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Medical Surveillance
Fact Sheet No. OSHA 93-52 Lead Exposure in Construction MEDICAL SURVEILLANCE When a construction employee is occupationally exposed to lead at or above the action level of 30 ug/m(3) on any one day in a calendar year, the employee must be provided initial medical surveillance consisting of biological monitoring in the form of blood sampling and analysis for lead and zinc protoporphyrin levels. Blood lead levels are currently the best indicator of personal lead exposure. Workers potentially exposed to lead at or above the action level must be monitored for the presence of lead in the blood and the effects of lead on the blood-forming system. Full medical surveillance is to be provided to employees exposed to lead at or above the action level for more than 30 days per year. All medical examinations and consultations shall be performed by or under the direct supervision of a qualified physician and shall be provided to employees at no cost, without loss of pay, and at a reasonable time and place. A qualified physician is a doctor of medicine (M.D.) or osteopathy (D.O.) familiar with the objectives and requirements of a medical surveillance program for lead exposure. The following conditions necessitate an immediate medical consultation including, as determined by the qualified physician, a physical examination and a blood sample for lead analysis (biological monitoring): whenever a worker develops signs or symptoms associated with lead toxicity; and before a worker restarts work following medical removal. 1. Biological Monitoring The purpose of biological monitoring is to identify workers with elevated blood lead levels. The data from biological monitoring is objective evidence of a worker's body burden from lead exposure, and this data can be used to follow changes in worker exposure. Blood lead and zinc protoporphyrin (ZPP) or free erythrocyte protoporphyrin (FEP) shall be monitored for those workers exposed to lead. In general, workers in high-risk occupations should be monitored as often as needed to prevent adverse health effects. Analysis of blood samples shall be conducted by a laboratory currently approved by OSHA. Employers should contact their local OSHA area office for a current list of approved labs. 2. Reproductive Hazard Issues Lead is toxic to both male and female reproductive systems. Workers who are actively seeking to have a child or who are pregnant should contact qualified medical personnel to arrange for a job evaluation and medical follow-up. Employers who have been contacted by employees with concerns about reproductive issues should refer them to qualified medical personnel. 3. Written Medical Opinion Employers must obtain a written signed opinion from the examining physician for each medical examination performed for each employee. This opinion should contain the results of the medical examination as they relate to occupational exposure to lead and must include: whether the employee has any detected medical condition which would place his/her health at increased risk from lead exposure; any special protective measures or limitations on worker's exposure to lead; any limitation on respirator use; results of blood lead determination; and a statement that the employee has been informed by the physician of the results of the consultation or medical examination and any medical condition that may require further examination or treatment. Findings of lab results or diagnoses unrelated to the workers' exposure to lead must not be communicated to the employer or included in a written opinion. Employees should be advised by each physician of any medical condition, occupational or non-occupational, which necessitates further medical evaluation or treatment. The employer should furnish the employee with a copy of the written medical opinion. 4. Chelation The use of chelating drugs as a prophylactic measure (i.e., to prevent a detectable rise in blood lead) is an unacceptable medical practice. Chelation may be used by a qualified physician only for diagnostic or therapeutic reasons (that is, to diagnose or treat the signs and symptoms of severe lead toxicity). 5. Medical Removal Medical removal will protect worker health both by stopping further occupational exposure and by enabling the worker to excrete the absorbed lead naturally. With good engineering, work practices, personal hygiene, and respiratory protection practices in place, very few employees should reach the medical removal trigger level specified in the OSHA standard. OSHA's interim final standard for lead in construction uses a medical removal trigger level of 50 ug/dl. However, some authorities believe that medical removal should take place at lower levels. Currently, 15 states require laboratories and health care providers to report cases of elevated blood lead concentrations to their state Health Departments. A list of the states that require such reporting, contact person, and the concentration that requires reporting for each state can be found in the NIOSH Alert: Preventing Lead Poisoning in Construction Workers. When employees are removed, or otherwise limited, they must be placed in jobs that will not result in exposure to lead at or above the action level of 30 ug/m(3). The employer may return the employee to his or her former job status when a qualified physician's medical determination is that the employee is no longer at risk from exposure to lead or when the employee's blood lead level drops below 40 ug/dl. In the case of medical removal, records must include the following information: the name and social security number of the worker; the date of each occasion that the worker was removed from current exposure to lead; the date on which the worker was returned to his or her former job status; a brief explanation of how each removal was or is being accomplished; and a statement indicating whether or not the reason for the removal was an elevated blood lead level. The employer must maintain this record for at least the duration of any worker's employment. 6. Recordkeeping The employer must maintain any employee exposure and medical records to document ongoing employee exposure, medical monitoring and medical removal of workers. This data provides a base to properly evaluate the employee's health. Employers must properly record cases on their OSHA form 200 when the worker: has a blood lead level that exceeds 50 mg/dl; has symptoms of lead poisoning, such as colic, nerve damage, renal damage, anemia, or gum problems; or receives medical treatment to lower blood lead levels or for lead poisoning. In addition, employees or former employees, their designated representatives, and OSHA must be provided access to exposure and medical records in accordance with 29 CFR 1910.20. This is one of a series of fact sheets highlighting U.S. Department of Labor programs. It is intended as a general description only and does not carry the force of legal opinion.

