This training program must also be provided at least annually thereafter. (4) The results of the blood lead determinations.
(A) The employer shall return an employee to his or her former job status: (1) For an employee removed due to a blood lead level at or above 60 g/100 g, or due to an average blood lead level at or above 50 g/100 g, when two consecutive blood sampling tests indicate that the employee's blood lead level is below 40 g/100 g of whole blood; (2) For an employee removed due to a final medical determination, when a subsequent final medical determination results in a medical finding, determination, or opinion that the employee no longer has a detected medical condition which places the employee at increased risk of material impairment to health from exposure to lead. The frequency is increased to every two months for employees whose last blood lead level was between 40 g/100 g whole blood and the level requiring employee medical removal to be discussed below. Your employer is required to provide all such equipment at no cost to you. 
Increasing concentrations of ALA are believed to result from the inhibition of the enzyme delta-aminolevulinic acid dehydrase (ALA-D). The employer shall remove any limitations placed on an employee or end any special protective measures provided to an employee pursuant to a final medical determination when a subsequent final medical determination indicates that the limitations or special protective measures are no longer necessary. Your employer is required to provide an information and training program for all employees exposed to lead above the action level or who may suffer skin or eye irritation from lead. The Occupational Safety and Health Administration's standard for inorganic lead places significant emphasis on the medical surveillance of all workers exposed to levels of inorganic lead above the action level of 30 g/m3 TWA. This second physician will review the findings, recommendations or determinations of the first physician and conduct any examinations, consultations or tests deemed necessary in an attempt to make a final medical determination. All initial exposure monitoring must have been completed by May 30, 1979. (ii) Environmental monitoring, medical removal, and medical records required by this paragraph shall be provided upon request to employees, designated representatives, and the Assistant Secretary in accordance with 29 CFR 1910.1020 (a)-(e) and (2) - (i). The standard's medical surveillance program has two parts-periodic biological monitoring and medical examinations. (vi) Alternate Physician Determination Mechanisms. 56, p. 24686, May 31, 1991. 4. Cardiovascular examination should evaluate possible early signs of congestive heart failure. (iv) The employer shall maintain or assure that the physician maintains those medical records for at least 40 years, or for the duration of employment plus 20 years, whichever is longer. (ii) Temporary removal due to a final medical determination. The urinalysis is normal in early lead nephropathy and the blood urea nitrogen and serum creatinine increase only when two-thirds of kidney function is lost. HSE aims to reduce work-related death, injury and ill health. There is no sharp dividing line between rapidly developing acute effects of lead, and chronic effects which take longer to acquire. All of the above kinds of records must be kept for 40 years, or for at least 20 years after your termination of employment, whichever is longer. The lead standard provides for a multiple physician review in cases where the employee wishes a second opinion concerning potential lead poisoning or toxicity. There is occasionally associated hypertension and hyperuricemia with or without gout. As part of the medical evaluation, the lead standard requires the following laboratory studies: 2. If a worker's PbB exceeds 40 g/100g the monitoring frequency must be increased from every 6 months to at least every 2 months and not reduced until two consecutive PbBs indicate a blood lead level below 40 g/100g. (B) controls to monitor the concentration of lead in the return air and to bypass the recirculation system automatically if it fails are installed, operating, and maintained. However, careful attention must be given to calibration and quality control procedures. However, since results of the standard's medical surveillance program can significantly affect the legal remedies of a worker who has acquired a job-related disease or impairment, it is proper for OSHA to make you aware of this. Thus biological monitoring under the standard is currently limited to PbB testing. (i) Floors and other surfaces where lead accumulates may not be cleaned by the use of compressed air. Under the standard's ultimate worker removal criteria, a worker is to be removed from any work having any eight hour TWA exposure to lead of 30 g/m3 or more whenever either of the following circumstances apply: (1) a blood lead level of 60 g/100 g or greater is obtained and confirmed by a second follow-up blood lead level performed within two weeks after the employer receives the results of the first blood sampling test, or (2) the average of the previous three blood lead determinations or the average of all blood lead determinations conducted during the previous six months, whichever encompasses the longest time period, equals or exceeds 50 g/100 g, unless the last blood sample indicates a blood lead level at or below 40 g/100 g in which case the employee need not be removed. Last blood lead level between 40 g/100 g and level requiring medical removal (see A above), 3. It should be emphasized that where an employer takes a worker who has no symptoms of lead poisoning and has chelation carried out by a physician (either inside or outside of a hospital) solely to reduce the worker's blood lead level, that will generally be considered prophylactic chelation. Your employer must establish a housekeeping program sufficient to maintain all surfaces as free as practicable of accumulations of lead dust. Your employer is required to provide and assure your use of respirators when your exposure to lead is not controlled below the PEL by other means. This section will discuss the blood lead level and ZPP in detail and will outline their relative advantages and disadvantages. The employer must also inform you that the standard requires temporary medical removal with economic protection when your PbB exceeds certain criteria. 8. Corrections to appendices, Federal Register, Vol. (g) Protective work clothing and equipment -. Past research into lead-related diseases, however, has focused heavily on associations between PbBs and various diseases. If, (1) the initial removal, special protection, or limitation of the employee resulted from a final medical determination which differed from the findings, determinations, or recommendations of the initial physician or. Enough sampling must be done to enable each employee's exposure level to be reasonably least one full shift (at least 7 hours) air sample. 39 FR 23502, June 27, 1974, unless otherwise noted. After this date, all new employees must be trained prior to initial assignment to areas where there is a possibility of exposure over the action level. Levels of delta-aminolevulinic acid (ALA) in the urine are also used as a measure of lead exposure.
