Worker Protection and Medical Monitoring Requirements

(1) Applicability. The requirements of 29 CFR 1926.62, and other applicable OSHA standards shall apply to the personal protection and medical monitoring of employees except that: (a) In accordance with 454 CMR 22.13(1), Deleading Contractors shall maintain as records the results of all personal exposure monitoring, respirator fit testing, medical examinations and blood lead testing conducted pursuant to the requirements of 29 CFR 1926.62(d), (f) and (j) or pursuant to the requirements of 454 CMR 22.09; and (b) The frequency of blood monitoring of employees licensed as Deleader-supervisors and Deleader-workers shall be governed by 454 CMR 22.09(5)(a). (c) The personal protection and medical monitoring of employees and other employees exempted from coverage by OSHA standards shall be governed by the provisions of 454 CMR 22.09. (2) General Respiratory Protection Requirements. The Deleading Contractor, Lead-safe Renovation Contractor, or employer conducting Class I Deleading, Moderate-risk Deleading or Renovation Work shall ensure that employees, inspectors and other persons involved in said work are provided with respiratory protection which meets the requirements of relevant OSHA regulations, including 29 CFR 1910.134 and 29 CFR 1926.62(f). Employers shall provide respirators and all necessary maintenance materials at no cost to employees and shall provide proper respirator fit testing prior to initial use and at least annually thereafter. (3) Requirements for the Use of Protective Clothing and Equipment. The Deleading Contractor, Lead-safe Renovation Contractor, or employer conducting Class I Deleading, Moderate-risk Deleading or Renovation Work shall ensure that employees, inspectors and other persons involved in said work are provided with protective clothing and other personal protective equipment in accordance with relevant OSHA regulations, including 29 CFR 1926.62(g). In addition, the following specific requirements must be met: (a) Employers shall provide employees with protective clothing and equipment without cost. (b) Protective clothing shall provide sufficient coverage and be sufficiently impermeable to lead dust, caustic paste, chemical solvents and other contaminants to prevent contamination of underlying garments or body surfaces. (c) Where dust generating methods are used, the employer shall provide a minimum of two changes of protective clothing during an eight-hour day. (d) Where caustic paste is used to remove paint, the employer shall provide and ensure the use of: full-body overalls impervious to caustic substances; gloves impervious to caustic substances; glove extenders; appropriate boot or shoe covers; and face shields, where caustic paste is to be applied or removed at or above face level. (4) Medical Examinations and Consultations. The Deleading Contractor, Lead-safe Renovator Contractor, or other employer conducting Class I Deleading Work, Moderate-risk Deleading Work or Renovation Work shall ensure that employees are provided with medical examinations and consultations in accordance with 29 CFR 1926.62(j)(1) and (3) and 454 CMR 22.09(4)(a) through (g). (a) Frequency of Medical Examinations. The medical examinations specified by 454 CMR 22.09(4) shall be provided: 1. As soon as possible, upon notification by an employee either that he or she has developed signs or symptoms commonly associated with lead intoxication, that the employee desires medical advice concerning the effects of current or past exposure to lead on the employee's ability to procreate a healthy child, that the employee is pregnant, or that the employee has demonstrated difficulty in breathing during a respirator fitting test or during use; or 2. Immediately following medical removal specified by 454 CMR 22.09(5)(b) or as medically appropriate, as determined by a physician. (b) Requirement for Physician's Involvement or Oversight. All medical examinations and consultations conducted pursuant to 454 CMR 22.09(4) shall be performed by or under the direction of a physician. (c) Information Provided to Examining and Consulting Physicians. The Deleading Contractor, Lead-safe Renovation Contractor or other employer shall provide to the physician conducting a medical examination or consultation under 454 CMR 22.09 the following information: 1. A copy of the following sections of the Department's regulations: a. 454 CMR 22.09: Worker Protection and Medical Monitoring Requirements; b. 454 CMR 22.11: Work Practices and Other Requirements for Renovation Work; and c. 454 CMR 22.12: Work Practices and Other Requirements for Deleading Projects. 