Occupational Safety and Health Standards for Cadmium in Shipyard Employment and Construction

Federal RegisterJan 3, 1994

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SUMMARY: The Occupational Safety and Health Administration (OSHA) is

correcting an error stemming from the wording of the amendatory

language of the final rule that incorporated applicable General

Industry standards for toxic substances into the Occupational Safety

and Health Standards for Shipyard Employment. The final rule, which

appeared in the Federal Register on July 1, 1993, had the effect of

mistakenly inferring that the cadmium standard for shipyard employment

from the Code of Federal Regulations was being deleted though the

preamble made it clear it was retained. This correction reprints the

full text of the cadmium standard as published on September 14, 1992,

and incorporates changes from an April 23, 1993, document that made

corrections and amendments to the original publication. In addition,

several cross-references regarding employee records are being amended

to reflect the designation of a new section in the shipyard employment

standards, and a number of effective dates are being converted to dates

certain.

In addition, OSHA is redesignating the cadmium standard for

construction employment, also published in the same September 14

document, into a different subpart. The redesignation merges it in with

the newly created subpart that contains specific toxic substance

standards for construction.

EFFECTIVE DATE: July 1, 1993.

FOR FURTHER INFORMATION CONTACT: Mr. James F. Foster, OSHA Office of

Public Affairs, Room N-3647, U.S. Department of Labor, 200 Constitution

Avenue NW., Washington, DC 20210, telephone (202) 219-8151.

SUPPLEMENTARY INFORMATION:

Background

The final regulations which are the subject of this action was

published in the Federal Register on June 30 and July 1, 1993 (58 FR

35076 and 35512, respectively). Up until then, most health standards

applicable to shipyard employment and construction were not codified in

the parts of title 29 of the Code of Federal Regulations that contained

the bulk of the standards applicable to shipyards (part 1915) and

construction (part 1926). These toxic substance standards were made

applicable by cross-reference to subpart Z of the general industry

standards (part 1910) and other parts and documents.

The Shipyard Employment Standard Advisory Committee (SESAC)

recommended that OSHA incorporate all toxic substance standards

covering shipyards into 29 CFR part 1915. As a first step to carry out

this recommendation, when OSHA issued the cadmium standard on September

14, 1992 (57 FR 42102), it created a subpart Z in part 1915 to include

health standards applicable to shipyards and included the cadmium

standard in subpart Z as Sec. 1915.1027. On April 23, 1993 (58 FR

21780), OSHA published a document that made corrections and amendments

to the September 14 document. As a second step, OSHA published a

technical amendment in the July 1, 1993, issue of the Federal Register,

which incorporated a comprehensive subpart Z into 29 CFR part 1915. The

July 1 document included the other toxic substance standards besides

cadmium, and added certain related standards applicable to shipyards.

In similar fashion to what SESAC sought, the Advisory Committee for

Construction Safety and Health also asked that OSHA incorporate the

general industry standards deemed applicable to construction into

OSHA's construction standards. This incorporation of the pertinent 1910

standards into part 1926 was accomplished on June 30, 1993 (58 FR

35076), and in doing so, OSHA created a subpart Z in part 1926, for the

applicable specific toxic substance standards.

Need for Correction

As published, the July 1 final regulation contained amendatory

language that had the effect of removing the regulatory text and

appendixes of Sec. 1915.1027--Cadmium, by mistake. The preamble of that

document made it clear that the Cadmium standard remained applicable to

shipyard employment (58 FR 35513). This document reinserts the

regulatory text and appendices of Sec. 1915.1027 into subpart Z--Toxic

and Hazardous Substances of part 1915 along with the corrections and

amendments made on April 23, 1993.

In addition, in the July 1 document, the text of existing

Sec. 1910.20, entitled ``Access to employee exposure and medical

records,'' was reprinted as an additional standard in part 1915, to add

it to the shipyard employment standards as new Sec. 1915.1120. OSHA is

changing cross-references in paragraphs (m) and (n) of the cadmium

standard to reflect the designation for the new section regarding

employee records within part 1915. These changes are to

Sec. 1915.1027(m)(4)(iii)(H), where the reference to ``Sec. 1910.20(g)

(1) and (2)'' is changed to read ``Sec. 1915.1120(g) (1) and (2)''; in

Sec. 1915.1027(n) (1)(iii), (3)(iii), and (5)(i), the reference to ``29

CFR 1910.20'' is changed to read ``Sec. 1915.1120 of this part''; and

in Sec. 1915.1027(n)(6), the reference to ``29 CFR 1910.20(h)'' is

changed to read ``Sec. 1915.1120(h) of this part.''

In this document, OSHA is also converting a number of effective

dates that were not computed to dates certain. As published on

September 14, 1992, the standard included over a dozen effective dates

that were based on the effective dates of the cadmium document, such as

for 60 and 90 days after the section or standard became effective.

These dates, set out in paragraphs (p)(2)(i)-(viii) (57 FR 42399) are

being computed in this document. The following list details the

specific instances where these changes are made:

In Sec. 1915.1027(p)(2)(i), the words ``60 days after the

effective date of this standard'' are changed to read ``February 12,

1993'';

In Sec. 1915.1027(p)(2)(vi)(A), the words ``60 days after

the effective date of this section'' are changed to read ``February 12,

1993'';

In Sec. 1915.1027(p)(2) (ii) and (iii), the words ``90

days after the effective date of this section'' are changed to read

``March 15, 1993'';

In Sec. 1915.1027(p)(2) (vii) and (viii), the words ``90

days after the effective date of this standard'' are changed to read

``March 15, 1993'';

In Sec. 1915.1027(p)(2)(i), the words ``120 days after the

effective date of this standard'' are changed to read ``April 14,

1993'';

In Sec. 1915.1027(p)(2) (ii) and (iii), the words ``150

days after the effective date of this section'' are changed to read

``May 14, 1993'';

In Sec. 1915.1027(p)(2) (vii) and (viii), the words ``180

days after the effective date of this standard'' are changed to read

``June 14, 1993'';

In Sec. 1915.1027(p)(2) (iv) and (iv)(B), the words ``1

year after the effective date of this section'' are changed to read

``December 14, 1993''; and

In Sec. 1915.1027(p)(2)(v), the words ``two (2) years

after the effective date of this section'' are changed to read

``December 14, 1994.''

When it was published in the same September 14, 1992, document, at

57 FR 42452, the cadmium standard for construction was codified as

Sec. 1926.63 in subpart D, which covers occupational health and

environmental controls. With the publication of the June 30, 1993,

document that created a separate subpart Z for specific toxic

substances within OSHA's construction standards, it follows that the

cadmium standard belongs with the new subpart. Therefore, this document

is redesignating Sec. 1926.63 as Sec. 1926.1127, to place it in the

appropriate place subpart Z of the construction standards.

In addition, in the June 30 document, the text of existing

Sec. 1910.20, entitled ``Access to employee exposure and medical

records,'' was reprinted as an additional standard in part 1926, to add

it to the construction standards as new Sec. 1926.33. OSHA is amending

cross-references in paragraphs (m) and (n) of the cadmium standard

(redesignated as Sec. 1926.1127) to reflect the designation for the new

section regarding employee records within part 1926. These changes are

to paragraph (m)(4)(iii)(H), where the reference to ``Sec. 1910.20(g)

(1) and (2)'' is changed to read ``Sec. 1926.33(g) (1) and (2)''; in

paragraphs (n) (1)(iii), (3)(iii), and (5)(i), where the reference to

``29 CFR 1910.20'' is changed to read ``Sec. 1926.33 of this part'';

and in paragraph (n)(6), the reference to ``29 CFR 1910.20(h)'' is

changed to read ``Sec. 1926.33(h) of this part.''

The corrections and technical amendments in this document are not

substantive regulatory actions, and therefore are not required to have

notice, comment, or an advance effective date. They are being made

retroactively effective, as of July 1, 1993, to make it clear that the

cadmium standard has been in effect covering shipyard employment since

December 14, 1992. The cadmium standard remained in effect subsequent

to the July 1, 1993, Federal Register document, as was OSHA's clearly

expressed intent.

List of Subjects

29 CFR Part 1915

Air contaminants, Hazardous materials, Hazard communication,

Laboratories, Medical records, Occupational safety and health,

Recordkeeping, Shipyards, Shipbuilding, Ship repairing, Shipbreaking,

Toxic chemicals.

29 CFR Part 1926

Construction industry, Hazardous materials, Occupational safety and

health, Protective equipment.

Authority and Signature

This document was prepared under the direction of Joseph A. Dear,

Assistant Secretary of Labor for Occupational Safety and Health, U.S.

Department of Labor, 200 Constitution Avenue, NW., Washington, DC

20210.

Accordingly, pursuant to sections 4, 6, and 8 of the Occupational

Safety and Health Act (29 U.S.C. 653, 655, and 657); section 107 of the

Contract Work Hours and Safety Standards Act (Construction Safety Act)

(40 U.S.C. 333); section 41 Longshore and Harbor Workers Compensation

Act (33 U.S.C. 941); section 4 of the Administrative Procedure Act (5

U.S.C. 553); and Secretary of Labor's Order No. 1-90 (55 FR 9033); OSHA

is issuing these corrections and technical amendments.

Signed at Washington, DC, 17th day of December, 1993.

Joseph A. Dear,

Assistant Secretary of Labor.

Accordingly, 29 CFR part 1915, subpart Z is corrected by the

following amendment:

PART 1915--OCCUPATIONAL SAFETY AND HEALTH STANDARDS FOR SHIPYARD

EMPLOYMENT

1. The authority citation for subpart Z of part 1915 continues to

read as follows:

Authority: Sections 4, 6, 8 Occupational Safety and Health Act,

29 U.S.C. 653, 655, 657; Sec. 4 of the Administrative Procedure Act,

5 U.S.C. 553; Secretary of Labor's Orders 12-71 (36 FR 8754), 8-76

(41 FR 25059), 9-83 (48 FR 35736), or 1-90 (55 FR 9033), as

applicable; and 29 CFR part 1911.

Subpart Z--Toxic and Hazardous Substances [Amended]

2. Subpart Z of part 1915 is corrected by adding the text and

appendices of Sec. 1915.1027 as follows:

Sec. 1915.1027 Cadmium.

(a) Scope. This standard applies to all occupational exposures to

cadmium and cadmium compounds, in all forms, and in all industries

covered by the Occupational Safety and Health Act, except the

construction-related industries, which are covered under 29 CFR

1926.63.

(b) Definitions.

Action level (AL) is defined as an airborne concentration of

cadmium of 2.5 micrograms per cubic meter of air (2.5 g/m\3\),

calculated as an 8-hour time-weighted average (TWA).

Assistant Secretary means the Assistant Secretary of Labor for

Occupational Safety and Health, U.S. Department of Labor, or designee.

Authorized person means any person authorized by the employer and

required by work duties to be present in regulated areas or any person

authorized by the OSH Act or regulations issued under it to be in

regulated areas.

Director means the Director of the National Institute for

Occupational Safety and Health (NIOSH), U.S. Department of Health and

Human Services, or designee.

Employee exposure and similar language referring to the air cadmium

level to which an employee is exposed means the exposure to airborne

cadmium that would occur if the employee were not using respiratory

protective equipment.

Final medical determination is the written medical opinion of the

employee's health status by the examining physician under paragraphs

(l)(3)-(12) of this section or, if multiple physician review under

paragraph (l)(13) of this section or the alternative physician

determination under paragraph (l)(14) of this section is invoked, it is

the final, written medical finding, recommendation or determination

that emerges from that process.

High-efficiency particulate air (HEPA) filter means a filter

capable of trapping and retaining at least 99.97 percent of mono-

dispersed particles of 0.3 micrometers in diameter.

Regulated area means an area demarcated by the employer where an

employee's exposure to airborne concentrations of cadmium exceeds, or

can reasonably be expected to exceed the permissible exposure limit

(PEL).

This section means this cadmium standard.

that no employee is exposed to an airborne concentration of cadmium in

excess of five micrograms per cubic meter of air (5 g/m\3\),

calculated as an eight-hour time-weighted average exposure (TWA).

(d) Exposure monitoring--(1) General. (i) Each employer who has a

workplace or work operation covered by this section shall determine if

any employee may be exposed to cadmium at or above the action level.

(ii) Determinations of employee exposure shall be made from

breathing zone air samples that reflect the monitored employee's

regular, daily 8-hour TWA exposure to cadmium.

(iii) Eight-hour TWA exposures shall be determined for each

employee on the basis of one or more personal breathing zone air

samples reflecting full shift exposure on each shift, for each job

classification, in each work area. Where several employees perform the

same job tasks, in the same job classification, on the same shift, in

the same work area, and the length, duration, and level of cadmium

exposures are similar, an employer may sample a representative fraction

of the employees instead of all employees in order to meet this

requirement. In representative sampling, the employer shall sample the

employee(s) expected to have the highest cadmium exposures.

(2) Specific. (i) Initial monitoring. Except as provided for in

paragraphs (d)(2)(ii) and (d)(2)(iii) of this section, the employer

shall monitor employee exposures and shall base initial determinations

on the monitoring results.

(ii) Where the employer has monitored after September 14, 1991,

under conditions that in all important aspects closely resemble those

currently prevailing and where that monitoring satisfies all other

requirements of this section, including the accuracy and confidence

levels of paragraph (d)(6) of this section, the employer may rely on

such earlier monitoring results to satisfy the requirements of

paragraph (d)(2)(i) of this section.

(iii) Where the employer has objective data, as defined in

paragraph (n)(2) of this section, demonstrating that employee exposure

to cadmium will not exceed the action level under the expected

conditions of processing, use, or handling, the employer may rely upon

such data instead of implementing initial monitoring.

(3) Monitoring Frequency (periodic monitoring). (i) If the initial

monitoring or periodic monitoring reveals employee exposures to be at

or above the action level, the employer shall monitor at a frequency

and pattern needed to represent the levels of exposure of employees and

where exposures are above the PEL to assure the adequacy of respiratory

selection and the effectiveness of engineering and work practice

controls. However, such exposure monitoring shall be performed at least

every six months. The employer, at a minimum, shall continue these

semi-annual measurements unless and until the conditions set out in

paragraph (d)(3)(ii) of this section are met.

(ii) If the initial monitoring or the periodic monitoring indicates

that employee exposures are below the action level and that result is

confirmed by the results of another monitoring taken at least seven

days later, the employer may discontinue the monitoring for those

employees whose exposures are represented by such monitoring.

(4) Additional monitoring. The employer also shall institute the

exposure monitoring required under paragraphs (d)(2)(i) and (d)(3) of

this section whenever there has been a change in the raw materials,

equipment, personnel, work practices, or finished products that may

result in additional employees being exposed to cadmium at or above the

action level or in employees already exposed to cadmium at or above the

action level being exposed above the PEL, or whenever the employer has

any reason to suspect that any other change might result in such

further exposure.

(5) Employee notification of monitoring results. (i) Within 15

working days after the receipt of the results of any monitoring

performed under this section, the employer shall notify each affected

employee individually in writing of the results. In addition, within

the same time period the employer shall post the results of the

exposure monitoring in an appropriate location that is accessible to

all affected employees.

(ii) Wherever monitoring results indicate that employee exposure

exceeds the PEL, the employer shall include in the written notice a

statement that the PEL has been exceeded and a description of the

corrective action being taken by the employer to reduce employee

exposure to or below the PEL.

(6) Accuracy of measurement. The employer shall use a method of

monitoring and analysis that has an accuracy of not less than plus or

minus 25 percent ( 25%), with a confidence level of 95

percent, for airborne concentrations of cadmium at or above the action

level, the permissible exposure limit (PEL), and the separate

engineering control air limit (SECAL).

(e) Regulated areas--(1) Establishment. The employer shall

establish a regulated area wherever an employee's exposure to airborne

concentrations of cadmium is, or can reasonably be expected to be in

excess of the permissible exposure limit (PEL).

(2) Demarcation. Regulated areas shall be demarcated from the rest

of the workplace in any manner that adequately establishes and alerts

employees of the boundaries of the regulated area.

(3) Access. Access to regulated areas shall be limited to

authorized persons.

(4) Provision of respirators. Each person entering a regulated area

shall be supplied with and required to use a respirator, selected in

accordance with paragraph (g)(2) of this section.

(5) Prohibited activities. The employer shall assure that employees

do not eat, drink, smoke, chew tobacco or gum, or apply cosmetics in

regulated areas, carry the products associated with these activities

into regulated areas, or store such products in those areas.

