications: Security Guard Series, 0085, Security Guard Series 0085 (opm.gov) |
| C.3-17 | Self-Contained Atmospheric Protective Ensemble (SCAPE) | 29 CFR § 1910.134 |
| C.3-18 | Soldering | IPC J-STD-001FS, Space Applications Electronic Hardware Addendum to IPC J-STD-001F Requirements for Soldered Electrical and Electronic Assemblies |
| C.3-19 | Voluntary Respirator Use | 29 CFR § 1910.134 29 CFR § 1910.134 Appendices A, B-1, B-2, and C (Mandatory) Information for Employees Using Respirators When Not Required Under the Standard, 29 CFR § 1910.134 Appendix D |
| C.3-20 | Range Safety Officer (RSO) and Flight Safety Officer (FSO) | NASA STD 8719.25, Range Flight Safety Requirements and OCHMO-STD-1880.1, NASA Aviation Medical Certification Standards |
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Table C.3-2. Childcare Employee
| Childcare Employee | |
|---|---|
| Reference | Caring for Our Children: National Health and Safety Performance Standards |
| Frequency | 1. Baseline evaluation 2. Variable or exposure-determined evaluation |
| Laboratory | 1. Baseline and annual TB screening and as required by the state 2. Discretionary vaccines offered a. Influenza b. MMR c. Td, Tdap 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 evaluation results and conditions of increased risk |
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Table C.3-3. Permit Entry Confined Space/Tank Entry
| Permit-Entry Confined Space/Tank Entry | |
|---|---|
| Reference | NIOSH Publication 80-106 29 CFR 1910.134 29 CFR 1910.146 |
| Frequency | 1. Baseline evaluation 2. Evaluation frequency age determined a. Annual, if age 50 or older b. Every three years, if under age 50 |
| 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. ECG. Baseline and with each exam over age 40 or clinically indicated 4. Urinalysis (dipstick) 5. Discretionary tests a. Chest x-ray (Baseline) b. 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 Table C.3-11, Occupational Respirator UseUse 4. Evaluation of other exposures may be required |
| Written Opinion | Job Certification with any limitations |
| Employee Counseling | Counseling on evaluation results and conditions of increased risk |
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Table C.3-4. Crane Operator/Rigger
| Crane Operator/Rigger Note: Includes ground floor, remote operation, high, cabin, pulpit cranes |
|
|---|---|
| Reference | NASA STD 8719.9 ASME B30.3 and B30.5 49 CFR § 1926.1427 29 CFR § 1910.178 |
| Frequency | 1. Baseline evaluation 2. Evaluation 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 (dipstick) c. Pulmonary function d. Hgb and Hct e. Hemoglobin A1c (HbA1c) |
| 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 | 1. Job certification with any limitations or referral for additional specialized clinical evaluation or testing 2. 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 3. Each Center with drivers requiring DOT certification will have a certified medical examiner 4. The Center's certified medical examiner employees will review a. The MSCA-5870, Insulin-Treated Diabetes Mellitus Assessment Form, from the employee's treating physician b. A letter from employee's supervisor stating 1) The workplace can meet requirements to accommodate the employee such as mitigating hypoglycemic symptoms, monitoring glucose levels, and training the employee to recognize hypoglycemic episodes. 2) If the crane has a dead-man switch. 5. 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 item 4 above, along with a waiver recommendation to OCHMO within 30 days of receipt of the required MSCA-5870 |
| Employee Counseling | Counseling on evaluation results and conditions of increased risk. |
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Table C.3-5. Diver
| Diver | |
|---|---|
| Reference | 29 CFR pt. 1910 subpt. T Appendix A International Consensus Standards for Commercial Diving and Underwater Operations |
| Frequency | 1. Baseline evaluation 2. Annual evaluation |
| Laboratory | 1. Audiogram 2. Baseline and annual ECG 3. Baseline chest x-ray (PA and lateral) every 3 years 4. Pulmonary function (vital capacity) 5. Urinalysis (dipstick) 6. Blood chemistry panel 7. CBC 8. TB screening (baseline) 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 evaluation results and conditions of increased risk |
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Table C.3-6. DOT/Commercial Driver License/Motor Vehicle Certification/Multiple Passenger Van
| DOT/Commercial Driver License/Motor Vehicle Certification/Multiple Passenger Van | |
|---|---|