From March 1, 1979 to March 1, 1980, the blood lead level requiring employee medical removal is 80 g/100 g. Workers found to have a confirmed blood lead at this level or greater need only be removed from work having a daily 8 hour TWA exposure to lead at or above 100 g/m3. The use of a hospital and a physician does not mean that prophylactic chelation is not being performed.
If you have questions or comments regarding a published document please Reproductive effects. It should be stressed that OSHA is in no way trying to either encourage or discourage claims or lawsuits. Vascular and electrocardiogarphic changes have been detected but have not been well characterized. These must include the names of the employees, the physician's written opinion, and a copy of the results of the examination. (iii) Measurements of airborne lead made in the preceding 12 months may be used to satisfy the requirement to monitor under paragraph (d)(3)(i) if the sampling and analytical methods used meet the accuracy and confidence levels of paragraph (d)(9) of this section. The medical history is also of fundamental importance and should include a listing of all past and current medical conditions, current medications including proprietary drug intake, previous surgeries and hospitalizations, allergies, smoking history, alcohol consumption, and also non-occupational lead exposures such as hobbies (hunting, riflery). 5. The review of symptoms should include the following: General - weight loss, fatigue, decreased appetite. Where vacuuming methods are selected, the vacuums shall be used and emptied in a manner which minimizes the reentry of lead into the workplace. Permissible exposure without regard to respirator protection is listed by industry in Table I. When the PEL is exceeded the employer must assure that food and beverage is not present or consumed, tobacco products are not present or used, and cosmetics are not applied, except in these facilities. Copies of the Standard and explanatory material may be obtained by writing or calling the OSHA Docket Office, U.S. Department of Labor, room N2634, 200 Constitution Avenue, N.W., Washington, DC 20210. Transplacental passage becomes detectable at 12-14 weeks of gestation and increases until birth. During the first year of the standard, if your blood lead level is 80 g/100g or above you must be removed from any exposure where your air lead level without a respirator would be 100 g/m3 or above. To ensure that your respirator fits properly and that facepiece leakage is minimal, your employer must give you either a qualitative or quantitative fit test as specified in appendix A of the Respiratory Protection standard located at 29 CFR 1910.134. The presence of pallor on skin examination may indicate an anemia, which if severe might also be associated with a tachycardia. The standard includes these accepted limitations due to a history of abuse of chelation therapy by some lead companies. Lead can be absorbed into your body by inhalation (breathing) and ingestion (eating). 653, 655, 657; Secretary of Labor's Order No. (i) The employer shall make readily available to all affected employees a copy of this standard and its appendices. Frequency which employees exposed to action level of lead (30 g/m, 1. The action level initiates several requirements of the standard, such as exposure monitoring, medical surveillance, and training and education. Under this program, the blood lead level of all employees who are exposed to lead above the action level of 30 g/m3 is to be determined at least every six months. The best way to prevent all forms of lead-related impairments and diseases - both short term and long term- is to maintain your PbB below 40 g/100g. Inhalation of airborne lead is generally the most important source of occupational lead absorption. Contaminated work clothing or equipment must be removed in change rooms and not worn home or you will extend your exposure and expose your family since lead from your clothing can accumulate in your house, car, etc. (B) Prior to June 1, 2015, employers may include the following information on bags or containers of contaminated protective clothing and equipment in lieu of the labeling requirements in paragraphs (g)(2)(vii)(A) of this section: CAUTION: CLOTHING CONTAMINATED WITH LEAD. 
