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Medical Surveillance and Evaluation Programs

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    Title:

    Medical Surveillance and Evaluation Programs

    Publication date:

    5/10/2022

    Effective date:

    12/12/2007

    BRIEF

    Policy Summary

    In accordance with Department of Energy regulations, Health Services offers two main categories of medical evaluations to eligible Lawrence Berkeley National Laboratory (Berkeley Lab) employees: Medical Surveillance and Employee Health Evaluations.

    Who Should Read This Policy

    All Laboratory employees and supervisors

    To Read the Full Policy, Go To:

    The POLICY tab on this wiki page

    Contact Information

    For assistance or information on Berkeley Lab's medical surveillance and evaluation programs, contact:
    Health Services
    (510) 486-6266

    Title:

    Medical Surveillance and Evaluation Programs

    Publication date:

    5/10/2022

    Effective date:

    12/12/2007

    POLICY

    A. Purpose

    Regulations require that medical evaluations be offered as a part of a comprehensive occupational medicine program. These are divided into three main categories:

    • Medical surveillance evaluations offered in accordance with Department of Energy (DOE) and California Occupational Safety and Health Administration (Cal/OSHA) regulations, as well as voluntary standards. The surveillance program is to ensure employees are not overexposed to hazards, and to detect early signs of disease, prevent disease progression, and protect other members of the workforce.
    • Certifications are required by DOE and Cal/OSHA regulations and standards depending on job classification. These periodic, hazard-based medical monitoring or qualification-based fitness for duty evaluations are considered mandatory unless otherwise specified.
    • Medical evaluations conducted when determined necessary by Health Services for the purpose of providing initial and continuing assessment of employee fitness for duty.

    B. Persons Affected

    All Berkeley Lab employees and supervisors

    C. Exceptions

    None

    D. Policy Statement

    Health Services at Berkeley Lab conducts both surveillance evaluations and health evaluations for eligible employees. The Laboratory Medical Director oversees these efforts and establishes the content based on the relevant exposures and hazards, or applicable regulations.

    1. Berkeley Lab provides a wide variety of medical surveillance evaluations based upon the following:
      • Actual exposure to certain hazardous chemicals, allergens, or biological agents.
      • Actual or possible exposure to physical agents and radiation.
      • The requirement or option to wear certain types of personal protective equipment.
      • Requirements from collaborating institutions (e.g., Antarctic Field Station).

    Health Services is typically required by regulations to offer medical surveillance evaluations to protect employees from known hazardous exposures. However, employees at the Lab, in most cases, have the option to decline the evaluation. These are handled on a case-by-case basis and are dependent on the regulatory requirements and Laboratory policy. New surveillance and monitoring programs may be initiated, as needed, when regulations change or new hazards are brought to the attention of EH&S and Health Services.

    1. Certifications are periodic, hazard-based medical monitoring or qualification-based fitness for duty evaluations required by regulations and standards, or as recommended by the occupational medicine services provider, and will be provided on the frequency required.
      • Most often, this category will apply to qualification standards to operate certain types of equipment or vehicles.
      • Requirements for these exams are based on job duties and job title classifications, and the exam itself will be designed to meet the regulatory requirements for the position.
      • As mandatory requirements, these will be included as a part of the job description and offer letter issued by HR.

    By definition, these evaluations are mandatory in order to perform the job duties.

    1. Worker health evaluations are conducted under the direction of a licensed physician, in accordance with current sound and acceptable medical practices and all pertinent statutory and regulatory requirements, such as the Americans with Disabilities Act. Evaluations providing initial and continuing assessment of employee fitness for duty must be conducted when determined necessary by the Laboratory Medical Director or their designee and are offered by Health Services as follows:
      • At the time of employment entrance or transfer to a job with new functions and hazards, a medical pre-placement evaluation of the individual's general health and physical and psychological capacity to perform the essential duties of their position will establish a baseline record of physical condition and assure fitness for duty. These evaluations are tailored to the job demands, as described by the supervisor, and are required only for specific roles.
      • Diagnostic evaluations will evaluate employees' injuries and illnesses to determine work-relatedness, the applicability of medical restrictions, and referral for definitive care, as appropriate.
      • After a work-related injury or illness or an absence due to any injury or illness lasting five or more consecutive workdays (or an equivalent time period for those individuals on an alternative work schedule), a return to work evaluation will determine the individual's physical and psychological capacity to perform work and return to duty.
      • At the time of separation from employment, individuals shall be offered a general health evaluation to establish a record of physical condition.

    Participation in worker health evaluations is typically voluntary. However, we recommend all employees discuss the offer of an evaluation and potential alternatives with one of our health providers to determine the best course of action. Mandatory evaluations may be necessary depending on the job duties, regulatory requirements, and Laboratory policy.