| Reference | 49 CFR pt. 383 |
| Frequency | 1. Baseline evaluation 2. Biennial evaluation unless more frequent evaluation 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. CBC c. Blood chemistry panel 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 | 1. Job certification with any limitations or referral for additional specialized clinical evaluation or testing 2. If an employee has ITDM a FMCSA-compliant waiver is required to obtain a 12-month certification 3. Each Center with drivers requiring DOT certification will have a certified medical examiner 4. The Center's certified medical examiner employees will review a. The MCSA-5870, Insulin-Treated Diabetes Mellitus Assessment Form, from the employee's treating physician b. A letter from employee's supervisor stating the workplace can meet requirements to accommodate the employee such as mitigating hypoglycemic symptoms, monitoring glucose levels, and training the employee to recognize hypoglycemic episodes. 5. 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 MCSA-5870 |
| Employee Counseling | Counseling on evaluation results and conditions of increased risk. |
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Table C.3-7. Down Range/Shipboard Duty
| Down Range/Shipboard Duty | |
|---|---|
| Reference | 46 CFR pt. 10 subpt. C |
| Frequency | 1. Baseline evaluation (temporary assignment to ships, submarines, or NASA test range shipboard) 2. Annual evaluation (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 will abide by the FDA Food Code |
| Written Opinion | Job Certification with limitations |
| Employee Counseling | Counseling on evaluation results and conditions of increased risk. |
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Table C.3-8. Fire Fighter
| Fire Fighter | |
|---|---|
| Reference | NFPA 1582 |
| Frequency | 1. Baseline evaluation 2. Annual evaluation 3. Variable or exposure-determined evaluation 4. Exit/reassignment evaluation |
| Laboratory | 1. Audiogram: Average hearing loss in the unaided better ear less than 40 dB at 500, 1000, 2000, and 3000 Hz. 2. Lab tests baseline, every 3 years under age 40. Annually over 40: a. Comprehensive metabolic panel (including cholesterol, High Density Lipoprotein (HDL), Low Density Lipoprotein (LDL), triglycerides, lipid ratios, LFTs) b. CBC 3. Chest x-ray, baseline and clinically indicated 4. ECG, Baseline and annually over age 40 or clinically indicated 5. Pulmonary function: Ratio of Forced Expiratory Volume in 1 second/Forced Vital Capacity (FEV1/FVC) will be greater than 0.70 if both FEV1 and FVC are below normal 6. Urinalysis (dipstick) 7. Visual acuity: Far (Snellen) at least 20/40 binocular corrected and at least 20/100 binocular uncorrected for those routinely using corrective lenses. Far visual acuity better than 20/100 in the worse eye, corrected or uncorrected. Near visual acuity no worse than 20/40 binocular, uncorrected or corrected. 8. Color perception 9. Stress test with imaging for 2 to 4 percent risk of ASCVD over the next 2 years or 10 to <20 percent risk of ASCVD over the next 10 years and as clinically indicated by history or symptoms. 10. Perform appropriate cancer screening counseling 11. TB Screening, baseline (PPD or blood) 12. Atherosclerotic cardiovascular disease risk stratification, age 40 and over 13. Discretionary tests a. Hepatitis C screen, baseline b. Immunizations offered: i. Hepatitis B vaccine ii. Td Vaccine iii. MMR vaccine iv. Polio vaccine v. Varicella vaccine vi. Influenza vaccine c. HIV screen, baseline d. Depth perception e. 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 Table C.3-11, Occupational Respirator Use |
| Written Opinion | Job certification with 1. Statement that the employee has enough 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 |
| Employee Counseling | Counseling on evaluation results and conditions of increased risk. |
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Table C.3-9. Locomotive Engineer
| Locomotive Engineer | |
|---|---|
| Reference | 49 CFR § 240.121 |
| Frequency | 1. Baseline evaluation 2. Triennial evaluation |
| Laboratory | 1. Audiogram: Hearing loss in better ear < 40 dB at 500, 1000, 2000 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 evaluation results and conditions of increased risk |
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Table C.3-10. Motive (Heavy) Equipment Operator
| Motive (Heavy) Equipment Operator Note: Includes specialized maintenance and construction equipment such as bulldozers, dump trucks, etc. |
|
|---|---|