(f) Methods of compliance--(1) Compliance hierarchy. (i) Except as

specified in paragraphs (f)(1) (ii), (iii) and (iv) of this section the

employer shall implement engineering and work practice controls to

reduce and maintain employee exposure to cadmium at or below the PEL,

except to the extent that the employer can demonstrate that such

controls are not feasible.

(ii) Except as specified in paragraphs (f)(1) (iii) and (iv) of

this section, in industries where a separate engineering control air

limit (SECAL) has been specified for particular processes (See Table 1

in this paragraph (f)(1)(ii)), the employer shall implement engineering

and work practice controls to reduce and maintain employee exposure at

or below the SECAL, except to the extent that the employer can

demonstrate that such controls are not feasible.

Table 1.--Separate Engineering Control Airborne Limits (SECALs) for

Processes in Selected Industries

------------------------------------------------------------------------

SECAL

Industry Process (g/

m3)

------------------------------------------------------------------------

Nickel cadmium battery.... Plate making, plate 50

preparation.

All other processes........... 15

Zinc/Cadmium refining*.... Cadmium refining, casting, 50

melting, oxide production,

sinter plant.

Pigment manufacture....... Calcine, crushing, milling, 50

blending.

All other processes........... 15

Stabilizers*.............. Cadmium oxide charging, 50

crushing, drying, blending.

Lead smelting*............ Sinter plant, blast furnace, 50

baghouse, yard area.

Plating*.................. Mechanical plating............ 15

------------------------------------------------------------------------

*Processes in these industries that are not specified in this table must

achieve the PEL using engineering controls and work practices as

required in f(1)(i).

(iii) The requirement to implement engineering and work practice

controls to achieve the PEL or, where applicable, the SECAL does not

apply where the employer demonstrates the following:

(A) The employee is only intermittently exposed; and

(B) The employee is not exposed above the PEL on 30 or more days

per year (12 consecutive months).

(iv) Wherever engineering and work practice controls are required

and are not sufficient to reduce employee exposure to or below the PEL

or, where applicable, the SECAL, the employer nonetheless shall

implement such controls to reduce exposures to the lowest levels

achievable. The employer shall supplement such controls with

respiratory protection that complies with the requirements of paragraph

(g) of this section and the PEL.

(v) The employer shall not use employee rotation as a method of

compliance.

(2) Compliance program. (i) Where the PEL is exceeded, the employer

shall establish and implement a written compliance program to reduce

employee exposure to or below the PEL by means of engineering and work

practice controls, as required by paragraph (f)(1) of this section. To

the extent that engineering and work practice controls cannot reduce

exposures to or below the PEL, the employer shall include in the

written compliance program the use of appropriate respiratory

protection to achieve compliance with the PEL.

(ii) Written compliance programs shall include at least the

following:

(A) A description of each operation in which cadmium is emitted;

e.g., machinery used, material processed, controls in place, crew size,

employee job responsibilities, operating procedures, and maintenance

practices;

(B) A description of the specific means that will be employed to

achieve compliance, including engineering plans and studies used to

determine methods selected for controlling exposure to cadmium, as well

as, where necessary, the use of appropriate respiratory protection to

achieve the PEL;

(D) Air monitoring data that document the sources of cadmium

emissions;

(E) A detailed schedule for implementation of the program,

including documentation such as copies of purchase orders for

equipment, construction contracts, etc.;

(F) A work practice program that includes items required under

paragraphs (h), (i), and (j) of this section;

(G) A written plan for emergency situations, as specified in

paragraph (h) of this section; and

(H) Other relevant information.

(iii) The written compliance programs shall be reviewed and updated

at least annually, or more often if necessary, to reflect significant

changes in the employer's compliance status.

(iv) Written compliance programs shall be provided upon request for

examination and copying to affected employees, designated employee

representatives as well as to the Assistant Secretary, and the

Director.

(3) Mechanical ventilation. (i) When ventilation is used to control

exposure, measurements that demonstrate the effectiveness of the system

in controlling exposure, such as capture velocity, duct velocity, or

static pressure shall be made as necessary to maintain its

effectiveness.

(ii) Measurements of the system's effectiveness in controlling

exposure shall be made as necessary within five working days of any

change in production, process, or control that might result in a

significant increase in employee exposure to cadmium.

(iii) Recirculation of air. If air from exhaust ventilation is

recirculated into the workplace, the system shall have a high

efficiency filter and be monitored to assure effectiveness.

(iv) Procedures shall be developed and implemented to minimize

employee exposure to cadmium when maintenance of ventilation systems

and changing of filters is being conducted.

(g) Respirator protection--(1) General. Where respirators are

required by this section, the employer shall provide them at no cost to

the employee and shall assure that they are used in compliance with the

requirements of this section. Respirators shall be used in the

following circumstances:

(i) Where exposure levels exceed the PEL, during the time period

necessary to install or implement feasible engineering and work

practice controls;

(ii) In those maintenance and repair activities and during those

brief or intermittent operations where exposures exceed the PEL and

engineering and work practice controls are not feasible or are not

required;

(iii) In regulated areas, as prescribed in paragraph (e) of this

section;

(iv) Where the employer has implemented all feasible engineering

and work practice controls and such controls are not sufficient to

reduce exposures to or below the PEL;

(v) In emergencies;

(vi) Wherever an employee who is exposed to cadmium at or above the

action level requests a respirator;

(vii) Wherever an employee is exposed above the PEL in an industry

to which a SECAL is applicable; and

(viii) Wherever an employee is exposed to cadmium above the PEL and

engineering controls are not required under paragraph (f)(1)(iii) of

this section.

(2) Respirator selection. (i) Where respirators are required under

this section, the employer shall select and provide the appropriate

respirator as specified in Table 2 in this paragraph (g)(2)(i). The

employer shall select respirators from among those jointly approved as

acceptable protection against cadmium dust, fume, and mist by the Mine

Safety and Health Administration (MSHA) and by the National Institute

for Occupational Safety and Health (NIOSH) under the provisions of 30

CFR part 11.

Table 2.--Respiratory Protection for Cadmium

----------------------------------------------------------------------------------------------------------------

Airborne concentration or condition of usea Required respirator typeb

----------------------------------------------------------------------------------------------------------------

10 x or less............................. A half mask, air-purifying respirator equipped with a HEPAc

filter.d

25 x or less............................. A powered air-purifying respirator (``PAPR'') with a loose-fitting

hood or helmet equipped with a HEPA filter, or a supplied-air

respirator with a loose-fitting hood or helmet facepiece operated

in the continuous flow mode.

50 x or less............................. A full facepiece air-purifying respirator equipped with a HEPA

filter, or a powered air-purifying respirator with a tight-fitting

half mask equipped with a HEPA filter, or a supplied air

respirator with a tight-fitting half mask operated in the

continuous flow mode.

250 x or less............................ A powered air-purifying respirator with a tight-fitting full

facepiece equipped with a HEPA filter, or a supplied-air

respirator with a tight-fitting full facepiece operated in the

continuous flow mode.

1000 x or less........................... A supplied-air respirator with half mask or full facepiece operated

in the pressure demand or other positive pressure mode.

>1000 x or unknown concentrations........ A self-contained breathing apparatus with a full facepiece operated

in the pressure demand or other positive pressure mode, or a

supplied-air respirator with a full facepiece operated in the

pressure demand or other positive pressure mode and equipped with

an auxiliary escape type self-contained breathing apparatus

operated in the pressure demand mode.

Fire fighting.............................. A self-contained breathing apparatus with full facepiece operated

in the pressure demand or other positive pressure mode.

----------------------------------------------------------------------------------------------------------------

aConcentrations expressed as multiple of the PEL.

bRespirators assigned for higher environmental concentrations may be used at lower exposure levels. Quantitative

fit testing is required for all tight-fitting air purifying respirators where airborne concentration of

cadmium exceeds 10 times the TWA PEL (10 x 5 g/m3=50 g/m3). A full facepiece respirator is

required when eye irritation is experienced.

cHEPA means High Efficiency Particulate Air.

dFit testing, qualitative or quantitative, is required.

SOURCE: Respiratory Decision Logic, NIOSH, 1987.

(ii) The employer shall provide a powered, air-purifying respirator

(PAPR) in lieu of a negative pressure respirator wherever:

(A) An employee entitled to a respirator chooses to use this type

of respirator; and

(B) This respirator will provide adequate protection to the

employee.

(3) Respirator program. (i) Where respiratory protection is

required, the employer shall institute a respirator protection program

in accordance with 29 CFR 1910.134.

(ii) The employer shall permit each employee who is required to use

an air purifying respirator to leave the regulated area to change the

filter elements or replace the respirator whenever an increase in

breathing resistance is detected and shall maintain an adequate supply

of filter elements for this purpose.

(iii) The employer shall also permit each employee who is required

to wear a respirator to leave the regulated area to wash his or her

face and the respirator facepiece whenever necessary to prevent skin

irritation associated with respirator use.

(iv) If an employee exhibits difficulty in breathing while wearing

a respirator during a fit test or during use, the employer shall make

available to the employee a medical examination in accordance with

paragraph (l)(6)(ii) of this section to determine if the employee can

wear a respirator while performing the required duties.

(v) No employee shall be assigned a task requiring the use of a

respirator if, based upon his or her most recent examination, an

examining physician determines that the employee will be unable to

continue to function normally while wearing a respirator. If the

physician determines the employee must be limited in, or removed from

his or her current job because of the employee's inability to wear a

respirator, the limitation or removal shall be in accordance with

paragraphs (l) (11) and (12) of this section.

(4) Respirator fit testing. (i) The employer shall assure that the

respirator issued to the employee is fitted properly and exhibits the

least possible facepiece leakage.

(ii) For each employee wearing a tight-fitting, air purifying

respirator (either negative or positive pressure) who is exposed to

airborne concentrations of cadmium that do not exceed 10 times the PEL

(10 x 5 g/m\3\ = 50 g/m\3\), the employer shall

perform either quantitative or qualitative fit testing at the time of

initial fitting and at least annually thereafter. If quantitative fit

testing is used for a negative pressure respirator, a fit factor that

is at least 10 times the protection factor for that class of

respirators (Table 2 in paragraph (g)(2)(i) of this section) shall be

achieved at testing.

(iii) For each employee wearing a tight-fitting air purifying

respirator (either negative or positive pressure) who is exposed to

airborne concentrations of cadmium that exceed 10 times the PEL (10 x

5 g/m\3\ = 50 g/m\3\), the employer shall perform

quantitative fit testing at the time of initial fitting and at least

annually thereafter. For negative-pressure respirators, a fit factor

that is at least 10 times the protection factor for that class of

respirators (Table 2 in paragraph (g)(2)(i) of this section) shall be

achieved during quantitative fit testing.

(iv) For each employee wearing a tight-fitting, supplied-air

respirator or self-contained breathing apparatus, the employer shall

perform quantitative fit testing at the time of initial fitting and at

least annually thereafter. This shall be accomplished by fit testing an

air purifying respirator of identical type facepiece, make, model, and

size as the supplied air respirator or self-contained breathing

apparatus that is equipped with HEPA filters and tested as a surrogate

(substitute) in the negative pressure mode. A fit factor that is at

least 10 times the protection factor for that class of respirators

(Table 2 in paragraph (g)(2)(i) of this section) shall be achieved

during quantitative fit testing. A supplied-air respirator or self-

contained breathing apparatus with the same type facepiece, make,

model, and size as the air purifying respirator with which the employee

passed the quantitative fit test may then be used by that employee up

to the protection factor listed in Table 2 for that class of

respirators.

(v) Fit testing shall be conducted in accordance with appendix C of

this section.

(h) Emergency situations. The employer shall develop and implement

a written plan for dealing with emergency situations involving

substantial releases of airborne cadmium. The plan shall include

provisions for the use of appropriate respirators and personal

protective equipment. In addition, employees not essential to

correcting the emergency situation shall be restricted from the area

and normal operations halted in that area until the emergency is

abated.

(i) Protective work clothing and equipment--(1) Provision and use.

If an employee is exposed to airborne cadmium above the PEL or where

skin or eye irritation is associated with cadmium exposure at any

level, the employer shall provide at no cost to the employee, and

assure that the employee uses, appropriate protective work clothing and

equipment that prevents contamination of the employee and the

employee's garments. Protective work clothing and equipment includes,

but is not limited to:

(i) Coveralls or similar full-body work clothing;

(ii) Gloves, head coverings, and boots or foot coverings; and

(iii) Face shields, vented goggles, or other appropriate protective

equipment that complies with 29 CFR 1910.133.

(2) Removal and storage. (i) The employer shall assure that

employees remove all protective clothing and equipment contaminated

with cadmium at the completion of the work shift and do so only in

change rooms provided in accordance with paragraph (j)(1) of this

section.

(ii) The employer shall assure that no employee takes cadmium-

contaminated protective clothing or equipment from the workplace,

except for employees authorized to do so for purposes of laundering,

cleaning, maintaining, or disposing of cadmium contaminated protective

clothing and equipment at an appropriate location or facility away from

the workplace.

(iii) The employer shall assure that contaminated protective

clothing and equipment, when removed for laundering, cleaning,

maintenance, or disposal, is placed and stored in sealed, impermeable

bags or other closed, impermeable containers that are designed to

prevent dispersion of cadmium dust.

(iv) The employer shall assure that bags or containers of

contaminated protective clothing and equipment that are to be taken out

of the change rooms or the workplace for laundering, cleaning,

maintenance or disposal shall bear labels in accordance with paragraph

(m)(3) of this section.

(3) Cleaning, replacement, and disposal. (i) The employer shall

provide the protective clothing and equipment required by paragraph

(i)(1) of this section in a clean and dry condition as often as

necessary to maintain its effectiveness, but in any event at least

weekly. The employer is responsible for cleaning and laundering the

protective clothing and equipment required by this paragraph to

maintain its effectiveness and is also responsible for disposing of

such clothing and equipment.

(ii) The employer also is responsible for repairing or replacing

required protective clothing and equipment as needed to maintain its

effectiveness. When rips or tears are detected while an employee is

working they shall be immediately mended, or the worksuit shall be

immediately replaced.

(iii) The employer shall prohibit the removal of cadmium from

protective clothing and equipment by blowing, shaking, or any other

means that disperses cadmium into the air.

(iv) The employer shall assure that any laundering of contaminated

clothing or cleaning of contaminated equipment in the workplace is done

in a manner that prevents the release of airborne cadmium in excess of

the permissible exposure limit prescribed in paragraph (c) of this

section.

(v) The employer shall inform any person who launders or cleans

protective clothing or equipment contaminated with cadmium of the

potentially harmful effects of exposure to cadmium and that the

clothing and equipment should be laundered or cleaned in a manner to

effectively prevent the release of airborne cadmium in excess of the

PEL.

(j) Hygiene areas and practices--(1) General. For employees whose

airborne exposure to cadmium is above the PEL, the employer shall

provide clean change rooms, handwashing facilities, showers, and

lunchroom facilities that comply with 29 CFR 1910.141.

(2) Change rooms. The employer shall assure that change rooms are

equipped with separate storage facilities for street clothes and for

protective clothing and equipment, which are designed to prevent

dispersion of cadmium and contamination of the employee's street

clothes.

(3) Showers and handwashing facilities. (i) The employer shall

assure that employees who are exposed to cadmium above the PEL shower

during the end of the work shift.

(ii) The employer shall assure that employees whose airborne

exposure to cadmium is above the PEL wash their hands and faces prior

to eating, drinking, smoking, chewing tobacco or gum, or applying

cosmetics.

(4) Lunchroom facilities. (i) The employer shall assure that the

lunchroom facilities are readily accessible to employees, that tables

for eating are maintained free of cadmium, and that no employee in a

lunchroom facility is exposed at any time to cadmium at or above a

concentration of 2.5 g/m\3\.

(ii) The employer shall assure that employees do not enter

lunchroom facilities with protective work clothing or equipment unless

surface cadmium has been removed from the clothing and equipment by

HEPA vacuuming or some other method that removes cadmium dust without

dispersing it.

(k) Housekeeping. (1) All surfaces shall be maintained as free as

practicable of accumulations of cadmium.

(2) All spills and sudden releases of material containing cadmium

shall be cleaned up as soon as possible.

(3) Surfaces contaminated with cadmium shall, wherever possible, be

cleaned by vacuuming or other methods that minimize the likelihood of

cadmium becoming airborne.