    E. Roles and Responsibilities

    See the ES&H Manual Chapter 3 for roles and responsibilities related to the execution of this policy's implementation.

    Role

    Responsibility

    Laboratory Medical Director

    • Must determine the content of the worker health evaluations, which must be conducted under the direction of a licensed physician, in accordance with current sound and acceptable medical practices and all pertinent statutory and regulatory requirements, such as the Americans with Disabilities Act.
    • Oversees medical surveillance efforts offered by Health Services.
    • Designs exposure-appropriate medical surveillance exams.

    Supervisors and Work Leads

    • Make employees available for medical surveillance evaluations.
    • Complete the Job Demands form prior to posting a job requisition.
    • Instruct the successful candidate to schedule a medical evaluation.
    • Receive and comply with prescribed work restrictions, if any.

    Employees

    • When offered an evaluation for any of the evaluations described, respond and determine whether to participate in consultation with the trained health professionals in Health Services.
    • For certification evaluation, or other mandatory evaluations, participate as needed to ensure compliance with regulatory or institutional requirements.

    Human Resources

    • Posts job demands along with job requisitions on the Berkeley Lab Careers site.
    • In the case of required fitness for duty evaluations, prepares the job-offer letter describing the condition for successfully passing the medical evaluation.
    • Assists the selected candidate in arranging a medical evaluation.
    • In a timely manner, provides Health Services the names and contact information of employees subject to medical evaluations, as described above.

    Health Services Program

    • Informs workers of the purpose and nature of the medical evaluations and tests offered by the occupational medicine provider.
      • The purpose, nature, and results of evaluations and tests must be clearly communicated verbally and in writing to each worker provided testing.
      • The communication must be documented in the worker's medical record.
    • Occupational medicine physicians, occupational health nurses, physician's assistants, nurse practitioners, psychologists, employee assistance counselors, and other occupational health personnel providing occupational medicine services must be licensed, registered, or certified as required by federal or California law.

    F. Definitions/Acronyms

    See ES&H Manual Chapter 3 for technical terms related to the details of this policy and its implementation.

    Term

    Definition

    EH&S

    Environment, Health and Safety Division at Berkeley Lab

    Fitness for Duty Evaluation

    A medical evaluation tailored to the essential functions of the position. This evaluation may or may not include a health history, physical examination, medical testing, or functional capacity testing, etc.

    Medical Surveillance

    Medical evaluations designed to detect adverse health effects from workplace exposures, with the intent of halting disease development and progression

    Occupational Medicine Provider

    The designated site occupational medicine director (SOMD) or the individual providing medical services (as defined in 10 CFR 851)

    Pre-placement

    A time period between the time of accepting a job offer and before placement into a new job

    Transfer Medical Evaluations for Jobs with New Physical Demands

    Relevant to job transfers, this evaluation trigger occurs when the new job has new or different physical demands from the prior Berkeley Lab position

    G. Recordkeeping Requirements

    Role

    Recordkeeping Requirement

    Health Services

    • Maintains confidential medical records of employees participating in medical surveillance programs.
    • Provides work status documentation to Berkeley Lab management as required by regulation.
    • Provides documentation of medical findings to Berkeley Lab employees as required by regulation.
    • Records verbal and written communication of the purpose, nature, and results of evaluations and tests of each worker provided testing in the worker's medical record.

    H. Implementing Documents

    Document number

    Reference number

    Title

    Type


    ES&H Manual Section 3.9

    Medical Surveillance Program

    Program

    02.13.002.001


    Health Services

    Program

    07.07.004.001


    Biosafety

    Program

    07.07.022.001


    Noise Hazard Assessment and Control

    Program

    07.07.018.001


    Laser Safety Program

    Program

    07.07.023.001


    Non-ionizing Radiation

    Program

    07.07.005.001


    Chemical Safety Hazards and Controls

    Program

    07.07.002.001


    Asbestos Hazards and Controls

    Program

    07.07.019.001


    Lead Hazards and Controls

    Program

    07.07.003.001


    Beryllium Hazards and Controls

    Program

    07.07.032.001


    Respiratory Protection

    Program

    07.07.013.001


    Exposure Assessment

    Program

    07.07.025.001


    Forklifts and Other Powered Industrial Trucks

    Program

    07.07.008.001


    Cranes, Hoisting, and Rigging Safety

    Program


    ES&H Manual Chapter 46

    COVID-19 Prevention Program

    Program

    I. Contact Information

    LBNL Health Services

    Laboratory Medical Director or

    Health Services Program Manager

    J. Revision History

    Date

    Revision

    By Whom

    Revision Description

    Section(s) Affected

    Change Type

    5/10/2022

    1.2

    T. Durrani

    Periodic review (no changes) and reorganization (this policy absorbed previously separate Medical Evaluations, Employment-Related policy)