| Reference | 29 CFR pt. 1926 subpt. O, Motor Vehicles, Mechanized Equipment, and Marine Operations |
| Frequency | 1. Pre-placement/baseline evaluation 2. Biennial evaluation 3. If Commercial Driver License (CDL) 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: 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 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 panel d. CBC e. HbA1c f. Depth perception |
| 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 | 1. Job certification with any limitations or referral for additional specialized clinical evaluation or testing 2. If an employee has ITDM a FMCSA-compliant waiver is required to obtain a 12-month certification 3. Each Center with drivers requiring DOT certification will have a certified medical examiner 4. The Center's certified medical examiner employees will review a. The MCSA-5870 from the employee's treating physician b. A letter from employee's supervisor stating i. The workplace can meet requirements to accommodate the employee such as mitigating hypoglycemic symptoms, monitoring glucose levels, and training the employee to recognize hypoglycemic episodes ii. If the heavy equipment has a dead-man switch 5. 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 MCSA-5870. |
| Employee Counseling | Counseling on evaluation results and conditions of increased risk. |
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Table C.3-11. Occupational Respirator Use
| Occupational Respirator Use | |
|---|---|
| Reference | 29 CFR § 1910.134 29 CFR § 1910.134, Appendices A, B-1, B-2, and C |
| Frequency | 1. Baseline evaluation 2. Baseline and annual respirator questionnaire 3. Variable or exposure-determined evaluation |
| Laboratory | Discretionary |
| Physical Exam | 1. OSHA Respirator Medical Evaluation Questionnaire – 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 29 CFR § 1910.134, Appendix C, part A, section 2, questions 1-8, or at the discretion of the physician 4. Discretionary tests a. Chest x-ray b. Pulmonary function (spirometry), performed by employees who maintain certification from a NIOSH approved course, as required by OSHA |
| 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 follow-up 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 Physician or Licensed Health Care Professional finds a medical condition that may place the employee's health at increased risk if the respirator is used, the employer will provide a Powered Air Purifying Respirator (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 evaluation results, conditions of increased risk and copy of written opinion provided to employer. |
| Medical Removal | No requirement in standard |
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Table C.3-12. Ordnance and Hydrogen Handler
| Ordnance Handler | |
|---|---|
| Reference | NAVMED P-117, section 15-107 ANSI/AIAA G-095 29 CFR § 1910.119 |
| Frequency | 1. Baseline evaluation 2. Every 2 years evaluation |
| 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. CBC c. Blood chemistry panel d. Chest x-ray e. 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 |
| Employee Counseling | Counseling on evaluation results and conditions of increased risk. |
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Table C.3-13. Primary Animal or Animal Product Contact
| Primary Animal or Animal Product Contact Note: May have to be modified to cover the animal species and specific agents being used. |
|
|---|---|
| Reference | The Guide for the Care and Use of Laboratory Animals Occupational Health and Safety in the Care and Use of Research Animals |
| Frequency | 1. Baseline evaluation, including physical examination 2. Annual evaluation 3. Variable or exposure-determined evaluation |
| Laboratory | 1. Baseline only a. CBC b. Blood chemistry panel c. Pulmonary function 2. Tetanus vaccine every 10 years 3. Discretionary a. Serum sample (10 mL) for storage b. Skin testing or serological immunoassay c. Rabies titer d. Measles (Rubeola) titer e. Hepatitis A and B vaccines f. Rabies vaccine g. Measles (Rubeola) vaccine h. TB screening |
| Physical Exam | 1. Medical and Occupational History with focus on immunization, conditions with suppression of the immune system, asthma, allergies, and any prior illnesses from contact with animals or animal products (e.g., tissues, blood, feces, or allergens associated with hair, dander, urine or saliva) 2. Physical Examination (baseline and discretionary) 3. Evaluation of ability to wear respirator may be required, see Table C.3-11, Occupational Respirator Use |