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Safety With Video Display Terminals
INFORMATION DATE 19920217 DESCRIPTION USDOL Program Highlights, Safety with Video Display Terminals TOPIC Video Display Terminals SUBJECT Safety with Video Display Terminals ABSTRACT Information is provided about possible safety and health problems associated with video display terminals (VDTs). Some concerns include high-voltage electricity, ergonomics, and noise. But the greatest interest is in whether extreme low-frequency fields or higher-frequency radiation fields emitted by VDTs pose any problem, particularly for pregnant women. U.S. Department of Labor Program Highlights Fact Sheet No. OSHA 92-24 SAFETY WITH VIDEO DISPLAY TERMINALS The Occupational Safety and Health Administration (OSHA) is often asked about possible safety and health problems associated with video display terminals (VDTs). Some concerns include high- voltage electricity, ergonomics, and noise. But the greatest interest is in whether extreme low-frequency fields or higher- frequency radiation fields emitted by VDTs pose any problem, particularly for pregnant women. OSHA has no standards that apply specifically to video display terminals or to extreme low-frequency electric and magnetic field exposure. However, OSHA does have standards to protect employees against overexposures to radiation, noise, and electrical hazards. RADIATION: The National Institute for Occupational Safety and Health (NIOSH), the U.S. Army Environmental Hygiene Agency, and others have measured radiation emitted by VDTs. The tests show that levels for all types of radiation are below those allowed in current standards. In fact, some measurements show radiation levels so low that they cannot be distinguished from general environmental radiation (background radiation). Currently, OSHA has no reliable information that any birth defect has ever resulted from a pregnant woman working at a video display terminal. However, the possible effects of radiation or extreme low-frequency fields from VDTs on pregnancies continue to concern employees. Therefore, NIOSH and others are currently conducting major studies to thoroughly investigate any potential problems. NOISE AND ELECTRICAL HAZARDS: It is unlikely that noise exposures in a typical office setting, even in an office with a pool of VDTs, would exceed OSHA standards. However, a cluster of high-speed printers without sound screens could produce some questionable noise levels. Noise levels should be kept within comfortable limits. Sound sources that are unacceptably noisy should be shielded by sound-absorbent screens or hoods or placed in a separate room. Absorbent materials such as acoustical ceiling tile, carpets, curtains, and upholstery also can cut noise. OSHA has a number of electrical requirements applicable to VDTs. The equipment must be properly installed, used, and grounded to ensure employee safety. PHYSICAL DISCOMFORTS: Video display operators sometimes report eye fatigue and irritation, blurred vision, headaches, dizziness, and pain or stiffness in the neck, shoulders, back, arms, wrists, and hands. These problems usually can be corrected by adjusting the physical and environmental setting where the VDT users work. The relation of the operator to the keyboard and the screen, the operator's posture, the lighting, and the background noise should be carefully examined to prevent discomfort. LIGHTING: Work stations and lighting should be arranged to avoid reflections on the screen or surrounding surfaces. Light should be directed so that it does not shine into the operator's eyes when the operator is looking at the screen. Normal office lighting can be supplemented by individual 'task lighting' at a work station if necessary. Task lighting enables operators to adjust lighting to their individual preferences. GLARE: Glare can result from light reflecting on a VDT screen or shiny keyboard. Anti-reflective screen treatment can be added to a VDT screen, and later model keyboards usually have an anti-glare matte finish. To avoid glare, display screens may be placed near a window so the line of sight between eye and screen is parallel to the window surface or the windows can be shielded to reduce excessive sunlight. Walls painted with a nonreflective medium-to-dark paint can minimize glare. WORK STATION DESIGN: An individual work station should provide the operator with a comfortable sitting position sufficiently flexible to reach, use, and observe the screen, keyboard, and document. Some general guidelines to minimize fatigue include: Posture support: The seat and backrest of the chair should support a comfortable posture permitting occasional variations in the sitting position. Chair height and backrest angle should be easily adjustable. A foot rest may be necessary for short individuals. Arms: When the operator's hands are resting on the keyboard, the upper arm and forearm should form a right angle. The hands should be in a reasonably straight line with the forearm. Long or unusually high reaches should be avoided. Armrests should permit periodic support as needed. Legs and feet: The chair height is correct when the entire sole of the foot can rest on the floor or footrest and the back of the knee is slightly higher than the seat of the chair. This allows the blood to circulate freely in the legs and feet. Adjustment of screen position: Screens which swivel horizontally and tilt or elevate vertically enable the operator to select the optimum viewing angle. Work station surface: The table or work station should suit the kind of task to be done. It should be large enough for any reference books, files, telephone, or text and also permit different positions of the screen and keyboard. Adjustable surface height is an advantage. Eye and screen: The topmost line of the display should not be higher than the user's eyes. The screen and document holder should be the same distance from the eye (to avoid constant changes of focus) and close together so the operator can look from one to the other without excessive movement of the neck or back. The incline of the document holder should be adjustable. Legibility is a prime consideration in selecting a display screen. This also applies to document selection. Legibility factors to be considered include: symbol size and design, contrast, and sharpness. Adjustment of the keyboard: A movable keyboard is a plus. It can be arranged to suit the type of work and the need to consult documents or notes. TASK CONSIDERATIONS: The type of task performed on a VDT influences the development of fatigue. Therefore, in designing a work station, the type of tasks a worker does should be considered when placing the screen and keyboard. Whatever the task, it is desirable for the operator to have some 'job control'-the opportunity to pace the work, add mini-breaks, or change positions. This is one of a series of fact sheets highlighting U.S. Department of Labor programs. It is intended as a general description only and does not carry the force of legal opinion.

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