    All

    Minor

    9/10/2013

    1.1

    P. Lichty

    Reviewed 8/29/13

    Brief, Policy, Definitions, Roles, Next Review date

    Minor

    1/2/2012

    1

    P. Lichty

    Rewrite for RPM

    all

    Minor

    DOCUMENT INFORMATION

    Title:

    Medical Surveillance and Evaluation Programs

    Document number

    07.05.002.000

    Revision number

    1.2

    Publication date:

    5/10/2022

    Effective date:

    12/12/2007

    Next review date:

    5/10/2027

    Policy Area:

    Health Services

    RPM Section (home)

    Human Services

    RPM Section (cross-reference)

    none

    Functional Division

    EH&S

    Prior reference information (optional)

    ES&H Manual Section 3.9, RPM Section 1.12(A)(1)

    Source Requirements Documents

    • 10 CFR 851 Appendix A, Section 8, (k)(3), Worker Health and Safety Program; Occupational Medicine Section; Employee Counseling and Health Promotional Programs
    • DOE O 440.1B Chg 3 (LtdChg), Worker Protection Program for DOE (Including the National Nuclear Security Administration) Federal Employees

    The following are in the Laboratory's DOE Contract 31, and are good references.

    Topic

    Subtopic

    Regulation#

    Animal Care Worker

    Initial exam

    Berkeley Lab Environmental Safety and Health Manual (PUB-3000) National Research Council Guide for the Care and Use of Laboratory Animals (reference only, not in Contract 31)

    Antarctica

    Exam

    Driven by the organization servicing the south pole groups (requirements are driven by a form brought in by the employee)

    Asbestos

    Comment

    There are no personnel who qualify for mandatory general industry asbestos and the number of individuals qualifying for mandatory construction surveillance is fairly small.

    Asbestos

    Voluntary

    N/A – Past exposure history

    Asbestos (construction)

    Annual exam

    8 CCR 1529(m)(2)(A)(3)

    Asbestos (construction)

    Exit exam

    8 CCR 1529(m)(2)(A)(6)

    Asbestos (construction)

    Initial exam

    8 CCR 1529(m)(2)(A)(1)-(2)

    Beryllium

    Emergency

    10 CFR 850

    Beryllium

    Initial

    10 CFR 850.34

    Beryllium

    Periodic

    10 CFR 850

    Biological Agents and Workers with Compromised Health

    Immune competence

    Biosafety in Microbiological and Biomedical Laboratories, 5th ed. Section IV, Laboratory Biosafety Level 2(A.11.) Criteria, and VII, Occupational Health and Immunoprophylaxis. Also Biosafety Manual Section 5.3 andC.3.1.11.

    Biological Exposure Incidents

    Exposure

    Biosafety in Microbiological and Biomedical Laboratories, 5th ed. Section IV, Laboratory Biosafety Level 2(B.8) Criteria, and Section VII, Occupational Health and Immunoprophylaxis. Also Biosafety Manual Section 5.3, 5.10.2, and C.3.2.8.

    Biosafety Human Pathogens

    Potential exposure identified in Biosafety Work Authorization

    Biosafety in Microbiological and Biomedical Laboratories, 5th ed. Section IV, Laboratory Biosafety Level 2(B.2.) Criteria, and Section VII, Occupational Health and Immunoprophylaxis. Also Biosafety Manual Section 5.3, and C.3.2.2

    Bloodborne Pathogen

    Exposure incident related to a job duty or not related to a job duty

    8 CCR 5193 Biosafety Manual Sections 3.3.4 , 5.3, and 5.10.2

    Bloodborne Pathogen

    Vaccination

    8 CCR 5193

    CERN

    Exam

    Driven by the organization (requirements and form brought in by employee)

    Chemical Hygiene

    Event

    8 CCR 5191

    Crane Operator

    Chapter 27.5 >2 tons

    DOE-STD-1090-2020, Section 5.2.2.Currently have PUB-3000 Chapter 27.Clinic follows NCCCO Handbooks, which match ASME B30 (NCCCO not found in Contract 31).10 CFR 851, Appendix A 8(g)(2)(ii), requires a fitness-for-duty exam.