(4) HEPA-filtered vacuuming equipment or equally effective

filtration methods shall be used for vacuuming. The equipment shall be

used and emptied in a manner that minimizes the reentry of cadmium into

the workplace.

(5) Shoveling, dry or wet sweeping, and brushing may be used only

where vacuuming or other methods that minimize the likelihood of

cadmium becoming airborne have been tried and found not to be

effective.

(6) Compressed air shall not be used to remove cadmium from any

surface unless the compressed air is used in conjunction with a

ventilation system designed to capture the dust cloud created by the

compressed air.

(7) Waste, scrap, debris, bags, containers, personal protective

equipment, and clothing contaminated with cadmium and consigned for

disposal shall be collected and disposed of in sealed impermeable bags

or other closed, impermeable containers. These bags and containers

shall be labeled in accordance with paragraph (m)(2) of this section.

(l) Medical surveillance--(1) General--(i) Scope. (A) Currently

exposed--The employer shall institute a medical surveillance program

for all employees who are or may be exposed to cadmium at or above the

action level unless the employer demonstrates that the employee is not,

and will not be, exposed at or above the action level on 30 or more

days per year (twelve consecutive months); and,

(B) Previously exposed--The employer shall also institute a medical

surveillance program for all employees who prior to the effective date

of this section might previously have been exposed to cadmium at or

above the action level by the employer, unless the employer

demonstrates that the employee did not prior to the effective date of

this section work for the employer in jobs with exposure to cadmium for

an aggregated total of more than 60 months.

(ii) To determine an employee's fitness for using a respirator, the

employer shall provide the limited medical examination specified in

paragraph (l)(6) of this section.

(iii) The employer shall assure that all medical examinations and

procedures required by this standard are performed by or under the

supervision of a licensed physician, who has read and is familiar with

the health effects section of appendix A to this section, the

regulatory text of this section, the protocol for sample handling and

laboratory selection in appendix F to this section, and the

questionnaire of appendix D to this section. These examinations and

procedures shall be provided without cost to the employee and at a time

and place that is reasonable and convenient to employees.

(iv) The employer shall assure that the collecting and handling of

biological samples of cadmium in urine (CdU), cadmium in blood (CdB),

and beta-2 microglobulin in urine (2-M) taken from

employees under this section is done in a manner that assures their

reliability and that analysis of biological samples of cadmium in urine

(CdU), cadmium in blood (CdB), and beta-2 microglobulin in urine

(2-M) taken from employees under this section is

performed in laboratories with demonstrated proficiency for that

particular analyte. (See appendix F to this section.)

(2) Initial examination. (i) The employer shall provide an initial

(preplacement) examination to all employees covered by the medical

surveillance program required in paragraph (l)(1)(i) of this section.

The examination shall be provided to those employees within 30 days

after initial assignment to a job with exposure to cadmium or no later

than 90 days after the effective date of this section, whichever date

is later.

(ii) The initial (preplacement) medical examination shall include:

(A) A detailed medical and work history, with emphasis on: Past,

present, and anticipated future exposure to cadmium; any history of

renal, cardiovascular, respiratory, hematopoietic, reproductive, and/or

musculo-skeletal system dysfunction; current usage of medication with

potential nephrotoxic side-effects; and smoking history and current

status; and

(B) Biological monitoring that includes the following tests:

(1) Cadmium in urine (CdU), standardized to grams of creatinine (g/

Cr);

(2) Beta-2 microglobulin in urine (2-M), standardized

to grams of creatinine (g/Cr), with pH specified, as described in

appendix F to this section; and

(3) Cadmium in blood (CdB), standardized to liters of whole blood

(lwb).

(iii) Recent Examination: An initial examination is not required to

be provided if adequate records show that the employee has been

examined in accordance with the requirements of paragraph (l)(2)(ii) of

this section within the past 12 months. In that case, such records

shall be maintained as part of the employee's medical record and the

prior exam shall be treated as if it were an initial examination for

the purposes of paragraphs (l)(3) and (4) of this section.

(3) Actions triggered by initial biological monitoring. (i) If the

results of the initial biological monitoring tests show the employee's

CdU level to be at or below 3 g/g Cr, 2-M level

to be at or below 300 g/g Cr and CdB level to be at or below 5

g/lwb, then:

(A) For currently exposed employees, who are subject to medical

surveillance under paragraph (l)(1)(i)(A) of this section, the employer

shall provide the minimum level of periodic medical surveillance in

accordance with the requirements in paragraph (l)(4)(i) of this

section; and

(B) For previously exposed employees, who are subject to medical

surveillance under paragraph (l)(1)(i)(B) of this section, the employer

shall provide biological monitoring for CdU, 2-M, and CdB

one year after the initial biological monitoring and then the employer

shall comply with the requirements of paragraph (l)(4)(v) of this

section.

(ii) For all employees who are subject to medical surveillance

under paragraph (l)(1)(i) of this section, if the results of the

initial biological monitoring tests show the level of CdU to exceed 3

g/g Cr, the level of 2-M to exceed 300

g/g Cr, or the level of CdB to exceed 5 g/lwb, the

employer shall:

(A) Within two weeks after receipt of biological monitoring

results, reassess the employee's occupational exposure to cadmium as

follows:

(1) Reassess the employee's work practices and personal hygiene;

(2) Reevaluate the employee's respirator use, if any, and the

respirator program;

(3) Review the hygiene facilities;

(4) Reevaluate the maintenance and effectiveness of the relevant

engineering controls;

(5) Assess the employee's smoking history and status;

(B) Within 30 days after the exposure reassessment, specified in

paragraph (l)(3)(ii)(A) of this section, take reasonable steps to

correct any deficiencies found in the reassessment that may be

responsible for the employee's excess exposure to cadmium; and,

provide a full medical examination to the employee in accordance with

the requirements of paragraph (l)(4)(ii) of this section. After

completing the medical examination, the examining physician shall

determine in a written medical opinion whether to medically remove the

employee. If the physician determines that medical removal is not

necessary, then until the employee's CdU level falls to or below 3

g/g Cr, 2-M level falls to or below 300

g/g Cr and CdB level falls to or below 5 g/lwb, the

employer shall:

(1) Provide biological monitoring in accordance with paragraph

(l)(2)(ii)(B) of this section on a semiannual basis; and

(2) Provide annual medical examinations in accordance with

paragraph (l)(4)(ii) of this section.

(iii) For all employees who are subject to medical surveillance

under paragraph (l)(1)(i) of this section, if the results of the

initial biological monitoring tests show the level of CdU to be in

excess of 15 g/g Cr, or the level of CdB to be in excess of 15

g/lwb, or the level of 2-M to be in excess of

1,500 g/g Cr, the employer shall comply with the requirements

of paragraphs (l)(3)(ii)(A)-(B) of this section. Within 90 days after

receipt of biological monitoring results, the employer shall provide a

full medical examination to the employee in accordance with the

requirements of paragraph (l)(4)(ii) of this section. After completing

the medical examination, the examining physician shall determine in a

written medical opinion whether to medically remove the employee.

However, if the initial biological monitoring results and the

biological monitoring results obtained during the medical examination

both show that: CdU exceeds 15 g/g Cr; or CdB exceeds 15

g/lwb; or 2-M exceeds 1500 g/g Cr, and

in addition CdU exceeds 3 g/g Cr or CdB exceeds 5 g/

liter of whole blood, then the physician shall medically remove the

employee from exposure to cadmium at or above the action level. If the

second set of biological monitoring results obtained during the medical

examination does not show that a mandatory removal trigger level has

been exceeded, then the employee is not required to be removed by the

mandatory provisions of this paragraph. If the employee is not required

to be removed by the mandatory provisions of this paragraph or by the

physician's determination, then until the employee's CdU level falls to

or below 3 g/g Cr, 2-M level falls to or below

300 g/g Cr and CdB level falls to or below 5 g/lwb,

the employer shall:

(A) Periodically reassess the employee's occupational exposure to

cadmium;

(B) Provide biological monitoring in accordance with paragraph

(l)(2)(ii)(B) of this section on a quarterly basis; and

paragraph (l)(4)(ii) of this section.

(iv) For all employees to whom medical surveillance is provided,

beginning on January 1, 1999, and in lieu of paragraphs (l)(3)(i)-(iii)

of this section:

(A) If the results of the initial biological monitoring tests show

the employee's CdU level to be at or below 3 g/g Cr,

2-M level to be at or below 300 g/g Cr and CdB

level to be at or below 5 g/lwb, then for currently exposed

employees, the employer shall comply with the requirements of paragraph

(l)(3)(i)(A) of this section, and for previously exposed employees, the

employer shall comply with the requirements of paragraph (l)(3)(i)(B)

of this section;

(B) If the results of the initial biological monitoring tests show

the level of CdU to exceed 3 g/g Cr, the level of

2-M to exceed 300 g/g Cr, or the level of CdB to

exceed 5 g/lwb, the employer shall comply with the

requirements of paragraphs (l)(3)(ii)(A)-(C) of this section; and,

the level of CdU to be in excess of 7 g/g Cr, or the level of

CdB to be in excess of 10 g/lwb, or the level of

2-M to be in excess of 750 g/g Cr, the employer

shall: Comply with the requirements of paragraphs (l)(3)(ii)(A)-(B) of

this section; and, within 90 days after receipt of biological

monitoring results, provide a full medical examination to the employee

in accordance with the requirements of paragraph (l)(4)(ii) of this

section. After completing the medical examination, the examining

physician shall determine in a written medical opinion whether to

medically remove the employee. However, if the initial biological

monitoring results and the biological monitoring results obtained

during the medical examination both show that: CdU exceeds 7

g/g Cr; or CdB exceeds 10 g/lwb; or 2-M

exceeds 750 g/g Cr, and in addition CdU exceeds 3 g/g

Cr or CdB exceeds 5 g/liter of whole blood, then the physician

shall medically remove the employee from exposure to cadmium at or

above the action level. If the second set of biological monitoring

results obtained during the medical examination does not show that a

mandatory removal trigger level has been exceeded, then the employee is

not required to be removed by the mandatory provisions of this

paragraph. If the employee is not required to be removed by the

mandatory provisions of this paragraph or by the physician's

determination, then until the employee's CdU level falls to or below 3

g/g Cr, 2-M level falls to or below 300

g/g Cr and CdB level falls to or below 5 g/lwb, the

employer shall: periodically reassess the employee's occupational

exposure to cadmium; provide biological monitoring in accordance with

paragraph (l)(2)(ii)(B) of this section on a quarterly basis; and

provide semiannual medical examinations in accordance with paragraph

(l)(4)(ii) of this section.

(4) Periodic medical surveillance. (i) For each employee who is

covered under paragraph (l)(1)(i)(A) of this section, the employer

shall provide at least the minimum level of periodic medical

surveillance, which consists of periodic medical examinations and

periodic biological monitoring. A periodic medical examination shall be

provided within one year after the initial examination required by

paragraph (l)(2) of this section and thereafter at least biennially.

Biological sampling shall be provided at least annually, either as part

of a periodic medical examination or separately as periodic biological

monitoring.

(ii) The periodic medical examination shall include:

(A) A detailed medical and work history, or update thereof, with

emphasis on: Past, present and anticipated future exposure to cadmium;

smoking history and current status; reproductive history; current use

of medications with potential nephrotoxic side-effects; any history of

renal, cardiovascular, respiratory, hematopoietic, and/or musculo-

skeletal system dysfunction; and as part of the medical and work

history, for employees who wear respirators, questions 3-11 and 25-32

in Appendix D to this section;

(B) A complete physical examination with emphasis on: Blood

pressure, the respiratory system, and the urinary system;

anterior chest X-ray (after the initial X-ray, the frequency of chest

X-rays is to be determined by the examining physician);

(D) Pulmonary function tests, including forced vital capacity (FVC)

and forced expiratory volume at 1 second (FEV1);

(E) Biological monitoring, as required in paragraph (l)(2)(ii)(B)

of this section;

(F) Blood analysis, in addition to the analysis required under

paragraph (l)(2)(ii)(B) of this section, including blood urea nitrogen,

complete blood count, and serum creatinine;

(G) Urinalysis, in addition to the analysis required under

paragraph (l)(2)(ii)(B) of this section, including the determination of

albumin, glucose, and total and low molecular weight proteins;

(H) For males over 40 years old, prostate palpation, or other at

least as effective diagnostic test(s); and

(I) Any additional tests deemed appropriate by the examining

physician.

(iii) Periodic biological monitoring shall be provided in

accordance with paragraph (l)(2)(ii)(B) of this section.

(iv) If the results of periodic biological monitoring or the

results of biological monitoring performed as part of the periodic

medical examination show the level of the employee's CdU,

2-M, or CdB to be in excess of the levels specified in

paragraphs (l)(3) (ii) or (iii); or, beginning on January 1, 1999, in

excess of the levels specified in paragraphs (l)(3) (ii) or (iv) of

this section, the employer shall take the appropriate actions specified

in paragraphs (l)(3)(ii)-(iv) of this section.

(v) For previously exposed employees under paragraph (l)(1)(i)(B)

of this section:

(A) If the employee's levels of CdU did not exceed 3 g/g

Cr, CdB did not exceed 5 g/lwb, and 2-M did not

exceed 300 g/g Cr in the initial biological monitoring tests,

and if the results of the followup biological monitoring required by

paragraph (l)(3)(i)(B) of this section one year after the initial

examination confirm the previous results, the employer may discontinue

all periodic medical surveillance for that employee.

(B) If the initial biological monitoring results for CdU, CdB, or

2-M were in excess of the levels specified in paragraph

(l)(3)(i) of this section, but subsequent biological monitoring results

required by paragraph (l)(3)(ii)-(iv) of this section show that the

employee's CdU levels no longer exceed 3 g/g Cr, CdB levels no

longer exceed 5 g/lwb, and 2-M levels no longer

exceed 300 g/g Cr, the employer shall provide biological

monitoring for CdU, CdB, and 2-M one year after these

most recent biological monitoring results. If the results of the

followup biological monitoring, specified in this paragraph, confirm

the previous results, the employer may discontinue all periodic medical

surveillance for that employee.

paragraph (l)(4)(v)(A) or (B) of this section indicate that the level

of the employee's CdU, 2-M, or CdB exceeds these same

levels, the employer is required to provide annual medical examinations

in accordance with the provisions of paragraph (l)(4)(ii) of this

section until the results of biological monitoring are consistently

below these levels or the examining physician determines in a written

medical opinion that further medical surveillance is not required to

protect the employee's health.

(vi) A routine, biennial medical examination is not required to be

provided in accordance with paragraphs (l)(3)(i) and (l)(4) of this

section if adequate medical records show that the employee has been

examined in accordance with the requirements of paragraph (l)(4)(ii) of

this section within the past 12 months. In that case, such records

shall be maintained by the employer as part of the employee's medical

record, and the next routine, periodic medical examination shall be

made available to the employee within two years of the previous

examination.

(5) Actions triggered by medical examinations. (i) If the results

of a medical examination carried out in accordance with this section

indicate any laboratory or clinical finding consistent with cadmium

toxicity that does not require employer action under paragraph (l)(2),

(3) or (4) of this section, the employer, within 30 days, shall

reassess the employee's occupational exposure to cadmium and take the

following corrective action until the physician determines they are no

longer necessary:

(A) Periodically reassess: The employee's work practices and

personal hygiene; the employee's respirator use, if any; the employee's

smoking history and status; the respiratory protection program; the

hygiene facilities; and the maintenance and effectiveness of the

relevant engineering controls;

(B) Within 30 days after the reassessment, take all reasonable

steps to correct the deficiencies found in the reassessment that may be

responsible for the employee's excess exposure to cadmium;

abnormal clinical sign(s) of cadmium toxicity until the results are

normal or the employee is medically removed; and

(D) Where the results of tests for total proteins in urine are

abnormal, provide a more detailed medical evaluation of the toxic

effects of cadmium on the employee's renal system.

(6) Examination for respirator use. (i) To determine an employee's

fitness for respirator use, the employer shall provide a medical

examination that includes the elements specified in paragraph (l)(6)(i)

(A)-(D) of this section. This examination shall be provided prior to

the employee's being assigned to a job that requires the use of a

respirator or no later than 90 days after this section goes into

effect, whichever date is later, to any employee without a medical

examination within the preceding 12 months that satisfies the

requirements of this paragraph.

