Medical Surveillance and Evaluation Programs

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.

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.

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.

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, 5^th 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, 5^th 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, 5^th 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)
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)

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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