(ii) The employer shall provide for the cleaning, laundering, or disposal of protective clothing and equipment required by paragraph (g)(1) of this section. Routine chelation to prevent increased or reduce current blood lead levels is unacceptable whatever the setting. The employer may remove the employee from exposure to lead, provide special protective measures to the employee, or place limitations upon the employee, consistent with the medical findings, determinations, or recommendations of any of the physicians who have reviewed the employee's health status. Microsoft Edge, Google Chrome, Mozilla Firefox, or Safari. Priority within this first round of medical surveillance must be given to employees whom the employer believes to be at greatest risk from continued exposure (for example, those with the longest prior exposure to lead, or those with the highest current exposure). A. 3. (iii) The employer shall repair or replace required protective clothing and equipment as needed to maintain their effectiveness. Cranial nerve evaluation should also be included in the routine examination. The two doctors would attempt to resolve any differences of opinion, and select a third physician to resolve any firm dispute. The standard contains a procedure whereby you can obtain a second opinion by a physician of your choice if the employer selected the initial physician. (ii) If the initial determination or subsequent monitoring reveals employee exposure to be at or above the action level but below the permissible exposure limit the employer shall repeat monitoring in accordance with this paragraph at least every 6 months. Early kidney disease is difficult to detect. These three units are essentially the same. endstream
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Overexposure to lead may result in decreased sex drive, impotence and sterility in men. Therefore, the ZPP level in blood reflects the average ZPP production over the previous 3-4 months and consequently the average lead exposure during that time interval.
If you have comments or suggestions on how to improve the www.ecfr.gov website or have questions about using www.ecfr.gov, please choose the 'Website Feedback' button below. In these situations MRP benefits must still be provided as though the standard required removal. An electrocardiogram and chest x-ray may be obtained as deemed appropriate. The zinc protoporphyrin test, unlike the blood lead determination, measures an adverse metabolic effect of lead and as such is a better indicator of lead toxicity than the level of blood lead itself. Statement of reasons, Federal Register, vol. With more advanced disease there is progressive interstitial fibrosis and impaired renal function. Finally, the appropriate laboratory testing for evaluating lead exposure and toxicity is presented. (i) The employer shall establish and maintain an accurate record for each employee removed from current exposure to lead pursuant to paragraph (k) of this section. The most important increase, however, is that of coproporphyrin III; levels may exceed 5,000 g/1 in the urine in lead poisoned individuals, but its correlation with blood lead levels and ZPP are not as good as those of ALA. Increases in urinary porphyrins are not diagnostic of lead toxicity and may be seen in porphyria, some liver diseases, and in patients with high reticulocyte counts. (i) If the initial monitoring reveals employee exposure to be below the action level the measurements need not be repeated except as otherwise provided in paragraph (d)(7) of this section. Within this process there are no sharp distinctions, but rather a continuum of effects. 29 U.S.C. 9. Excluded from this definition are all other organic lead compounds. (v) Prior to June 1, 2016, employers may use the following legend in lieu of that specified in paragraph (m)(2)(ii) of this section: (i) The employer shall establish and maintain an accurate record of all monitoring required in paragraph (d) of this section. Pre-assignment and annual medical examinations must include (1) a detailed work history and medical history, (2) a thorough physical examination, and (3) a series of laboratory tests designed to check your blood chemistry and your kidney function. When lead is scattered in the air as a dust, fume or mist it can be inhaled and absorbed through you lungs and upper respiratory tract. 7. A careful and complete review must be performed to assess both recognized complaints and subtle or slowly acquired symptoms which the worker might not appreciate as being significant. Section 1910.1000, Tables Z-1, Z-2 and Z-3 also issued under 5 U.S.C. which your employer is required to make available to you. %PDF-1.5
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Gastrointestinal - nausea, vomiting, heartburn, abdominal pain, constipation or diarrhea.