(A) A detailed medical and work history, or update thereof, with

emphasis on: Past exposure to cadmium; smoking history and current

status; any history of renal, cardiovascular, respiratory,

hematopoietic, and/or musculoskeletal system dysfunction; a description

of the job for which the respirator is required; and questions 3-11 and

25-32 in appendix D to this section;

(B) A blood pressure test;

2-M in accordance with the requirements of paragraph

(l)(2)(ii)(B) of this section, unless such results already have been

obtained within the previous 12 months; and

(D) Any other test or procedure that the examining physician deems

appropriate.

(ii) After reviewing all the information obtained from the medical

examination required in paragraph (l)(6)(i) of this section, the

physician shall determine whether the employee is fit to wear a

respirator.

(iii) Whenever an employee has exhibited difficulty in breathing

during a respirator fit test or during use of a respirator, the

employer, as soon as possible, shall provide the employee with a

periodic medical examination in accordance with paragraph (l)(4)(ii) of

this section to determine the employee's fitness to wear a respirator.

(iv) Where the results of the examination required under paragraph

(l)(6)(i), (ii), or (iii) of this section are abnormal, medical

limitation or prohibition of respirator use shall be considered. If the

employee is allowed to wear a respirator, the employee's ability to

continue to do so shall be periodically evaluated by a physician.

(7) Emergency examinations. (i) In addition to the medical

surveillance required in paragraphs (l)(2)-(6) of this section, the

employer shall provide a medical examination as soon as possible to any

employee who may have been acutely exposed to cadmium because of an

emergency.

(ii) The examination shall include the requirements of paragraph

(l)(4)(ii) of this section, with emphasis on the respiratory system,

other organ systems considered appropriate by the examining physician,

and symptoms of acute overexposure, as identified in paragraphs II

(B)(1)-(2) and IV of appendix A to this section.

(8) Termination of employment examination. (i) At termination of

employment, the employer shall provide a medical examination in

accordance with paragraph (l)(4)(ii) of this section, including a chest

X-ray, to any employee to whom at any prior time the employer was

required to provide medical surveillance under paragraphs (l)(1)(i) or

(l)(7) of this section. However, if the last examination satisfied the

requirements of paragraph (l)(4)(ii) of this section and was less than

six months prior to the date of termination, no further examination is

required unless otherwise specified in paragraphs (l)(3) or (l)(5) of

this section;

(ii) However, for employees covered by paragraph (l)(1)(i)(B) of

this section, if the employer has discontinued all periodic medical

surveillance under paragraph (l)(4)(v) of this section, no termination

of employment medical examination is required.

(9) Information provided to the physician. The employer shall

provide the following information to the examining physician:

(i) A copy of this standard and appendices;

(ii) A description of the affected employee's former, current, and

anticipated duties as they relate to the employee's occupational

exposure to cadmium;

(iii) The employee's former, current, and anticipated future levels

of occupational exposure to cadmium;

(iv) A description of any personal protective equipment, including

respirators, used or to be used by the employee, including when and for

how long the employee has used that equipment; and

(v) relevant results of previous biological monitoring and medical

examinations.

(10) Physician's written medical opinion. (i) The employer shall

promptly obtain a written, signed medical opinion from the examining

physician for each medical examination performed on each employee. This

written opinion shall contain:

(A) The physician's diagnosis for the employee;

(B) The physician's opinion as to whether the employee has any

detected medical condition(s) that would place the employee at

increased risk of material impairment to health from further exposure

to cadmium, including any indications of potential cadmium toxicity;

evaluations that directly assess the employee's absorption of cadmium;

(D) Any recommended removal from, or limitation on the activities

or duties of the employee or on the employee's use of personal

protective equipment, such as respirators;

(E) A statement that the physician has clearly and carefully

explained to the employee the results of the medical examination,

including all biological monitoring results and any medical conditions

related to cadmium exposure that require further evaluation or

treatment, and any limitation on the employee's diet or use of

medications.

(ii) The employer promptly shall obtain a copy of the results of

any biological monitoring provided by an employer to an employee

independently of a medical examination under paragraphs (l)(2) and

(l)(4) of this section, and, in lieu of a written medical opinion, an

explanation sheet explaining those results.

(iii) The employer shall instruct the physician not to reveal

orally or in the written medical opinion given to the employer specific

findings or diagnoses unrelated to occupational exposure to cadmium.

(11) Medical Removal Protection (MRP)--(i) General. (A) The

employer shall temporarily remove an employee from work where there is

excess exposure to cadmium on each occasion that medical removal is

required under paragraph (l)(3), (l)(4), or (l)(6) of this section and

on each occasion that a physician determines in a written medical

opinion that the employee should be removed from such exposure. The

physician's determination may be based on biological monitoring

results, inability to wear a respirator, evidence of illness, other

signs or symptoms of cadmium-related dysfunction or disease, or any

other reason deemed medically sufficient by the physician.

(B) The employer shall medically remove an employee in accordance

with paragraph (l)(11) of this section regardless of whether at the

time of removal a job is available into which the removed employee may

be transferred.

(l)(11) of this section, the employer shall transfer the removed

employee to a job where the exposure to cadmium is within the

permissible levels specified in that paragraph as soon as one becomes

available.

(D) For any employee who is medically removed under the provisions

of paragraph (l)(11)(i) of this section, the employer shall provide

follow-up biological monitoring in accordance with (l)(2)(ii)(B) of

this section at least every three months and follow-up medical

examinations semi-annually at least every six months until in a written

medical opinion the examining physician determines that either the

employee may be returned to his/her former job status as specified

under paragraph (l)(11)(iv)-(v) of this section or the employee must be

permanently removed from excess cadmium exposure.

(E) The employer may not return an employee who has been medically

removed for any reason to his/her former job status until a physician

determines in a written medical opinion that continued medical removal

is no longer necessary to protect the employee's health.

(ii) Where an employee is found unfit to wear a respirator under

paragraph (l)(6)(ii) of this section, the employer shall remove the

employee from work where exposure to cadmium is above the PEL.

(iii) Where removal is based on any reason other than the

employee's inability to wear a respirator, the employer shall remove

the employee from work where exposure to cadmium is at or above the

action level.

(iv) Except as specified in paragraph (l)(11)(v) of this section,

no employee who was removed because his/her level of CdU, CdB and/or

2-M exceeded the medical removal trigger levels in

paragraph (l)(3) or (l)(4) of this section may be returned to work with

exposure to cadmium at or above the action level until the employee's

levels of CdU fall to or below 3 g/g Cr, CdB falls to or below

5 g/lwb, and 2-M falls to or below 300

g/g Cr.

(v) However, when in the examining physician's opinion continued

exposure to cadmium will not pose an increased risk to the employee's

health and there are special circumstances that make continued medical

removal an inappropriate remedy, the physician shall fully discuss

these matters with the employee, and then in a written determination

may return a worker to his/her former job status despite what would

otherwise be unacceptably high biological monitoring results.

Thereafter, the returned employee shall continue to be provided with

medical surveillance as if he/she were still on medical removal until

the employee's levels of CdU fall to or below 3 g/g Cr, CdB

falls to or below 5 g/lwb, and 2-M falls to or

below 300 g/g Cr.

(vi) Where an employer, although not required by paragraph

(l)(11)(i)-(iii) of this section to do so, removes an employee from

exposure to cadmium or otherwise places limitations on an employee due

to the effects of cadmium exposure on the employee's medical condition,

the employer shall provide the same medical removal protection benefits

to that employee under paragraph (l)(12) of this section as would have

been provided had the removal been required under paragraph (l)(11)(i)-

(iii) of this section.

(12) Medical Removal Protection Benefits (MRPB). (i) The employer

shall provide MRPB for up to a maximum of 18 months to an employee each

time and while the employee is temporarily medically removed under

paragraph (l)(11) of this section.

(ii) For purposes of this section, the requirement that the

employer provide MRPB means that the employer shall maintain the total

normal earnings, seniority, and all other employee rights and benefits

of the removed employee, including the employee's right to his/her

former job status, as if the employee had not been removed from the

employee's job or otherwise medically limited.

(iii) Where, after 18 months on medical removal because of elevated

biological monitoring results, the employee's monitoring results have

not declined to a low enough level to permit the employee to be

returned to his/her former job status:

(A) The employer shall make available to the employee a medical

examination pursuant to this section in order to obtain a final medical

determination as to whether the employee may be returned to his/her

former job status or must be permanently removed from excess cadmium

exposure; and

(B) The employer shall assure that the final medical determination

indicates whether the employee may be returned to his/her former job

status and what steps, if any, should be taken to protect the

employee's health.

(iv) The employer may condition the provision of MRPB upon the

employee's participation in medical surveillance provided in accordance

with this section.

(13) Multiple physician review. (i) If the employer selects the

initial physician to conduct any medical examination or consultation

provided to an employee under this section, the employee may designate

a second physician to:

(A) Review any findings, determinations, or recommendations of the

initial physician; and

(B) Conduct such examinations, consultations, and laboratory tests

as the second physician deems necessary to facilitate this review.

(ii) The employer shall promptly notify an employee of the right to

seek a second medical opinion after each occasion that an initial

physician provided by the employer conducts a medical examination or

consultation pursuant to this section. The employer may condition its

participation in, and payment for, multiple physician review upon the

employee doing the following within fifteen (15) days after receipt of

this notice, or receipt of the initial physician's written opinion,

whichever is later:

(A) Informing the employer that he or she intends to seek a medical

opinion; and

(B) Initiating steps to make an appointment with a second

physician.

(iii) 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.

(iv) If the two physicians have been unable to quickly resolve

their disagreement, then the employer and the employee, through their

respective physicians, shall designate a third physician to:

(A) Review any findings, determinations, or recommendations of the

other two physicians; and

(B) Conduct such examinations, consultations, laboratory tests, and

discussions with the other two physicians as the third physician deems

necessary to resolve the disagreement among them.

(v) The employer shall act consistently with the findings,

determinations, and recommendations of the third physician, unless the

employer and the employee reach an agreement that is consistent with

the recommendations of at least one of the other two physicians.

(14) Alternate physician determination. The employer and an

employee or designated employee representative may agree upon the use

of any alternate form of physician determination in lieu of the

multiple physician review provided by paragraph (l)(13) of this

section, so long as the alternative is expeditious and at least as

protective of the employee.

(15) Information the employer must provide the employee. (i) The

employer shall provide a copy of the physician's written medical

opinion to the examined employee within two weeks after receipt

thereof.

(ii) The employer shall provide the employee with a copy of the

employee's biological monitoring results and an explanation sheet

explaining the results within two weeks after receipt thereof.

(iii) Within 30 days after a request by an employee, the employer

shall provide the employee with the information the employer is

required to provide the examining physician under paragraph (l)(9) of

this section.

(16) Reporting. In addition to other medical events that are

required to be reported on the OSHA Form No. 200, the employer shall

report any abnormal condition or disorder caused by occupational

exposure to cadmium associated with employment as specified in Chapter

(V)(E) of the Reporting Guidelines for Occupational Injuries and

Illnesses.

(m) Communication of cadmium hazards to employees--(1) General. In

communications concerning cadmium hazards, employers shall comply with

the requirements of OSHA's Hazard Communication Standard, 29 CFR

1910.1200, including but not limited to the requirements concerning

warning signs and labels, material safety data sheets (MSDS), and

employee information and training. In addition, employers shall comply

with the following requirements:

(2) Warning signs. (i) Warning signs shall be provided and

displayed in regulated areas. In addition, warning signs shall be

posted at all approaches to regulated areas so that an employee may

read the signs and take necessary protective steps before entering the

area.

(ii) Warning signs required by paragraph (m)(2)(i) of this section

shall bear the following information:

DANGER

CADMIUM

CANCER HAZARD

CAN CAUSE LUNG AND KIDNEY DISEASE

AUTHORIZED PERSONNEL ONLY

RESPIRATORS REQUIRED IN THIS AREA

(iii) The employer shall assure that signs required by this

paragraph are illuminated, cleaned, and maintained as necessary so that

the legend is readily visible.

(3) Warning labels. (i) Shipping and storage containers containing

cadmium, cadmium compounds, or cadmium contaminated clothing,

equipment, waste, scrap, or debris shall bear appropriate warning

labels, as specified in paragraph (m)(3)(ii) of this section.

(ii) The warning labels shall include at least the following

information:

DANGER

CONTAINS CADMIUM

CANCER HAZARD

AVOID CREATING DUST

CAN CAUSE LUNG AND KIDNEY DISEASE

(iii) Where feasible, installed cadmium products shall have a

visible label or other indication that cadmium is present.

(4) Employee information and training. (i) The employer shall

institute a training program for all employees who are potentially

exposed to cadmium, assure employee participation in the program, and

maintain a record of the contents of such program.

(ii) Training shall be provided prior to or at the time of initial

assignment to a job involving potential exposure to cadmium and at

least annually thereafter.

(iii) The employer shall make the training program understandable

to the employee and shall assure that each employee is informed of the

following:

(A) The health hazards associated with cadmium exposure, with

special attention to the information incorporated in appendix A to this

section;

(B) The quantity, location, manner of use, release, and storage of

cadmium in the workplace and the specific nature of operations that

could result in exposure to cadmium, especially exposures above the

PEL;

employee's job assignment;

(D) The measures employees can take to protect themselves from

exposure to cadmium, including modification of such habits as smoking

and personal hygiene, and specific procedures the employer has

implemented to protect employees from exposure to cadmium such as

appropriate work practices, emergency procedures, and the provision of

personal protective equipment;

(E) The purpose, proper selection, fitting, proper use, and

limitations of respirators and protective clothing;

(F) The purpose and a description of the medical surveillance

program required by paragraph (l) of this section;

(G) The contents of this section and its appendices; and

(H) The employee's rights of access to records under Sec. 1915.1120

(e) and (g).

(iv) Additional access to information and training program and

materials.

(A) The employer shall make a copy of this section and its

appendices readily available without cost to all affected employees and

shall provide a copy if requested.

(B) The employer shall provide to the Assistant Secretary or the

Director, upon request, all materials relating to the employee

information and the training program.

(n) Recordkeeping--(1) Exposure monitoring. (i) The employer shall

establish and keep an accurate record of all air monitoring for cadmium

in the workplace.

(ii) This record shall include at least the following information:

(A) The monitoring date, duration, and results in terms of an 8-

hour TWA of each sample taken;

(B) The name, social security number, and job classification of the

employees monitored and of all other employees whose exposures the

monitoring is intended to represent;

evidence of their accuracy;

(D) The type of respiratory protective device, if any, worn by the

monitored employee;

(E) A notation of any other conditions that might have affected the

monitoring results.

(iii) The employer shall maintain this record for at least thirty

(30) years, in accordance with Sec. 1915.1120 of this part.

(2) Objective data for exemption from requirement for initial

monitoring. (i) For purposes of this section, objective data are

information demonstrating that a particular product or material

containing cadmium or a specific process, operation, or activity

involving cadmium cannot release dust or fumes in concentrations at or

above the action level even under the worst-case release conditions.

Objective data can be obtained from an industry-wide study or from

laboratory product test results from manufacturers of cadmium-

containing products or materials. The data the employer uses from an

industry-wide survey must be obtained under workplace conditions

closely resembling the processes, types of material, control methods,

work practices and environmental conditions in the employer's current

operations.

(ii) The employer shall establish and maintain a record of the

objective data for at least 30 years.

(3) Medical surveillance. (i) The employer shall establish and

maintain an accurate record for each employee covered by medical

surveillance under paragraph (l)(1)(i) of this section.

(ii) The record shall include at least the following information

about the employee:

(A) Name, social security number, and description of the duties;

(B) A copy of the physician's written opinions and an explanation

sheet for biological monitoring results;

examination and all test results that are required to be provided by

this section, including biological tests, X-rays, pulmonary function

tests, etc., or that have been obtained to further evaluate any

condition that might be related to cadmium exposure;

(D) The employee's medical symptoms that might be related to

exposure to cadmium; and

(E) A copy of the information provided to the physician as required

by paragraph (l)(9)(ii)-(v) of this section.

(iii) The employer shall assure that this record is maintained for

the duration of employment plus thirty (30) years, in accordance with

Sec. 1915.1120 of this part.

(4) Training. The employer shall certify that employees have been

trained by preparing a certification record which includes the identity

of the person trained, the signature of the employer or the person who

conducted the training, and the date the training was completed. The

certification records shall be prepared at the completion of training

and shall be maintained on file for one (1) year beyond the date of

training of that employee.