2. A description of the employee's duties as they relate to exposure to lead or other harmful substances; 3. The employee's exposure level or anticipated exposure level to lead and, where applicable, to any other toxic substance; 4. A description of any personal protective equipment used or to be used; 5. Prior blood lead determinations; and 6. All prior written medical opinions in the employer's possession or control. (d) Employer's Instructions to Physicians. The Deleading Contractor, Lead-safe Renovation Contractor, or other employer shall instruct any examining or consulting physician to: 1. Not reveal to the employer, either in a written statement of medical findings or in any other means of communication, any findings, including laboratory results or diagnoses unrelated to an applicant's occupational exposure to lead or ability to engage in Deleading or Renovation Work; 2. Advise the applicant or employee of any medical condition, occupational or non-occupational, which dictates further medical examination or treatment; 3. Provide the applicant or employee with a clear warning of the reproductive hazards caused by exposure to lead; and 4. Provide to the employer a copy of the Reporting Physician's Statement for provision to the applicant or employee as required under 454 CMR 22.09(4)(f). (e) Elements of Medical Examination. Medical examinations made pursuant to 454 CMR 22.09 shall include the following elements: 1. A detailed work history and a medical history, with particular attention to past lead exposure, personal habits and hygiene, and past or present gastrointestinal, hematologic, renal, cardiovascular, reproductive and neurological problems; 2. A thorough physical examination, with particular attention to teeth, gums, hematologic, gastrointestinal, renal, cardiovascular, neurological, and pulmonary systems; 3. A blood pressure measurement; 4. A blood sample which determines: a. Blood lead level; b. Hemoglobin and hematocrit determinations, red cell indices, and examination of peripheral smear morphology; c. Zpp; d. Blood urea nitrogen; e. Serum creatinine; 5. A routine urinalysis with microscopic examination; and 6. Any laboratory or other test relevant to lead exposure which the examining physician deems necessary by sound medical practice. (f) Reporting Physician's Statement. Within two working days after receipt of the Reporting Physician's Statement, the Deleading Contractor, Lead Safe Renovation Contractor, or other employer, shall furnish a copy of the same to the applicant or employee. (g) Reporting of Blood Lead Levels. Within two working days after the receipt of the report of the applicant's or employee's blood lead level, the Deleading Contractor, Lead-safe Renovation Contractor, or other employer shall furnish the applicant or employee with a copy thereof. (5) Blood Lead and Zpp Level Monitoring. (a) Frequency of Testing. 1. Deleader-supervisors and Deleader-workers shall receive blood lead and zpp monitoring every two months during the first six months following licensure or certification and at least quarterly thereafter. 2. Except as specified by 454 CMR 22.09(5)(a)3., Lead-safe Renovator-supervisors and Workers on Renovation Projects shall receive blood lead and zpp monitoring according to the schedule set forth at 29 CFR 1926.62(j). 3. Persons tested pursuant to 454 CMR 22.09(5)(a)1. or 2. whose last blood lead analysis indicates a lead level at or above 25 ug/dl of whole blood shall be tested at least every two months until two consecutive blood lead analyses indicate blood lead levels below 25 ug/dl of whole blood. 4. Where a person is removed from Deleading or Renovation Work pursuant to 454 CMR 22.09(5)(b), said person shall receive blood lead and zpp testing at least monthly during the period of medical removal. 5. Upon being hired to perform Deleading Work for a new employer, and before engaging in such work, Deleader-supervisors and Deleader-workers shall receive blood lead and zpp monitoring in accordance with the schedule set forth at 454 CMR 22.09(5)(a) unless more frequent testing is indicated by 454 CMR 22.09(5)(a)3. or 4. (b) Medical Removal. No person whose blood lead level is above 50 ug/dl shall be permitted to engage in Deleading or Renovation Work that further exposes the individual to lead hazards. Said person shall immediately be removed from any lead exposure when the result of any single test of his or her blood lead level is at or above 50 ug/dl of whole blood. In order to confirm the accuracy of the laboratory test result, a second blood test shall be taken within two weeks. (c) Return to Work Following Medical Removal. A person medically removed from Deleading or Renovation Work pursuant to 454 CMR 22.09(5)(b) may return to his or her former job status when two consecutive blood sampling tests indicate that the blood lead level is below 40 ug/dl of whole blood, in accordance with the standard set forth at 29 OSHA 1926.62(K)(1)(iii)(A)(1). (d) Blood Lead Testing Laboratories. Blood lead samples collected in accordance with 454 CMR 22.00 shall be analyzed by the Department of Labor Standards, Industrial Hygiene Laboratory, or by laboratories approved by OSHA-CDC for blood lead analysis.