| Written Opinion | Job Certification with any limitations. Recommend PPE. |
| Employee Counseling | Counseling on results of evaluation, including conditions of increased risk |
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Table C.3-14. Health Stabilization Program
| Health Stabilization Program | |
|---|---|
| Reference | CDC Immunization Schedules |
| Frequency | 1. Initial pre-quarantine medical screening at ~L-21 to L-14 days 2. Subsequent periodic screening as required |
| Laboratory | 1. Required: a. Immunizations per CDC immunization schedules, FDA or WHO-approved vaccine manufacturer instructions, or history of disease 2. Discretionary Tests for all others a. Serological testing b. Bacterial, parasitic, or viral testing c. CBC with differential d. Urinalysis (dipstick) e. TB screening f. Chest x-ray |
| Physical Exam | Electronic or in-person medical screening with focus on detection of infectious disease |
| Written Opinion | Job certification with any limitations |
| Employee Counseling | Counseling on evaluation results and conditions of increased risk. |
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Table C.3-15. Crew Food Handler/Technician
| Crew Food Handler/Technician Note: Includes personnel who produce astronaut meals during the pre-flight quarantine and immediate post-flight periods, as well as the food production team that procures, processes, and packages the food supply for spaceflight. | |
|---|---|
| Reference | FDA Food Code |
| Frequency | 1. Baseline examination 2. Annual examination |
| Laboratory | 1. Required at baseline: a. Hepatitis A (unless not clinically indicated) b. TB screening 2. Discretionary tests: a. Serological testing b. Bacterial, parasitic, or viral testing c. CBC with differential d. TB testing e. Chest x-ray |
| Physical Exam | 1. Medical and occupational history focused on transmittable infectious diseases 2. Focused physical examination |
| Written Opinion | Job certification with any limitations |
| Employee Counseling | Counseling on evaluation results and conditions of increased risk. |
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Table C.3-16. Security
| Security | |
|---|---|
| Reference | OPM Policy, Data, Oversight Classification & Qualifications: Security Guard Series, 0085 |
| Frequency | 1. Baseline evaluation 2. Annual evaluation |
| Laboratory | 1. Audiogram 2. Visual acuity, color vision, visual field 3. ECG 4. Urinalysis (dipstick) 5. TB test (skin or blood) at baseline with TB screening annually 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 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 |
| Employee Counseling | Counseling on evaluation results and conditions of increased risk. |
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Table C.3-17. Self-Contained Atmospheric Protective Ensemble
| Self-Contained Atmospheric Protective Ensemble (SCAPE) | |
|---|---|
| Reference | 29 CFR § 1910.134 |
| Frequency | 1. Baseline evaluation 2. Annual evaluation |
| Laboratory | 1. Blood chemistry panel 2. 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 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 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 follow-up 3. Statement that employer/employee has been given a copy of the written opinion |
| Employee Counseling | Counseling on evaluation results, conditions of increased risk and copy of written opinion provided to employer. |
| Medical Removal | No requirement in standard |
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Table C.3-18. Soldering
| Soldering | |
|---|---|
| Reference | IPC J-STD-001FS |
| Frequency | 1. Baseline evaluation 2. Biennial evaluation 3. Variable or exposure-determined evaluation |
| Laboratory | 1. Pulmonary function (baseline only) 2. Visual acuity: Near vision 20/20 with or without correction. Binocular vision not required 3. Color discrimination: Ability to distinguish red, green, blue and yellow |
| 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 Table C.3-11, 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 evaluation results and conditions of increased risk. |
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Table C.3-19. Voluntary Respirator Use
| Voluntary Respirator Use | |
|---|---|
| Reference | 29 CFR § 1910.134 Appendices A, B1, B2, C, and D |
| Frequency | Baseline evaluation |
| Physical Exam | 1. Focused physical examination 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 |
| Written Opinion | Required 1. Any limitations in job functions or ability to wear PPE |