(5) Availability. (i) Except as otherwise provided for in this

section, access to all records required to be maintained by paragraphs

(n)(1)-(4) of this section shall be in accordance with the provisions

of Sec. 1915.1120 of this part.

(ii) Within 15 days after a request, the employer shall make an

employee's medical records required to be kept by paragraph (n)(3) of

this section available for examination and copying to the subject

employee, to designated representatives, to anyone having the specific

written consent of the subject employee, and after the employee's death

or incapacitation, to the employee's family members.

(6) Transfer of records. Whenever an employer ceases to do business

and there is no successor employer to receive and retain records for

the prescribed period or the employer intends to dispose of any records

required to be preserved for at least 30 years, the employer shall

comply with the requirements concerning transfer of records set forth

in Sec. 1915.1120(h) of this part.

(o) Observation of monitoring--(1) Employee observation. The

employer shall provide affected employees or their designated

representatives an opportunity to observe any monitoring of employee

exposure to cadmium.

(2) Observation procedures. When observation of monitoring requires

entry into an area where the use of protective clothing or equipment is

required, the employer shall provide the observer with that clothing

and equipment and shall assure that the observer uses such clothing and

equipment and complies with all other applicable safety and health

procedures.

(p) Dates--(1) Effective date. This section shall become effective

December 14, 1992.

(2) Start-up dates. All obligations of this section commence on the

effective date except as follows:

(i) Exposure monitoring. Except for small businesses (nineteen (19)

or fewer employees), initial monitoring required by paragraph (d)(2) of

this section shall be completed as soon as possible and in any event no

later than February 12, 1993. For small businesses, initial monitoring

required by paragraph (d)(2) of this section shall be completed as soon

as possible and in any event no later than April 14, 1993.

(ii) Regulated areas. Except for small business, defined under

paragraph (p)(2)(i) of this section, regulated areas required to be

established by paragraph (e) of this section shall be set up as soon as

possible after the results of exposure monitoring are known and in any

event no later than March 15, 1993. For small businesses, regulated

areas required to be established by paragraph (e) of this section shall

be set up as soon as possible after the results of exposure monitoring

are known and in any event no later than May 14, 1993.

(iii) Respiratory protection. Except for small businesses, defined

under paragraph (p)(2)(i) of this section, respiratory protection

required by paragraph (g) of this section shall be provided as soon as

possible and in any event no later than 90 days after the effective

date of this section. For small businesses, respiratory protection

required by paragraph (g) of this section shall be provided as soon as

possible and in any event no later than March 15, 1993.

(iv) Compliance program. Written compliance programs required by

paragraph (f)(2) of this section shall be completed and available for

inspection and copying as soon as possible and in any event no later

than December 14, 1993.

(v) Methods of compliance. The engineering controls required by

paragraph (f)(1) of this section shall be implemented as soon as

possible and in any event no later than December 14, 1994. Work

practice controls shall be implemented as soon as possible. Work

practice controls that are directly related to engineering controls to

be implemented in accordance with the compliance plan shall be

implemented as soon as possible after such engineering controls are

implemented.

(vi) Hygiene and lunchroom facilities. (A) Handwashing facilities,

permanent or temporary, shall be provided in accordance with 29 CFR

1910.141 (d)(1) and (2) as soon as possible and in any event no later

than February 12, 1993.

(B) Change rooms, showers, and lunchroom facilities shall be

completed as soon as possible and in any event no later than December

14, 1993.

(vii) Employee information and training. Except for small

businesses, defined under paragraph (p)(2)(i) of this section, employee

information and training required by paragraph (m)(4) of this section

shall be provided as soon as possible and in any event no later than

March 15, 1993. For small businesses, employee information and training

required by paragraph (m)(4) of this standard shall be provided as soon

as possible and in any event no later than June 14, 1993.

(viii) Medical surveillance. Except for small businesses, defined

under paragraph (p)(2)(i) of this section, initial medical examinations

required by paragraph (l) of this section shall be provided as soon as

possible and in any event no later than March 15, 1993. For small

businesses, initial medical examinations required by paragraph (l) of

this section shall be provided as soon as possible and in any event no

later than June 14, 1993.

(q) Appendices. (1) Appendix C to this section is incorporated as

part of this section, and compliance with its contents is mandatory.

(2) Except where portions of appendices A, B, D, E, and F to this

section are expressly incorporated in requirements of this section,

these appendices are purely informational and are not intended to

create any additional obligations not otherwise imposed or to detract

from any existing obligations.

Appendix A to Sec. 1915.1027--Substance Safety Data Sheet

Cadmium

I. Substance Identification

A. Substance: Cadmium.

B. 8-Hour, Time-weighted-average, Permissible Exposure Limit

(TWA PEL):

1. TWA PEL: Five micrograms of cadmium per cubic meter of air 5

g/m3, time-weighted average (TWA) for an 8-hour

workday.

C. Appearance: Cadmium metal--soft, blue-white, malleable,

lustrous metal or grayish-white powder. Some cadmium compounds may

also appear as a brown, yellow, or red powdery substance.

II. Health Hazard Data

A. Routes of Exposure. Cadmium can cause local skin or eye

irritation. Cadmium can affect your health if you inhale it or if

you swallow it.

B. Effects of Overexposure.

1. Short-term (acute) exposure: Cadmium is much more dangerous

by inhalation than by ingestion. High exposures to cadmium that may

be immediately dangerous to life or health occur in jobs where

workers handle large quantities of cadmium dust or fume; heat

cadmium-containing compounds or cadmium-coated surfaces; weld with

cadmium solders or cut cadmium-containing materials such as bolts.

2. Severe exposure may occur before symptoms appear. Early

symptoms may include mild irritation of the upper respiratory tract,

a sensation of constriction of the throat, a metallic taste and/or a

cough. A period of 1-10 hours may precede the onset of rapidly

progressing shortness of breath, chest pain, and flu-like symptoms

with weakness, fever, headache, chills, sweating and muscular pain.

Acute pulmonary edema usually develops within 24 hours and reaches a

maximum by three days. If death from asphyxia does not occur,

symptoms may resolve within a week.

3. Long-term (chronic) exposure. Repeated or long-term exposure

to cadmium, even at relatively low concentrations, may result in

kidney damage and an increased risk of cancer of the lung and of the

prostate.

C. Emergency First Aid Procedures.

1. Eye exposure: Direct contact may cause redness or pain. Wash

eyes immediately with large amounts of water, lifting the upper and

lower eyelids. Get medical attention immediately.

2. Skin exposure: Direct contact may result in irritation.

Remove contaminated clothing and shoes immediately. Wash affected

area with soap or mild detergent and large amounts of water. Get

medical attention immediately.

3. Ingestion: Ingestion may result in vomiting, abdominal pain,

nausea, diarrhea, headache and sore throat. Treatment for symptoms

must be administered by medical personnel. Under no circumstances

should the employer allow any person whom he retains, employs,

supervises or controls to engage in therapeutic chelation. Such

treatment is likely to translocate cadmium from pulmonary or other

tissue to renal tissue. Get medical attention immediately.

4. Inhalation: If large amounts of cadmium are inhaled, the

exposed person must be moved to fresh air at once. If breathing has

stopped, perform cardiopulmonary resuscitation. Administer oxygen if

available. Keep the affected person warm and at rest. Get medical

attention immediately.

5. Rescue: Move the affected person from the hazardous exposure.

If the exposed person has been overcome, attempt rescue only after

notifying at least one other person of the emergency and putting

into effect established emergency procedures. Do not become a

casualty yourself. Understand your emergency rescue procedures and

know the location of the emergency equipment before the need arises.

III. Employee Information

A. Protective Clothing and Equipment.

1. Respirators: You may be required to wear a respirator for

non-routine activities; in emergencies; while your employer is in

the process of reducing cadmium exposures through engineering

controls; and where engineering controls are not feasible. If

respirators are worn in the future, they must have a joint Mine

Safety and Health Administration (MSHA) and National Institute for

Occupational Safety and Health (NIOSH) label of approval. Cadmium

does not have a detectable odor except at levels well above the

permissible exposure limits. If you can smell cadmium while wearing

a respirator, proceed immediately to fresh air. If you experience

difficulty breathing while wearing a respirator, tell your employer.

2. Protective Clothing: You may be required to wear impermeable

clothing, gloves, foot gear, a face shield, or other appropriate

protective clothing to prevent skin contact with cadmium. Where

protective clothing is required, your employer must provide clean

garments to you as necessary to assure that the clothing protects

you adequately. The employer must replace or repair protective

clothing that has become torn or otherwise damaged.

3. Eye Protection: You may be required to wear splash-proof or

dust resistant goggles to prevent eye contact with cadmium.

B. Employer Requirements.

1. Medical: If you are exposed to cadmium at or above the action

level, your employer is required to provide a medical examination,

laboratory tests and a medical history according to the medical

surveillance provisions under paragraph (1) of this standard. (See

summary chart and tables in this appendix A.) These tests shall be

provided without cost to you. In addition, if you are accidentally

exposed to cadmium under conditions known or suspected to constitute

toxic exposure to cadmium, your employer is required to make special

tests available to you.

2. Access to Records: All medical records are kept strictly

confidential. You or your representative are entitled to see the

records of measurements of your exposure to cadmium. Your medical

examination records can be furnished to your personal physician or

designated representative upon request by you to your employer.

3. Observation of Monitoring: Your employer is required to

perform measurements that are representative of your exposure to

cadmium and you or your designated representative are entitled to

observe the monitoring procedure. You are entitled to observe the

steps taken in the measurement procedure, and to record the results

obtained. When the monitoring procedure is taking place in an area

where respirators or personal protective clothing and equipment are

required to be worn, you or your representative must also be

provided with, and must wear the protective clothing and equipment.

C. Employee Requirements.--You will not be able to smoke, eat,

drink, chew gum or tobacco, or apply cosmetics while working with

cadmium in regulated areas. You will also not be able to carry or

store tobacco products, gum, food, drinks or cosmetics in regulated

areas because these products easily become contaminated with cadmium

from the workplace and can therefore create another source of

unnecessary cadmium exposure.

Some workers will have to change out of work clothes and shower

at the end of the day, as part of their workday, in order to wash

cadmium from skin and hair. Handwashing and cadmium-free eating

facilities shall be provided by the employer and proper hygiene

should always be performed before eating. It is also recommended

that you do not smoke or use tobacco products, because among other

things, they naturally contain cadmium. For further information,

read the labeling on such products.

IV. Physician Information

A. Introduction.--The medical surveillance provisions of

paragraph (1) generally are aimed at accomplishing three main

interrelated purposes: First, identifying employees at higher risk

of adverse health effects from excess, chronic exposure to cadmium;

second, preventing cadmium-induced disease; and third, detecting and

minimizing existing cadmium-induced disease. The core of medical

surveillance in this standard is the early and periodic monitoring

of the employee's biological indicators of: (a) Recent exposure to

cadmium; (b) cadmium body burden; and (c) potential and actual

kidney damage associated with exposure to cadmium.

The main adverse health effects associated with cadmium

overexposure are lung cancer and kidney dysfunction. It is not yet

known how to adequately biologically monitor human beings to

specifically prevent cadmium-induced lung cancer. By contrast, the

kidney can be monitored to provide prevention and early detection of

cadmium-induced kidney damage. Since, for non-carcinogenic effects,

the kidney is considered the primary target organ of chronic

exposure to cadmium, the medical surveillance provisions of this

standard effectively focus on cadmium-induced kidney disease. Within

that focus, the aim, where possible, is to prevent the onset of such

disease and, where necessary, to minimize such disease as may

already exist. The by-products of successful prevention of kidney

disease are anticipated to be the reduction and prevention of other

cadmium-induced diseases.

B. Health Effects.--The major health effects associated with

cadmium overexposure are described below.

1. Kidney: The most prevalent non-malignant disease observed

among workers chronically exposed to cadmium is kidney dysfunction.

Initially, such dysfunction is manifested as proteinuria. The

proteinuria associated with cadmium exposure is most commonly

characterized by excretion of low-molecular weight proteins (15,000

to 40,000 MW) accompanied by loss of electrolytes, uric acid,

calcium, amino acids, and phosphate. The compounds commonly excreted

include: beta-2-microglobulin (2-M), retinol binding

protein (RBP), immunoglobulin light chains, and lysozyme. Excretion

of low molecular weight proteins are characteristic of damage to the

proximal tubules of the kidney (Iwao et al., 1980).

It has also been observed that exposure to cadmium may lead to

urinary excretion of high-molecular weight proteins such as albumin,

immunoglobulin G, and glycoproteins (Ex. 29). Excretion of high-

molecular weight proteins is typically indicative of damage to the

glomeruli of the kidney. Bernard et al., (1979) suggest that damage

to the glomeruli and damage to the proximal tubules of the kidney

may both be linked to cadmium exposure but they may occur

independently of each other.

Several studies indicate that the onset of low-molecular weight

proteinuria is a sign of irreversible kidney damage (Friberg et al.,

1974; Roels et al., 1982; Piscator 1984; Elinder et al., 1985; Smith

et al., 1986). Above specific levels of 2-M associated

with cadmium exposure it is unlikely that 2-M levels

return to normal even when cadmium exposure is eliminated by removal

of the individual from the cadmium work environment (Friberg, Ex.

29, 1990).

Some studies indicate that such proteinuria may be progressive;

levels of 2-M observed in the urine increase with time

even after cadmium exposure has ceased. See, for example, Elinder et

al., 1985. Such observations, however, are not universal, and it has

been suggested that studies in which proteinuria has not been

observed to progress may not have tracked patients for a

sufficiently long time interval (Jarup, Ex. 8-661).

When cadmium exposure continues after the onset of proteinuria,

chronic nephrotoxicity may occur (Friberg, Ex. 29). Uremia results

from the inability of the glomerulus to adequately filter blood.

This leads to severe disturbance of electrolyte concentrations and

may lead to various clinical complications including kidney stones

(L-140-50).

After prolonged exposure to cadmium, glomerular proteinuria,

glucosuria, aminoaciduria, phosphaturia, and hypercalciuria may

develop (Exs. 8-86, 4-28, 14-18). Phosphate, calcium, glucose, and

amino acids are essential to life, and under normal conditions,

their excretion should be regulated by the kidney. Once low

molecular weight proteinuria has developed, these elements dissipate

from the human body. Loss of glomerular function may also occur,

manifested by decreased glomerular filtration rate and increased

serum creatinine. Severe cadmium-induced renal damage may eventually

develop into chronic renal failure and uremia (Ex. 55).

Studies in which animals are chronically exposed to cadmium

confirm the renal effects observed in humans (Friberg et al., 1986).

Animal studies also confirm problems with calcium metabolism and

related skeletal effects which have been observed among humans

exposed to cadmium in addition to the renal effects. Other effects

commonly reported in chronic animal studies include anemia, changes

in liver morphology, immunosuppression and hypertension. Some of

these effects may be associated with co-factors. Hypertension, for

example, appears to be associated with diet as well as cadmium

exposure. Animals injected with cadmium have also shown testicular

necrosis (Ex. 8-86B).

2. Biological Markers

It is universally recognized that the best measures of cadmium

exposures and its effects are measurements of cadmium in biological

fluids, especially urine and blood. Of the two, CdU is

conventionally used to determine body burden of cadmium in workers

without kidney disease. CdB is conventionally used to monitor for

recent exposure to cadmium. In addition, levels of CdU and CdB

historically have been used to predict the percent of the population

likely to develop kidney disease (Thun et al., Ex. L-140-50; WHO,

Ex. 8-674; ACGIH, Exs. 8-667, 140-50).

The third biological parameter upon which OSHA relies for

medical surveillance is Beta-2-microglobulin in urine

(2-M), a low molecular weight protein. Excess

2-M has been widely accepted by physicians and

scientists as a reliable indicator of functional damage to the

proximal tubule of the kidney (Exs. 8-447, 144-3-C, 4-47, L-140-45,

19-43-A).

Excess 2-M is found when the proximal tubules can

no longer reabsorb this protein in a normal manner. This failure of

the proximal tubules is an early stage of a kind of kidney disease

that commonly occurs among workers with excessive cadmium exposure.

Used in conjunction with biological test results indicating abnormal

levels of CdU and CdB, the finding of excess 2-M can

establish for an examining physician that any existing kidney

disease is probably cadmium-related (Trs. 6/6/90, pp. 82-86, 122,

134). The upper limits of normal levels for cadmium in urine and

cadmium in blood are 3 g Cd/gram creatinine in urine and 5

gCd/liter whole blood, respectively. These levels were

derived from broad-based population studies.