    Crane Operator

    Chapter 27.5 >2 tons and mobile crane driver

    8 CCR 5006.1
    10 CFR 851, Appendix A 8(g)(2)(ii)

    Crane Operator

    Chapter 27.5 <2 tons

    DOE-STD-1090-2020, Section 5.2.2.Currently have PUB-3000 Chapter 27.Clinic follows NCCCO Handbooks, which match ASME B30 (NCCCO not found in Contract 31).10 CFR 851, Appendix A 8(g)(2)(ii)
    Fitness-for-duty exam not currently required.

    COVID-19

    Prevention program

    PUB-3000, Chapter 46.
    DOE COVID-19 Workplace Safety and Reentry Framework.
    Title 8, Subchapter 7, (General Industry Safety Orders), Group 16 (Control of Hazardous Substances), Article 109 (Hazardous Substances and Processes), Sections 3205 through 3205.4, COVID-19 Prevention (Emergency Temporary Standard) (8 CCR 3205-3205.4)

    Crystalline Silica

    Non-mandatory surveillance

    8 CCR 1532.3b (reference only, not currently applicable)

    DOT Driver

    Driver medical E\exam

    49 CFR 391.41 et seq. (Reference only — not in Contract 31)

    General Health Exam

    Age based

    10 CFR 851, Appendix A 8(g)(2)(info)

    General Health Exam

    Termination

    10 CFR 851, Appendix A 8(g)(2)(v)

    Hazwoper

    Annual or periodic exam

    8 CCR 5192(f)

    Hazwoper

    Exposure exam

    8 CCR 5192(f)

    Hazwoper

    Pre-placement

    8 CCR 5192(f)

    Hazwoper

    Termination exam

    8 CCR 5192(f)

    Hearing Conservation

    Annual exam

    8 CCR 5097

    Hearing Conservation

    Baseline

    8 CCR 5097

    Laser

    Exposure exam

    ANSI Z136.1

    Laser

    Pre-use

    ANSI Z136.1 PUB-3000 Section 16.4.3.2

    Laser

    Termination exam

    Legal considerations, courtesy to user

    Lead

    Comment

    There are no personnel who qualify for mandatory annual surveillance for construction.

    Lead

    Voluntary

    8 CCCR 5198c ; 8 CCR 1532.1(j) (as guides)

    Lead (construction)

    Initial

    8 CCR 1532.1(j)(1); 8 CCCR 5198c

    Nanoparticle

    Initial

    DOE Notice/Order 456.1 (proposed)

    Nanoparticle

    Termination

    DOE Notice/Order 456.1

    PIT Operator

    Medical clearance

    ASME B56.1, Powered Industrial Trucks PUB-3000 Section 28.5 Berkeley Lab Health Services Clinic follows NCCCO Handbooks, which match ASME B30 (NCCCO not found in Contract 31) 10 CFR 851, Appendix A, 8(g)(2)(ii) requires a fitness-for-duty exam

    Pre-placement Exam

    None

    10 CFR 851, Appendix A 8(g)(2)

    Respiratory Protection

    Annual exam (SCBA users)

    8 CCR 5144 Z88.6 9.1.2

    Respiratory Protection

    Fit test

    8 CCR 5144

    Respiratory Protection

    Initial non-voluntary use

    8 CCR 5144

    Respiratory Protection

    Voluntary users (non-dust mask)

    8 CCR 5144

    Return to Work Exam

    Suitability

    10 CFR 851, Appendix A, 8(g)(2)(iv)

    Transfer Exam

    None

    10 CFR 851, Appendix A, 8(g)(2)(info)

    Related Berkeley Lab Policies

    • EHS Core Policy, 07.01.001.000
    • Health Services Overview, 02.13.002.000
    • Family and Medical Leave Policy, 02.07.003.000
    • Workers' Compensation Policy, 02.06.008.000

    Implementing Documents

    Document number

    Reference number

    Title

    Type

    07.05.002.001

    ES&H Manual Section 3.9

    Medical Surveillance Program

    Program

    02.13.002.001


    Health Services

    Program

    07.07.004.001


    Biosafety

    Program

    07.07.022.001


    Noise Hazard Assessment and Control

    Program

    07.07.018.001


    Laser Safety Program

    Program

    07.07.023.001


    Non-ionizing Radiation

    Program

    07.07.005.001


    Chemical Safety Hazards and Controls

    Program

    07.07.002.001


    Asbestos Hazards and Controls

    Program

    07.07.019.001


    Lead Hazards and Controls

    Program

    07.07.003.001


    Beryllium Hazards and Controls

    Program

    07.07.032.001


    Respiratory Protection

    Program

    07.07.013.001


    Exposure Assessment

    Program

    07.07.025.001


    Forklifts and Other Powered Industrial Trucks

    Program

    07.07.008.001


    Cranes, Hoisting, and Rigging Safety

    Program





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