| Employee Counseling | Counseling on evaluation results and conditions of increased risk. |
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Table C.3-20. Range Safety Officer (RSO) and Flight Safety Officer (FSO)
| Range Safety Officer (RSO) and Flight Safety Officer (FSO) | |
|---|---|
| Reference | NASA STD 8719.25 and OCHMO-STD-1880.1 |
| Frequency | 1. Baseline evaluation 2. Every 2 years evaluation |
| Laboratory | 1. Audiogram 2. Visual acuity (distance 20/20), depth perception, color perception (as related to specific job requirements) 3. Urinalysis (dipstick) 4. Discretionary tests a. ECG b. CBC c. Blood chemistry panel d. Chest x-ray e. 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 |
| Employee Counseling | Counseling on evaluation results and conditions of increased risk. |
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Table C.4-1. Surveillance Examinations for Employees who Participate in Flight Activities
| Exam | Regulation | |
|---|---|---|
| C.4-2 | NASA Pilots, Flight Engineers, Other Primary Aircrew, Qualified Non-Crewmember, and Unmanned Aircraft System (UAS) Pilots and Observers | OCHMO-STD-1880.1 Medical Standards and Certification, 14 CFR pt. 67 |
| C.4-3 | Air Traffic Control Specialist (Not Requiring FAA Certification) | OPM Policy, Data, Oversight Classification & Qualifications, Air Traffic Control Series, 2152 |
| C.4-4 | Second Class Airman Medical Certification (Air Traffic Control Tower Operator) | 14 CFR pt. 67 |
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Table C.4-2. NASA Pilots, Flight Engineers, Other Primary Aircrew, Qualified Non-Crewmember, and Unmanned Aircraft System Pilots and Observers
| NASA Pilots, Flight Engineers, Other Primary Aircrew, Qualified Non-Crewmember, and Unmanned Aircraft System (UAS) Pilots and Observers |
|---|
| Requirements are documented in OCHMO-STD-1880.1 and 14 CFR pt. 67 |
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Table C.4-3. Air Traffic Control Specialist (Not Requiring FAA Certification)
| Air Traffic Control Specialist (Not Requiring FAA Certification) | |
|---|---|
| Reference | OPM Policy, Data, Oversight Classification & Qualifications, Air Traffic Control Series, 2152 |
| Frequency | 1. Baseline evaluation 2. Annual evaluation |
| Laboratory | 1. Audiogram: No hearing loss in either ear of more than 30 decibels at 500, 1000, or 2000 Hz. No hearing loss in these ranges of more than 25 decibels in the better ear. (See OPM Classification and Standards for initial employment hearing standards) 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. Discretionary tests a. Blood chemistry panel (can include fasting blood sugar and blood lipid profile) b. 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 |
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Table C.4-4. Second Class Airman Medical Certificate (Air Traffic Control Tower Operator)
| Second Class Airman Medical Certificate (Air Traffic Control Tower Operator) | ||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Reference | 14 CFR pt. 67 | |||||||||||||||||||
| Frequency | 1. Baseline evaluation 2. Annual evaluation |
|||||||||||||||||||
| Laboratory | 1. Audiogram
2. Visual testing and requirements a. Distant 20/20 each eye separately b. Near 20/40 each eye separately with or without correction at 16 inches c. Intermediate 20/20 each with or without correction at age 50 or over at 32 inches 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 panel (can include fasting blood sugar and blood lipid profile) b. 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 blood pressure should not exceed 155mm/95mm 4. Check FAA Guide for Aviation Medical Examiners 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 pt. 67 for medical standards and certification |
|||||||||||||||||||
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Table C.5-1. Surveillance Examinations for Employees who Require Special Administrative Examinations
| Exam | Regulation | |
|---|---|---|
| C.5-2 | Fitness for Duty (FFD) | NPR 1800.1 |
| C.5-3 | Return to Work (RTW) | NPR 1800.1 |
| C.5-4 | International Traveler | NPR 1810.1 CDC |
| C.5-4a | Pre- and Post-Travel Support | N/A |
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Table C.5-2. Fitness for Duty
| Fitness for Duty (FFD) | |
|---|---|
| Regulation | NPR 1800.1 |
| Defined | FFD evaluation 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 evaluation should be completed as soon as possible after a written request through management has been made |