Three issues confront the physicians in the use of

2-M as a marker of kidney dysfunction and material

impairment. First, there are a few other causes of elevated levels

of 2-M not related to cadmium exposures, some of which

may be rather common diseases and some of which are serious diseases

(e.g., myeloma or transient flu, Exs. 29 and 8-086). These can be

medically evaluated as alternative causes (Friberg, Ex. 29). Also,

there are other factors that can cause 2-M to degrade

so that low levels would result in workers with tubular dysfunction.

For example, regarding the degradation of 2-M, workers

with acidic urine (pH2-M levels that

are within the ``normal'' range when in fact kidney dysfunction has

occurred (Ex. L-140-1) and the low molecular weight proteins are

degraded in acid urine. Thus, it is very important that the pH of

urine be measured, that urine samples be buffered as necessary (See

appendix F.), and that urine samples be handled correctly, i.e.,

measure the pH of freshly voided urine samples, then if necessary,

buffer to pH>6 (or above for shipping purposes), measure pH again

and then, perhaps, freeze the sample for storage and shipping. (See

also appendix F.) Second, there is debate over the pathological

significance of proteinuria, however, most world experts believe

that 2-M levels greater than 300 g/g Cr are

abnormal (Elinder, Ex. 55, Friberg, Ex. 29). Such levels signify

kidney dysfunction that constitutes material impairment of health.

Finally, detection of 2-M at low levels has often been

considered difficult, however, many laboratories have the capability

of detecting excess 2-M using simple kits, such as the

Phadebas Delphia test, that are accurate to levels of 100 g

2-M/g Cr U (Ex. L-140-1).

Specific recommendations for ways to measure 2-M

and proper handling of urine samples to prevent degradation of

2-M have been addressed by OSHA in appendix F, in the

section on laboratory standardization. All biological samples must

be analyzed in a laboratory that is proficient in the analysis of

that particular analyte, under paragraph (l)(1)(iv). (See appendix

F). Specifically, under paragraph (l)(1)(iv), the employer is to

assure that the collecting and handling of biological samples of

cadmium in urine (CdU), cadmium in blood (CdB), and beta-2

microglobulin in urine (2-M) taken from employees is

collected in a manner that assures reliability. The employer must

also assure that analysis of biological samples of cadmium in urine

(CdU), cadmium in blood (CdB), and beta-2 microglobulin in urine

(2-M) taken from employees is performed in

laboratories with demonstrated proficiency for that particular

analyte. (See appendix F.)

3. Lung and Prostate Cancer

The primary sites for cadmium-associated cancer appear to be the

lung and the prostate (L-140-50). Evidence for an association

between cancer and cadmium exposure derives from both

epidemiological studies and animal experiments. Mortality from

prostate cancer associated with cadmium is slightly elevated in

several industrial cohorts, but the number of cases is small and

there is not clear dose-response relationship. More substantive

evidence exists for lung cancer.

The major epidemiological study of lung cancer was conducted by

Thun et al., (Ex. 4-68). Adequate data on cadmium exposures were

available to allow evaluation of dose-response relationships between

cadmium exposure and lung cancer. A statistically significant excess

of lung cancer attributed to cadmium exposure was observed in this

study even when confounding variables such as co-exposure to arsenic

and smoking habits were taken into consideration (Ex. L-140-50).

The primary evidence for quantifying a link between lung cancer

and cadmium exposure from animal studies derives from two rat

bioassay studies; one by Takenaka et al., (1983), which is a study

of cadmium chloride and a second study by Oldiges and Glaser (1990)

of four cadmium compounds.

Based on the above cited studies, the U.S. Environmental

Protection Agency (EPA) classified cadmium as ``B1'', a probable

human carcinogen, in 1985 (Ex. 4-4). The International Agency for

Research on Cancer (IARC) in 1987 also recommended that cadmium be

listed as ``2A'', a probable human carcinogen (Ex. 4-15). The

American Conference of Governmental Industrial Hygienists (ACGIH)

has recently recommended that cadmium be labeled as a carcinogen.

Since 1984, NIOSH has concluded that cadmium is possibly a human

carcinogen and has recommended that exposures be controlled to the

lowest level feasible.

4. Non-carcinogenic Effects

Acute pneumonitis occurs 10 to 24 hours after initial acute

inhalation of high levels of cadmium fumes with symptoms such as

fever and chest pain (Exs. 30, 8-86B). In extreme exposure cases

pulmonary edema may develop and cause death several days after

exposure. Little actual exposure measurement data is available on

the level of airborne cadmium exposure that causes such immediate

adverse lung effects, nonetheless, it is reasonable to believe a

cadmium concentration of approximately 1 mg/m3 over an eight

hour period is ``immediately dangerous'' (55 FR 4052, ANSI; Ex. 8-

86B).

In addition to acute lung effects and chronic renal effects,

long term exposure to cadmium may cause other severe effects on the

respiratory system. Reduced pulmonary function and chronic lung

disease indicative of emphysema have been observed in workers who

have had prolonged exposure to cadmium dust or fumes (Exs. 4-29, 4-

22, 4-42, 4-50, 4-63). In a study of workers conducted by Kazantzis

et al., a statistically significant excess of worker deaths due to

chronic bronchitis was found, which in his opinion was directly

related to high cadmium exposures of 1 mg/m3 or more (Tr. 6/8/

90, pp. 156-157).

Cadmium need not be respirable to constitute a hazard.

Inspirable cadmium particles that are too large to be respirable but

small enough to enter the tracheobronchial region of the lung can

lead to bronchoconstriction, chronic pulmonary disease, and cancer

of that portion of the lung. All of these diseases have been

associated with occupational exposure to cadmium (Ex. 8-86B).

Particles that are constrained by their size to the extra-thoracic

regions of the respiratory system such as the nose and maxillary

sinuses can be swallowed through mucocillary clearance and be

absorbed into the body (ACGIH, Ex. 8-692). The impaction of these

particles in the upper airways can lead to anosmia, or loss of sense

of smell, which is an early indication of overexposure among workers

exposed to heavy metals. This condition is commonly reported among

cadmium-exposed workers (Ex. 8-86-B).

C. Medical Surveillance

In general, the main provisions of the medical surveillance

section of the standard, under paragraphs (l)(1)-(17) of the

regulatory text, are as follows:

1. Workers exposed above the action level are covered;

2. Workers with intermittent exposures are not covered;

3. Past workers who are covered receive biological monitoring

for at least one year;

4. Initial examinations include a medical questionnaire and

biological monitoring of cadmium in blood (CdB), cadmium in urine

(CdU), and Beta-2-microglobulin in urine (2-M);

5. Biological monitoring of these three analytes is performed at

least annually; full medical examinations are performed biennially;

6. Until five years from the effective date of the standard,

medical removal is required when CdU is greater than 15 g/

gram creatinine (g Cr), or CdB is greater than 15 g/liter

whole blood (lwb), or 2-M is greater than 1500

g/g Cr, and CdB is greater than 5 g/lwb or CdU is

greater than 3 g/g Cr;

7. Beginning five years after the standard is in effect, medical

removal triggers will be reduced;

8. Medical removal protection benefits are to be provided for up

to 18 months;

9. Limited initial medical examinations are required for

respirator usage;

10. Major provisions are fully described under section (l) of

the regulatory text; they are outlined here as follows:

A. Eligibility

B. Biological monitoring

C. Actions triggered by levels of CdU, CdB, and 2-

M (See Summary Charts and Tables in Attachment-1.)

D. Periodic medical surveillance

E. Actions triggered by periodic medical surveillance (See

appendix A Summary Chart and Tables in Attachment-1.)

F. Respirator usage

G. Emergency medical examinations

H. Termination examination

I. Information to physician

J. Physician's medical opinion

K. Medical removal protection

L. Medical removal protection benefits

M. Multiple physician review

N. Alternate physician review

O. Information employer gives to employee

P. Recordkeeping

Q. Reporting on OSHA form 200

11. The above mentioned summary of the medical surveillance

provisions, the summary chart, and tables for the actions triggered

at different levels of CdU, CdB and 2-M (in appendix A

Attachment-1) are included only for the purpose of facilitating

understanding of the provisions of paragraphs (l)(3) of the final

cadmium standard. The summary of the provisions, the summary chart,

and the tables do not add to or reduce the requirements in paragraph

(l)(3).

D. Recommendations to Physicians

1. It is strongly recommended that patients with tubular

proteinuria are counseled on: The hazards of smoking; avoidance of

nephrotoxins and certain prescriptions and over-the-counter

medications that may exacerbate kidney symptoms; how to control

diabetes and/or blood pressure; proper hydration, diet, and exercise

(Ex. 19-2). A list of prominent or common nephrotoxins is attached.

(See appendix A Attachment-2.)

2. DO NOT CHELATE; KNOW WHICH DRUGS ARE NEPHROTOXINS OR ARE

ASSOCIATED WITH NEPHRITIS.

3. The gravity of cadmium-induced renal damage is compounded by

the fact there is no medical treatment to prevent or reduce the

accumulation of cadmium in the kidney (Ex. 8-619). Dr. Friberg, a

leading world expert on cadmium toxicity, indicated in 1992, that

there is no form of chelating agent that could be used without

substantial risk. He stated that tubular proteinuria has to be

treated in the same way as other kidney disorders (Ex. 29).

4. After the results of a workers' biological monitoring or

medical examination are received the employer is required to provide

an information sheet to the patient, briefly explaining the

significance of the results. (See Attachment 3 of this appendix A.)

5. For additional information the physician is referred to the

following additional resources:

a. The physician can always obtain a copy of the preamble, with

its full discussion of the health effects, from OSHA's Computerized

Information System (OCIS).

b. The Docket Officer maintains a record of the rulemaking. The

Cadmium Docket (H-057A), is located at 200 Constitution Ave. NW.,

room N-2625, Washington, DC 20210; telephone: 202-219-7894.

c. The following articles and exhibits in particular from that

docket (H-057A):

------------------------------------------------------------------------

Exhibit No. Author and paper title

------------------------------------------------------------------------

8-447....... Lauwerys et. al., Guide for physicians, ``Health

Maintenance of Workers Exposed to Cadmium,'' published by

the Cadmium Council.

4-67........ Takenaka, S., H. Oldiges, H. Konig, D. Hochrainer, G.

Oberdorster. ``Carcinogenicity of Cadmium Chloride

Aerosols in Wistar Rats''. JNCI 70:367-373, 1983. (32)

4-68........ Thun, M.J., T.M. Schnoor, A.B. Smith, W.E. Halperin, R.A.

Lemen. ``Mortality Among a Cohort of U.S. Cadmium

Production Workers--An Update.'' JNCI 74(2):325-33, 1985.

(8)

4-25........ Elinder, C.G., Kjellstrom, T., Hogstedt, C., et al.,

``Cancer Mortality of Cadmium Workers.'' Brit. J. Ind.

Med. 42:651-655, 1985. (14)

4-26........ Ellis, K.J. et al., ``Critical Concentrations of Cadmium

in Human Renal Cortex: Dose Effect Studies to Cadmium

Smelter Workers.'' J. Toxicol. Environ. Health 7:691-703,

1981. (76)

4-27........ Ellis, K.J., S.H. Cohn and T.J. Smith. ``Cadmium

Inhalation Exposure Estimates: Their Significance with

Respect to Kidney and Liver Cadmium Burden.'' J. Toxicol.

Environ. Health 15:173-187, 1985.

4-28........ Falck, F.Y., Jr., Fine, L.J., Smith, R.G., McClatchey,

K.D., Annesley, T., England, B., and Schork, A.M.

``Occupational Cadmium Exposure and Renal Status.'' Am.

J. Ind. Med. 4:541, 1983. (64)

8-86A....... Friberg, L., C.G. Elinder, et al., ``Cadmium and Health a

Toxicological and Epidemiological Appraisal, Volume I,

Exposure, Dose, and Metabolism.'' CRC Press, Inc., Boca

Raton, FL, 1986. (Available from the OSHA Technical Data

Center)

8-86B....... Friberg, L., C.G. Elinder, et al., ``Cadmium and Health: A

Toxicological and Epidemiological Appraisal, Volume II,

Effects and Response.'' CRC Press, Inc., Boca Raton, FL,

1986. (Available from the OSHA Technical Data Center)

L-140-45.... Elinder, C.G., ``Cancer Mortality of Cadmium Workers'',

Brit. J. Ind. Med., 42, 651-655, 1985.

L-140-50.... Thun, M., Elinder, C.G., Friberg, L, ``Scientific Basis

for an Occupational Standard for Cadmium, Am. J. Ind.

Med., 20; 629-642, 1991.

------------------------------------------------------------------------

V. Information Sheet

The information sheet (appendix A Attachment-3.) or an equally

explanatory one should be provided to you after any biological

monitoring results are reviewed by the physician, or where

applicable, after any medical examination.

Appendix A

Attachment 1--Appendix A Summary Chart and Tables A and B of Actions

Triggered by Biological Monitoring

Appendix A Summary Chart: Section (1)(3) Medical Surveillance

Categorizing Biological Monitoring Results

(A) Biological monitoring results categories are set forth in

Appendix A Table A for the periods ending December 31, 1998 and for

the period beginning January 1, 1999.

(B) The results of the biological monitoring for the initial

medical exam and the subsequent exams shall determine an employee's

biological monitoring result category.

Actions Triggered by Biological Monitoring

(A)

(i) The actions triggered by biological monitoring for an

employee are set forth in Appendix A Table B.

(ii) The biological monitoring results for each employee under

section (1)(3) shall determine the actions required for that

employee. That is, for any employee in biological monitoring

category C, the employer will perform all of the actions for which

there is an X in column C of Appendix A Table B.

(iii) An employee is assigned the alphabetical category (``A''

being the lowest) depending upon the test results of the three

biological markers.

(iv) An employee is assigned category A if monitoring results

for all three biological markers fall at or below the levels

indicated in the table listed for category A.

(v) An employee is assigned category B if any monitoring result

for any of the three biological markers fall within the range of

levels indicated in the table listed for category B, providing no

result exceeds the levels listed for category B.

(vi) An employee is assigned category C if any monitoring result

for any of the three biological markers are above the levels listed

for category C.

(B) The user of Appendix A Tables A and B should know that these

tables are provided only to facilitate understanding of the relevant

provisions of paragraph (l)(3) of this section. Appendix A Tables A

and B are not meant to add to or subtract from the requirements of

those provisions.

Appendix A Table A

Categorization of Biological Monitoring Results

Applicable Through 1998 Only

----------------------------------------------------------------------------------------------------------------

Monitoring result categories

Biological marker ----------------------------------------------

A B C

----------------------------------------------------------------------------------------------------------------

Cadmium in urine (CdU) (g/g creatinine)................. 3 and 15 >15

2-microglobulin (2-M) (g/g creatinine) 300 and 1500 >1500*

Cadmium in blood (CdB) (g/liter whole blood)............ 5 and 15 >15

----------------------------------------------------------------------------------------------------------------

* If an employee's 2-M levels are above 1,500 g/g creatinine, in order for mandatory medical

removal to be required (See Appendix A Table B.), either the employee's CdU level must also be >3 g/g

creatinine or CdB level must also be >5 g/liter whole blood.

Applicable Beginning January 1, 1999

----------------------------------------------------------------------------------------------------------------

Monitoring result categories

Biological marker ----------------------------------------------

A B C

----------------------------------------------------------------------------------------------------------------

Cadmium in urine (CdU) (g/g creatinine)................. 3 and 7 >7

2-microglobulin (2-M) (g/g creatinine) 300 and 750 >750*

Cadmium in blood (CdB) (g/liter whole blood)............ 5 and 10 >10

----------------------------------------------------------------------------------------------------------------

* If an employee's 2-M levels are above 750 g/g creatinine, in order for mandatory medical

removal to be required (See Appendix A Table B.), either the employee's CdU level must also be >3 g/g

creatinine or CdB level must also be >5 g/liter whole blood.

Appendix A Table B--Actions Determined by Biological Monitoring

This table presents the actions required based on the monitoring

result in Appendix A Table A. Each item is a separate requirement in

citing non-compliance. For example, a medical examination within 90

days for an employee in category B is separate from the requirement to

administer a periodic medical examination for category B employees on

an annual basis.

------------------------------------------------------------------------

Monitoring result category

Required actions -----------------------------------

A\1\ B\1\ C\1\

------------------------------------------------------------------------

(1) Biological monitoring:

(a) Annual...................... X .......... ..........