10. The employer must also obtain from the physician and provide the employee with a written medical opinion containing blood lead levels, the physicians's opinion as to whether the employee is at risk of material impairment to health, any recommended protective measures for the employee if further exposure is permitted, as well as any recommended limitations upon an employee's use of respirators. A PAPR has a filter, cartridge, or canister to clean the air, and a power source that continuously blows filtered air into your breathing zone. (B) For the purposes of this section, the phrase final medical determination shall mean the outcome of the multiple physician review mechanism or alternate medical determination mechanism used pursuant to the medical surveillance provisions of this section. You as a worker, however, also have a responsibility to assist your employer in complying with the standard. The schedule which is based on individual industry considerations is given in Table 1. Last blood lead level less than 40 g/100 g, 2. 4998-4999, February 13, 1991. You also must be permitted to periodically leave your work area to wash your face and respirator facepiece whenever necessary to prevent skin irritation. This respirator selection table will enable your employer to choose a type of respirator that will give you a proper amount of protection based on your airborne lead exposure. (iii) Multiple physician review mechanism. A very important component of the total lead body burden is lead in soft tissue (liver, kidney, and brain). They must also instruct each physician to advise the employee of any occupationally or non-occupationally related medical condition requiring further treatment or evaluation. DO NOT REMOVE DUST BY BLOWING OR SHAKING. The Office of the Federal Register publishes documents on behalf of Federal agencies but does not have any authority over their programs. After showering, no clothing or equipment worn during the shift may be worn home, and this includes shoes and underwear. The abdominal examination should include auscultation for bowel sounds and abdominal bruits and palpation for organomegaly, masses, and diffuse abdominal tenderness. The blood lead level is a good index of current or recent lead absorption when there is no anemia present and when the worker has not taken any chelating agents. Inorganic lead has been found to have toxic effects on both the central and peripheral nervous systems. In male workers exposed to lead there can be a decrease in sexual drive, impotence, decreased ability to produce healthy sperm, and sterility. If you are exposed to lead above the PEL, or if you are exposed to lead compounds such as lead arsenate or lead azide which can cause skin and eye irritation, your employer must provide you with protective work clothing and equipment appropriate for the hazard. The longer you have an elevated PbB, the greater the risk that large quantities of lead are being gradually stored in your organs and tissues (body burden). Eventually extensive interstitial fibrosis ensues with sclerotic glomeruli and dilated and atrophied proximal tubules; all represent end stage kidney disease. (v) Other credits. All of the facilities and hygiene practices just discussed are essential to minimize additional sources of lead absorption from inhalation or ingestion of lead that may accumulate on you, your clothes, or your possessions. (iii) Full shift personal samples shall be representative of the monitored employee's regular, daily exposure to lead. Periodic medical surveillance of individual workers will help detect those failures. (C) At least monthly during the removal period of each employee removed from exposure to lead due to an elevated blood lead level. Lead is thought to impair thyroid function and interfere with the pituitary-adrenal axis, but again these effects have not been well defined. Renal. Your employer may select a type of respirator that provides greater protection than that required by the standard; that is, one recommended for a higher concentration of lead than is present in your workplace. 6. Short term occupational exposures of this magnitude are highly unusual, but not impossible. Renal function remains normal and the changes in this stage are probably reversible. During the period of any form of special protection or removal, the employer must maintain the worker's earnings, seniority, and other employment rights and benefits (as though the worker had not been removed) for a period of up to 18 months. Some of this lead is quickly filtered out of your body and excreted, but some remains in the blood and other tissues. (C) If the findings, determinations or recommendations of the second physician differ from those of the initial physician, then the employer and the employee shall assure that efforts are made for the two physicians to resolve any disagreement. This factor is the length of time you have had elevated PbBs. An abnormal Ca-EDTA mobilization test has been used to differentiate between lead-induced and other nephropathies, but this procedure is not widely accepted. The eCFR is displayed with paragraphs split and indented to follow the hierarchy of the document.
It is only through a careful and detailed medical and work history, a complete physical examination and appropriate laboratory testing that an accurate assessment can be made. The Electronic Code of Federal Regulations (eCFR) is a continuously updated online version of the CFR. Following discontinuation of exposure to lead, the excess body burden is only slowly mobilized from bone and other relatively stable body stores and excreted. Compounds Covered by the Standard: The word lead when used in this standard means elemental lead, all inorganic lead compounds and a class of organic lead compounds called lead soaps. Assistant Secretary means the Assistant Secretary of Labor for Occupational Safety and Health, U.S. Department of Labor, or designee. Appropriate protective work clothing and equipment can include coveralls or similar full-body work clothing, gloves, hats, shoes or disposable shoe coverlets, and face shields or vented goggles. Blood lead levels of 50-60 g/100 g in children can cause significant neurobehavioral impairments and there is evidence of hyperactivity at blood levels as low as 25 g/100 g. Given the overall body of literature concerning the adverse health effects of lead in children, OSHA feels that the blood lead level in children should be maintained below 30 g/100 g with a population mean of 15 g/100 g. Blood lead levels in the fetus and newborn likewise should not exceed 30 g/100 g. Because of lead's ability to pass through the placental barrier and also because of the demonstrated adverse effects of lead on reproductive function in both the male and female as well as the risk of genetic damage of lead on both the ovum and sperm, OSHA recommends a 30 g/100 g maximum permissible blood lead level in both males and females who wish to bear children.