| Scope | The physician or licensed healthcare provider 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/primary care provider(s), as well as other services such as the EAP can be of help to an affected employee |
| Managers Responsibilities | The supervisor/manager requesting the FFD evaluation should notify the employee and have their consent, provide documentation to the physician and a copy of the employee's job description. Managers will 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 will contact the DFWP coordinator to arrange testing |
| Laboratory | Discretionary |
| Confidentiality | Confidentiality is of utmost importance and all recommendations and reports will 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 |
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Table C.5-3. Return to Work
| Return to Work (RTW) | |
|---|---|
| Regulation | NPR 1800.1 |
| 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 evaluation |
| 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 examination and/or certain tests are necessary |
| Managers Responsibilities | The manager requesting the RTW evaluation will 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 will be limited to work-related matters, e.g., work limitation, modifications, or accommodations |
| Written Opinion | An RTW certificate for the employee's manager should indicate 1. A statement of work limitations (including modifications and duration) 2. A statement of any 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 |
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Table C.5-4. International Traveler
| International Traveler | |
|---|---|
| Reference | NPR 1810.1 CDC |
| Frequency | 1. Variable or exposure-determined evaluation 2. Note: Medical clearance required for 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. 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 |
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Table C.5-4a. Pre- and Post-Travel Support
| Pre- and Post-Travel Support |
|---|
|
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Table C.6-1. Surveillance Examinations for Employees who Participate in Voluntary Health Maintenance
| Exam | Regulation | |
| C.6-2 | Preventive Health Examination | U.S. Preventive Services Task Force (USPSTF) |
| C.6-3 | Fitness Center Clearance | NPR 1800.1 |
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Table C.6-2. Preventive Health Examination
| Preventive Health Examination | |
|---|---|
| Reference | USPSTF |
| Frequency | 1. Offer annually to NASA employees 2. Offer at retirement to NASA employees if not previously done |
| Laboratory (age appropriate or clinically indicated) | 1. CBC 2. Blood chemistry panel (includes fasting blood glucose) 3. Lipid profile 4. Urinalysis (dipstick) 5. High sensitivity fecal occult blood age 45-75 |
| Physical Exam | 1. Medical and family history if history of smoking -- offer smoking cessation 2. Vital signs 3. BMI 4. Physical examination, complete baseline then focused as clinically indicated and age appropriate 5. Total body skin examination: Baseline and at providers discretion 6. Baseline and at providers discretion a. Visual acuity b. Audiogram c. Pulmonary function d. ECG 7. Breast examination 8. PAP smear (at clinical discretion) 9. PSA test (at clinical discretion) 10. Digital rectal examination offered to at risk employees aged 55-69; high risk may be considered at younger age |
| Counseling/ Education | 1. Tobacco cessation, if indicated 2. Healthful diet and physical activity 3. Risk factors based on age, history and examination 4. Breast or testicular self-examination 5. Mammogram 6. Colonoscopy |
| Target Organs | Multiple organs |
| Written Opinion | A summary of evaluation and laboratory results provided to the employee along with individualized preventive health recommendations |
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Table C.6-3. Fitness Center Clearance
| Fitness Center Clearance | |
|---|---|
| Reference | NPR 1800.1 |
| Frequency | Per Center or component facility policy |
| Laboratory | Discretionary |
| Physical Exam | 1. Review of appropriate pre-exercise screening questionnaire, 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 will 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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| TOC | Preface | Chapter1 | Chapter2 | Chapter3 | Chapter4 | Chapter5 | Chapter6 | Chapter7 | AppendixA | AppendixB | AppendixC | AppendixD | ALL | |
| | NODIS Library | Organization and Administration(1000s) | Search | |
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