(b) Semiannual.................. .......... X ..........

(2) Medical examination:

(a) Biennial.................... X .......... ..........

(b) Annual...................... .......... X ..........

(d) Within 90 days.............. .......... X X

(3) Assess within two weeks:

(a) Excess cadmium exposure..... .......... X X

(b) Work practices.............. .......... X X

(d) Respirator usage............ .......... X X

(e) Smoking history............. .......... X X

(f) Hygiene facilities.......... .......... X X

(g) Engineering controls........ .......... X X

(h) Correct within 30 days...... .......... X X

(i) Periodically assess .......... .......... X

exposures.

(4) Discretionary medical removal... .......... X X

(5) Mandatory medical removal....... .......... .......... X\2\

------------------------------------------------------------------------

\1\For all employees covered by medical surveillance exclusively because

of exposures prior to the effective date of this standard, if they are

in Category A, the employer shall follow the requirements of

paragraphs (l)(3)(i)(B) and (l)(4)(v)(A). If they are in Category B or

C, the employer shall follow the requirements of paragraphs

(l)(4)(v)(B)-(C).

\2\See footnote Appendix A Table A.

Appendix A--Attachment-2: List of Medications

A list of the more common medications that a physician, and the

employee, may wish to review is likely to include some of the

following: (1) Anticonvulsants: Paramethadione, phenytoin,

trimethadone; (2) antihypertensive drugs: Captopril, methyldopa; (3)

antimicrobials: Aminoglycosides, amphotericin B, cephalosporins,

ethambutol; (4) antineoplastic agents: Cisplatin, methotrexate,

mitomycin-C, nitrosoureas, radiation; (4) sulfonamide diuretics:

Acetazolamide, chlorthalidone, furosemide, thiazides; (5)

halogenated alkanes, hydrocarbons, and solvents that may occur in

some settings: Carbon tetrachloride, ethylene glycol, toluene;

iodinated radiographic contrast media; nonsteroidal anti-

inflammatory drugs; and, (7) other miscellaneous compounds:

Acetominophen, allopurinol, amphetamines, azathioprine, cimetidine,

cyclosporine, lithium, methoxyflurane, methysergide, D-

penicillamine, phenacetin, phenendione. A list of drugs associated

with acute interstitial nephritis includes: (1) Antimicrobial drugs:

Cephalosporins, chloramphenicol, colistin, erythromycin, ethambutol,

isoniazid, para-aminosalicylic acid, penicillins, polymyxin B,

rifampin, sulfonamides, tetracyclines, and vancomycin; (2) other

miscellaneous drugs: Allopurinol, antipyrene, azathioprine,

captopril, cimetidine, clofibrate, methyldopa, phenindione,

phenylpropanolamine, phenytoin, probenecid, sulfinpyrazone,

sulfonamid diuretics, triamterene; and, (3) metals: Bismuth, gold.

This list have been derived from commonly available medical

textbooks (e.g., Ex. 14-18). The list has been included merely to

facilitate the physician's, employer's, and employee's

understanding. The list does not represent an official OSHA opinion

or policy regarding the use of these medications for particular

employees. The use of such medications should be under physician

discretion.

Attachment 3--Biological Monitoring and Medical Examination Results

Employee---------------------------------------------------------------

Testing Date-----------------------------------------------------------

Cadmium in Urine ______ g/g Cr--Normal Levels:

3 g/g Cr.

Cadmium in Blood ______ g/lwb--Normal Levels:

5 g/lwb.

Beta-2-microglobulin in Urine ______ g/g Cr--Normal

Levels: 300 g/g Cr.

Physical Examination Results: N/A ______ Satisfactory ______

Unsatisfactory ______ (see physician again).

Physician's Review of Pulmonary Function Test: N/A ______ Normal

______ Abnormal ______.

Next biological monitoring or medical examination scheduled for--------

The biological monitoring program has been designed for three

main purposes: 1) to identify employees at risk of adverse health

effects from excess, chronic exposure to cadmium; 2) to prevent

cadmium-induced disease(s); and 3) to detect and minimize existing

cadmium-induced disease(s).

The levels of cadmium in the urine and blood provide an estimate

of the total amount of cadmium in the body. The amount of a specific

protein in the urine (beta-2-microglobulin) indicates changes in

kidney function. All three tests must be evaluated together. A

single mildly elevated result may not be important if testing at a

later time indicates that the results are normal and the workplace

has been evaluated to decrease possible sources of cadmium exposure.

The levels of cadmium or beta-2-microglobulin may change over a

period of days to months and the time needed for those changes to

occur is different for each worker.

If the results for biological monitoring are above specific

``high levels'' [cadmium urine greater than 10 micrograms per gram

of creatinine (g/g Cr), cadmium blood greater than 10

micrograms per liter of whole blood (g/lwb), or beta-2-

microglobulin greater than 1000 micrograms per gram of creatinine

(g/g Cr)], the worker has a much greater chance of

developing other kidney diseases.

One way to measure for kidney function is by measuring beta-2-

microglobulin in the urine. Beta-2-microglobulin is a protein which

is normally found in the blood as it is being filtered in the

kidney, and the kidney reabsorbs or returns almost all of the beta-

2-microglobulin to the blood. A very small amount (less than 300

g/g Cr in the urine) of beta-2-microglobulin is not

reabsorbed into the blood, but is released in the urine. If cadmium

damages the kidney, the amount of beta-2-microglobulin in the urine

increases because the kidney cells are unable to reabsorb the beta-

2-microglobulin normally. An increase in the amount of beta-2-

microglobulin in the urine is a very early sign of kidney

dysfunction. A small increase in beta-2-microglobulin in the urine

will serve as an early warning sign that the worker may be absorbing

cadmium from the air, cigarettes contaminated in the workplace, or

eating in areas that are cadmium contaminated.

Even if cadmium causes permanent changes in the kidney's ability

to reabsorb beta-2-microglobulin, and the beta-2-microglobulin is

above the ``high levels'', the loss of kidney function may not lead

to any serious health problems. Also, renal function naturally

declines as people age. The risk for changes in kidney function for

workers who have biological monitoring results between the ``normal

values'' and the ``high levels'' is not well known. Some people are

more cadmium-tolerant, while others are more cadmium-susceptible.

For anyone with even a slight increase of beta-2-microglobulin,

cadmium in the urine, or cadmium in the blood, it is very important

to protect the kidney from further damage. Kidney damage can come

from other sources than excess cadmium-exposure so it is also

recommended that if a worker's levels are ``high'' he/she should

receive counseling about drinking more water; avoiding cadmium-

tainted tobacco and certain medications (nephrotoxins,

acetaminophen); controlling diet, vitamin intake, blood pressure and

diabetes; etc.

Appendix B to Sec. 1915.1027--Substance Technical Guidelines for

Cadmium

I. Cadmium Metal.

A. Physical and Chemical Data.

1. Substance Identification.

Chemical name: Cadmium.

Formula: Cd.

Molecular Weight: 112.4.

Chemical Abstracts Service (CAS) Registry No.: 7740-43-9.

Other Identifiers: RETCS EU9800000; EPA D006; DOT 2570 53.

Synonyms: Colloidal Cadmium: Kadmium (German): CI 77180.

2. Physical data.

Boiling point: (760 mm Hg): 765 degrees C.

Melting point: 321 degrees C.

Specific Gravity: (H[email protected] 20 deg.C): 8.64.

Solubility: Insoluble in water; soluble in dilute nitric acid

and in sulfuric acid.

Appearance: Soft, blue-white, malleable, lustrous metal or

grayish-white powder.

B. Fire, Explosion and Reactivity Data.

1. Fire.

Fire and Explosion Hazards: The finely divided metal is

pyrophoric, that is the dust is a severe fire hazard and moderate

explosion hazard when exposed to heat or flame. Burning material

reacts violently with extinguishing agents such as water, foam,

carbon dioxide, and halons.

Flash point: Flammable (dust).

Extinguishing media: Dry sand, dry dolomite, dry graphite, or

sodimum chloride.

2. Reactivity.

Conditions contributing to instability: Stable when kept in

sealed containers under normal temperatures and pressure, but dust

may ignite upon contact with air. Metal tarnishes in moist air.

Incompatibilities: Ammonium nitrate, fused: Reacts violently or

explosively with cadmium dust below 20 deg.C. Hydrozoic acid:

Violent explosion occurs after 30 minutes. Acids: Reacts violently,

forms hydrogen gas. Oxidizing agents or metals: Strong reaction with

cadmium dust. Nitryl fluoride at slightly elevated temperature:

Glowing or white incandescence occurs. Selenium: Reacts

exothermically. Ammonia: Corrosive reaction. Sulfur dioxide:

Corrosive reaction. Fire extinguishing agents (water, foam, carbon

dioxide, and halons): Reacts violently. Tellurium: Incandescent

reaction in hydrogen atmosphere.

Hazardous decomposition products: The heated metal rapidly forms

highly toxic, brownish fumes of oxides of cadmium.

C. Spill, Leak and Disposal Procedures.

1. Steps to be taken if the materials is released or spilled. Do

not touch spilled material. Stop leak if you can do it without risk.

Do not get water inside container. For large spills, dike spill for

later disposal. Keep unnecessary people away. Isolate hazard area

and deny entry. The Superfund Amendments and Reauthorization Act of

1986 Section 304 requires that a release equal to or greater than

the reportable quantity for this substance (1 pound) must be

immediately reported to the local emergency planning committee, the

state emergency response commission, and the National Response

Center (800) 424-8802; in Washington, DC metropolitan area (202)

426-2675.

II. Cadmium Oxide.

A. Physical and Chemical Date.

1. Substance identification.

Chemical name: Cadmium Oxide.

Formula: CdO.

Molecular Weight: 128.4.

CAS No.: 1306-19-0.

Other Identifiers: RTECS EV1929500.

Synonyms: Kadmu tlenek (Polish).

2. Physical data.

Boiling point (760 mm Hg): 950 degrees C decomposes.

Melting point: 1500 deg.C.

Specific Gravity: (H[email protected] deg.C): 7.0.

Solubility: Insoluble in water; soluble in acids and alkalines.

Appearance: Red or brown crystals.

B. Fire, Explosion and Reactivity Data.

1. Fire.

Fire and Explosion Hazards: Negligible fire hazard when exposed

to heat or flame.

Flash point: Nonflammable.

Extinguishing media: Dry chemical, carbon dioxide, water spray

or foam.

2. Reactivity.

Conditions contributing to instability: Stable under normal

temperatures and pressures.

Incompatibilities: Magnesium may reduce CdO2 explosively on

heating.

Hazardous decomposition products: Toxic fumes of cadmium.

C. Spill Leak and Disposal Procedures.

1. Steps to be taken if the material is released or spilled. Do

not touch spilled material. Stop leak if you can do it without risk.

For small spills, take up with sand or other absorbent material and

place into containers for later disposal. For small dry spills, use

a clean shovel to place material into clean, dry container and then

cover. Move containers from spill area. For larger spills, dike far

ahead of spill for later disposal. Keep unnecessary people away.

Isolate hazard area and deny entry. The Superfund Amendments and

Reauthorization Act of 1986 Section 304 requires that a release

equal to or greater than the reportable quantity for this substance

(1 pound) must be immediately reported to the local emergency

planning committee, the state emergency response commission, and the

National Response Center (800) 424-8802; in Washington, DC

metropolitan area (202) 426-2675.

III. Cadmium Sulfide.

A. Physical and Chemical Data.

1. Substance Identification.

Chemical name: Cadmium sulfide.

Formula: CdS.

Molecular weight: 144.5.

CAS No. 1306-23-6.

Other Identifiers: RTECS EV3150000.

Synonyms: Aurora yellow; Cadmium Golden 366; Cadmium Lemon

Yellow 527; Cadmium Orange; Cadmium Primrose 819; Cadmium Sulphide;

Cadmium Yellow; Cadmium Yellow 000; Cadmium Yellow Conc. Deep;

Cadmium Yellow Conc. Golden; Cadmium Yellow Conc. Lemon; Cadmium

Yellow Conc. Primrose; Cadmium Yellow Oz. Dark; Cadmium Yellow

Primrose 47-1400; Cadmium Yellow 10G Conc.; Cadmium Yellow 892;

Cadmopur Golden Yellow N; Cadmopur Yellow: Capsebon; C.I. 77199;

C.I. Pigment Orange 20; CI Pigment Yellow 37; Ferro Lemon Yellow;

Ferro Orange Yellow; Ferro Yellow; Greenockite; NCI-C02711.

2. Physical data.

Boiling point (760 mm. Hg): sublines in N2 at 980 deg.C.

Melting point: 1750 degrees C (100 atm).

Specific Gravity: (H[email protected] 20 deg.C): 4.82.

Solubility: Slightly soluble in water; soluble in acid.

Appearance: Light yellow or yellow-orange crystals.

B. Fire, Explosion and Reactivity Data.

1. Fire.

Fire and Explosion Hazards: Neglible fire hazard when exposed to

heat or flame.

Flash point: Nonflammable.

Extinguishing media: Dry chemical, carbon dioxide, water spray

or foam.

2. Reactivity.

Conditions contributing to instability: Generally non-reactive

under normal conditions. Reacts with acids to form toxic hydrogen

sulfide gas.

Incompatibilities: Reacts vigorously with iodinemonochloride.

Hazardous decomposition products: Toxic fumes of cadmium and

sulfur oxides.

C. Spill Leak and Disposal Procedures.

1. Steps to be taken if the material is released or spilled. Do

not touch spilled material. Stop leak if you can do it without risk.

For small, dry spills, with a clean shovel place material into

clean, dry container and cover. Move containers from spill area. For

larger spills, dike far ahead of spill for later disposal. Keep

unnecessary people away. Isolate hazard and deny entry.

IV. Cadmium Chloride.

A. Physical and Chemical Data.

1. Substance Identification.

Chemical name: Cadmium chloride.

Formula: CdCl2.

Molecular weight: 183.3.

CAS No. 10108-64-2.

Other Identifiers: RTECS EY0175000.

Synonyms: Caddy; Cadmium dichloride; NA 2570 (DOT); UI-CAD;

dichlorocadmium.

2. Physical data.

Boiling point (760 mm Hg): 960 degrees C.

Melting point: 568 degrees C.

Specific Gravity: (H2O=1 @ 20 deg.C): 4.05.

Solubility: Soluble in water (140 g/100 cc); soluble in acetone.

Appearance: Small, white crystals.

B. Fire, Explosion and Reactivity Data.

1. Fire.

Fire and Explosion Hazards: Negligible fire and negligible

explosion hazard in dust form when exposed to heat or flame.

Flash point: Nonflamable.

Extinguishing media: Dry chemical, carbon dioxide, water spray

or foam.

2. Reactivity.

Conditions contributing to instability: Generally stable under

normal temperatures and pressures.

Incompatibilities: Bromine triflouride rapidly attacks cadmium

chloride. A mixture of potassium and cadmium chloride may produce a

strong explosion on impact.

Hazardous decomposition products: Thermal ecompostion may

release toxic fumes of hydrogen chloride, chloride, chlorine or

oxides of cadmium.

C. Spill Leak and Disposal Procedures.

1. Steps to be taken if the materials is released or spilled. Do

not touch spilled material. Stop leak if you can do it without risk.

For small, dry spills, with a clean shovel place material into

clean, dry container and cover. Move containers from spill area. For

larger spills, dike far ahead of spill for later disposal. Keep

unnecessary people away. Isolate hazard and deny entry. The

Superfund Amendments and Reauthorization Act of 1986 Section 304

requires that a release equal to or greater than the reportable

quantity for this substance (100 pounds) must be immediately

reported to the local emergency planning committee, the state

emergency response commission, and the National Response Center

(800) 424-8802; in Washington, DC Metropolitan area (202) 426-2675.

Appendix C to Sec. 1915.1027--Qualitative and Quantitative Fit

Testing Procedures

I. Fit Test Protocols

A. General: The employer shall include the following provisions

in the fit test procedures. These provisions apply to both

qualitative fit testing (QLFT) and quantitative fit testing (QNFT).

All testing is to be conducted annually.

1. The test subject shall be allowed to pick the most

comfortable respirator from a selection including respirators of

various sizes from different manufacturers. The selection shall

include at least three sizes of elastomeric facepieces of the type

of respirator that is to be tested, i.e., three sizes of half mask;

or three sizes of full facepiece. Respirators of each size must be

provided from at least two manufacturers.

2. Prior to the selection process, the test subject shall be

shown how to put on a respirator, how it should be positioned on the

face, how to set strap tension and how to determine a comfortable

fit. A mirror shall be available to assist the subject in evaluating

the fit and positioning the respirator. This instruction may not

constitute the subject's formal training on respirator use; it is

only a review.

3. The test subject shall be informed that he/she is being asked

to select the respirator which provides the most comfortable fit.

Each respirator represents a different size and shape, and if

fitted, maintained and used properly, will provide substantial

protection.

4. The test subject shall be instructed to hold each facepiece

up to the face and eliminate those which obviously do not give a

comfortable fit.

5. The more comfortable facepieces are noted; the most

comfortable mask is donned and worn at least five minutes to assess

comfort. Assistance in assessing comfort can be given by discussing

the points in item 6 below. If the test subject is not familiar with

using a particular respirator, the test subject shall be directed to

don the mask several times and to adjust the straps each time to

become adept at setting proper tension on the straps.

6. Assessment of comfort shall include reviewing the following

points with the test subject and allowing the test subject adequate

time to determine the comfort of the respirator:

(a) Position of the mask on the nose;

(b) Room for eye protection;

(d) Position of mask on face and cheeks.

7. The following criteria shall be used to help determine the

adequacy of the respirator fit:

(a) Chin properly placed;

(b) Adequate strap tension, not overly tightened;

(d) Respirator of proper size to span distance from nose to

chin;

(e) Tendency of respirator to slip; and

(f) Self-observation in mirror to evaluate fit and respirator

position.

8. The test subject shall conduct the negative and positive

pressure fit checks as described below or in ANSI Z88.2-1980. Before

conducting the negative or positive pressure test, the subject shall

be told to seat the mask on the face by moving the head from side-

to-side and up and down slowly while taking in a few slow deep

breaths. Another facepiece shall be selected and retested if the

test subject fails the fit check tests.

(a). Positive pressure test. Close off the exhalation valve and

exhale gently onto the facepiece. The face fit is considered

satisfactory if a slight positive pressure can be built up inside

the facepiece without any evidence of outward leakage of air at the

seal. For most respirators this method of leak testing requires the

wearer to first remove the exhalation valve cover before closing off

the exhalation valve and then carefully replacing it after the test.

(b). Negative pressure test. Close off the inlet opening of the

canister or cartridge(s) by covering with the palm of the hand(s) or

by replacing the filter seal(s). Inhale gently so that the facepiece

collapses slightly, and hold the breath for ten seconds. If the

facepiece remains in its slightly collapsed condition and no inward

leakage of air is detected, the tightness of the respirator is

considered satisfactory.

9. The test shall not be conducted if there is any hair growth

between the skin and the facepiece sealing surface, such as stubble

beard growth, beard, or long sideburns which cross the respirator

sealing surface. Any type of apparel which interferes with a

satisfactory fit shall be altered or removed.

10. If a test subject exhibits difficulty in breathing during

the tests, she or he shall be referred to a physician trained in

respiratory disease or pulmonary medicine to determine, in

accordance with paragraph (l)(2) and (3) of this standard, whether

the test subject can wear a respirator while performing her or his

duties.

11. The test subject shall be given the opportunity to wear the

successfully fitted respirator for a period of two weeks. If at any

time during this period the respirator becomes uncomfortable, the

test subject shall be given the opportunity to select a different

facepiece and to be retested.

12. The employer shall maintain a record of the fit test

administered to an employee. The record shall contain at least the

following information:

(a) Name of employee;

(b) Type of respirator;

(d) Date of test; and

(e) Where QNFT is used, the fit factor and strip chart recording

or other recording of the results of the test. The record shall be

maintained until the next fit test is administered.

13. Exercise regimen. Prior to the commencement of the fit test,

the test subject shall be given a description of the fit test and

the test subject's responsibilities during the test procedure. The

description of the process shall include a description of the test

exercises that the subject will be performing. The respirator to be

tested shall be worn for at least 5 minutes before the start of the

fit test.

14. Test Exercises. The test subject shall perform exercises, in

the test environment, in the manner described below:

(a) Normal breathing. In a normal standing position, without

talking, the subject shall breathe normally.

(b) Deep breathing. In a normal standing position, without

talking, the subject shall breathe slowly and deeply, taking care so

as to not hyperventilate.

shall slowly turn his/her head from side to side between the extreme

positions on each side. The head shall be held at each extreme

momentarily so the subject can inhale at each side.

(d) Moving head up and down. Standing in place, the subject

shall slowly move his/her head up and down. The subject shall be

instructed to inhale in the up position (i.e., when looking toward

the ceiling).

(e) Talking. The subject shall talk out loud slowly and loud

enough so as to be heard clearly by the test conductor. The subject

can read from a prepared text such as the Rainbow Passage, count

backward from 100, or recite a memorized poem or song.

(f) Grimace. The test subject shall grimace by smiling or

frowning.

(g) Bending over. The test subject shall bend at the waist as if

he/she were to touch his/her toes. Jogging in place shall be

substituted for this exercise in those test environments such as

shroud type QNFT units which prohibit bending at the waist.

(h) Normal breathing. Same as exercise 1. Each test exercise

shall be performed for one minute except for the grimace exercise

which shall be performed for 15 seconds. The test subject shall be

questioned by the test conductor regarding the comfort of the

respirator upon completion of the protocol. If it has become

uncomfortable, another model of respirator shall be tried.

B. Qualitative Fit Test (QLFT) Protocols

1. General

(a) The employer shall assign specific individuals who shall

assume full responsibility for implementing the respirator

qualitative fit test program.

(b) The employer shall assure that persons administering QLFTs

are able to prepare test solutions, calibrate equipment and perform

tests properly, recognize invalid tests, and assure that test

equipment is in proper working order.

and well maintained so as to operate within the parameters for which

it was designed.

2. Isoamyl Acetate Protocol

(a) Odor threshold screening. The odor threshold screening test,

performed without wearing a respirator, is intended to determine if

the individual tested can detect the odor of isoamyl acetate.

(1) Three 1-liter glass jars with metal lids are required.

(2) Odor free water (e.g. distilled or spring water) at

approximately 25 degrees C shall be used for the solutions.

(3) The isoamyl acetate (IAA) (also known as isopentyl acetate)

stock solution is prepared by adding 1 cc of pure IAA to 800 cc of

odor free water in a 1 liter jar and shaking for 30 seconds. A new

solution shall be prepared at least weekly.

(4) The screening test shall be conducted in a room separate

from the room used for actual fit testing. The two rooms shall be

well ventilated and shall not be connected to the same recirculating

ventilation system.

(5) The odor test solution is prepared in a second jar by

placing 0.4 cc of the stock solution into 500 cc of odor free water

using a clean dropper or pipette. The solution shall be shaken for

30 seconds and allowed to stand for two to three minutes so that the

IAA concentration above the liquid may reach equilibrium. This

solution shall be used for only one day.

(6) A test blank shall be prepared in a third jar by adding 500

cc of odor free water.

(7) The odor test and test blank jars shall be labeled 1 and 2

for jar identification. Labels shall be placed on the lids so they

can be periodically peeled, dried off and switched to maintain the

integrity of the test.

(8) The following instruction shall be typed on a card and

placed on the table in front of the two test jars (i.e., 1 and 2):

``The purpose of this test is to determine if you can smell banana

oil at a low concentration. The two bottles in front of you contain

water. One of these bottles also contains a small amount of banana

oil. Be sure the covers are on tight, then shake each bottle for two

seconds. Unscrew the lid of each bottle, one at a time, and sniff at

the mouth of the bottle. Indicate to the test conductor which bottle

contains banana oil.''

(9) The mixtures used in the IAA odor detection test shall be

prepared in an area separate from where the test is performed, in

order to prevent olfactory fatigue in the subject.

(10) If the test subject is unable to correctly identify the jar

containing the odor test solution, the IAA qualitative fit test

shall not be performed.

(11) If the test subject correctly identifies the jar containing

the odor test solution, the test subject may proceed to respirator

selection and fit testing.

(b) Isoamyl acetate fit test--

(1) The fit test chamber shall be similar to a clear 55-gallon

drum liner suspended inverted over a 2-foot diameter frame so that

the top of the chamber is about 6 inches above the test subject's

head. The inside top center of the chamber shall have a small hook

attached.

(2) Each respirator used for the fitting and fit testing shall

be equipped with organic vapor cartridges or offer protection

against organic vapors. The cartridges or masks shall be changed at

least weekly.

(3) After selecting, donning, and properly adjusting a

respirator, the test subject shall wear it to the fit testing room.

This room shall be separate from the room used for odor threshold

screening and respirator selection, and shall be well ventilated, as

by an exhaust fan or lab hood, to prevent general room

contamination.

(4) A copy of the test exercises and any prepared text from

which the subject is to read shall be taped to the inside of the

test chamber.

(5) Upon entering the test chamber, the test subject shall be

given a 6-inch by 5-inch piece of paper towel, or other porous,

absorbent, single-ply material, folded in half and wetted with 0.75

cc of pure IAA. The test subject shall hang the wet towel on the

hook at the top of the chamber.

(6) Allow two minutes for the IAA test concentration to

stabilize before starting the fit test exercises. This would be an

appropriate time to talk with the test subject; to explain the fit

test, the importance of his/her cooperation, and the purpose for the

head exercises; and to demonstrate some of the exercises.

(7) If at any time during the test, the subject detects the

banana like odor of IAA, the respirator fit is inadequate. The

subject shall quickly exit from the test chamber and leave the test

area to avoid olfactory fatigue.

(8) If the respirator fit was inadequate, the subject shall

return to the selection room and remove the respirator, repeat the

odor sensitivity test, select and put on another respirator, return

to the test chamber and again begin the procedure described in

paragraph (I)(B)(2)(b) (1) through (7) of this appendix. The process

continues until a respirator that fits well has been found. Should

the odor sensitivity test be failed, the subject shall wait about 5

minutes before retesting. Odor sensitivity will usually have

returned by this time.

(9) When a respirator is found that passes the test, its

efficiency shall be demonstrated for the subject by having the

subject break the face seal and take a breath before exiting the

chamber.

(10) When the test subject leaves the chamber, the subject shall

remove the saturated towel and return it to the person conducting

the test. To keep the test area from becoming contaminated, the used

towels shall be kept in a self sealing bag so there is no

significant IAA concentration build-up in the test chamber during

subsequent tests.

3. Irritant Fume Protocol

(a) The respirator to be tested shall be equipped with high-

efficiency particulate air (HEPA) filters.

(b) The test subject shall be allowed to smell a weak

concentration of the irritant smoke before the respirator is donned

to become familiar with its characteristic odor.

stannic oxychloride, such as the MSA part No. 5645, or equivalent.

Attach one end of the smoke tube to a low flow air pump set to

deliver 200 milliliters per minute.

(d) Advise the test subject that the smoke can be irritating to

the eyes and instruct the subject to keep his/her eyes closed while

the test is performed.

(e) The test conductor shall direct the stream of irritant smoke

from the smoke tube towards the face seal area of the test subject.

He/she shall begin at least 12 inches from the facepiece and

gradually move to within one inch, moving around the whole perimeter

of the mask.

(f) The exercises identified in section I. A. 14 above shall be

performed by the test subject while the respirator seal is being

challenged by the smoke.

(g) Each test subject passing the smoke test without evidence of

a response shall be given a sensitivity check of the smoke from the

same tube once the respirator has been removed to determine whether

he/she reacts to the smoke. Failure to evoke a response shall void

the fit test.

(h) The fit test shall be performed in a location with exhaust

ventilation sufficient to prevent general contamination of the

testing area by the test agent.

4. Saccharin Solution Aerosol Protocol

The entire screening and testing procedure shall be explained to

the test subject prior to the conduct of the screening test.

(a) Taste threshold screening. The saccharin taste threshold

screening, performed without wearing a respirator, is intended to

determine whether the individual being tested can detect the taste

of saccharin.

(1) Threshold screening as well as fit testing subjects shall

wear an enclosure about the head and shoulders that is approximately

12 inches in diameter by 14 inches tall with at least the front

portion clear and that allows free movements of the head when a

respirator is worn. An enclosure substantially similar to the 3M

hood assembly, parts # FT 14 and # FT 15 combined, is adequate.

(2) The test enclosure shall have a \3/4\ inch hole in front of

the test subject's nose and mouth area to accommodate the nebulizer

nozzle.

(3) The test subject shall don the test enclosure. Throughout

the threshold screening test, the test subject shall breathe through

his/her wide open mouth with tongue extended.

(4) Using a DeVilbiss Model 40 Inhalation Medication Nebulizer

the test conductor shall spray the threshold check solution into the

enclosure. This nebulizer shall be clearly marked to distinguish it

from the fit test solution nebulizer.

(5) The threshold check solution consists of 0.83 grams of

sodium saccharin USP in 1 cc of warm water. It can be prepared by

putting 1 cc of the fit test solution (see (b)(5) below) in 100 cc

of distilled water.

(6) To produce the aerosol, the nebulizer bulb is firmly

squeezed so that it collapses completely, then released and allowed

to fully expand.

(7) Ten squeezes are repeated rapidly and then the test subject

is asked whether the saccharin can be tasted.

(8) If the first response is negative, ten more squeezes are

repeated rapidly and the test subject is again asked whether the

saccharin is tasted.

(9) If the second response is negative, ten more squeezes are

repeated rapidly and the test subject is again asked whether the

saccharin is tasted.

(10) The test conductor will take note of the number of squeezes

required to solicit a taste response.

(11) If the saccharin is not tasted after 30 squeezes (step 10),

the test subject may not perform the saccharin fit test.

(12) If a taste response is elicited, the test subject shall be

asked to take note of the taste for reference in the fit test.

(13) Correct use of the nebulizer means that approximately 1 cc

of liquid is used at a time in the nebulizer body.

(14) The nebulizer shall be thoroughly rinsed in water, shaken

dry, and refilled at least each morning and afternoon or at least

every four hours.

(b) Saccharin solution aerosol fit test procedure

(1) The test subject may not eat, drink (except plain water), or

chew gum for 15 minutes before the test.

(2) The fit test uses the same enclosure described in (a) above.

(3) The test subject shall don the enclosure while wearing the

respirator selected in section (a) above. The respirator shall be

properly adjusted and equipped with a particulate filter(s).

(4) A second DeVilbiss Model 40 Inhalation Medication Nebulizer

is used to spray the fit test solution into the enclosure. This

nebulizer shall be clearly marked to distinguish it from the

screening test solution nebulizer.

(5) The fit test solution is prepared by adding 83 grams of

sodium saccharin to 100 cc of warm water.

(6) As before, the test subject shall breathe through the open

mouth with tongue extended.

(7) The nebulizer is inserted into the hole in the front of the

enclosure and the fit test solution is sprayed into the enclosure

using the same number of squeezes required to elicit a taste

response in the screening test.

(8) After generating the aerosol the test subject shall be

instructed to perform the exercises in section I.A. 14 above.

(9) Every 30 seconds the aerosol concentration shall be

replenished using one half the number of squeezes as initially.

(10) The test subject shall indicate to the test conductor if at

any time during the fit test the taste of saccharin is detected.

(11) If the taste of saccharin is detected, the fit is deemed

unsatisfactory and a different respirator shall be tried''.

C. Quantitative Fit Test (QNFT) Protocol

1. General

(a) The employer shall assign specific individuals who shall

assume full responsibility for implementing the respirator

quantitative fit test program.

(b) The employer shall ensure that persons administering QNFT

are able to calibrate equipment and perform tests properly,

recognize invalid tests, calculate fit factors properly and assure

that test equipment is in proper working order.

and well maintained so as to operate at the parameters for which it

was designed.

2. Definitions

(a) Quantitative fit test. The test is performed in a test

chamber. The normal air-purifying element of the respirator is

replaced by a high-efficiency particulate air (HEPA) filter in the

case of particulate QNFT aerosols or a sorbent offering contaminant

penetration protection equivalent to high-efficiency filters where

the QNFT test agent is a gas or vapor.

(b) Challenge agent means the aerosol, gas or vapor introduced

into a test chamber so that its concentration inside and outside the

respirator may be measured.

quantitative fit testing.

(d) Normal standing position means standing erect and straight

with arms down along the sides and looking straight ahead.

(e) Maximum peak penetration method means the method of

determining test agent penetration

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