U.S. Geological Survey Manual
SM 445-2-H CHAPTER 23
Occupational Medicine Program
Instruction: Chapter revised to include changes in organizational structure and chapter name; deletes definitions; revises and reorganizes information in Appendix A; and deletes Appendices B, C and D. In addition, Human Resource responsibilities were removed since the Office of Human Capital responsibilities are defined elsewhere in USGS policy.
1. Purpose. This chapter specifies medical evaluations as part of the Occupational Medicine Program requirements to ensure the safety and health of employees who may be exposed to occupational hazards as a result of assigned responsibilities. The chapter addresses: 1) medical surveillance to medically monitor possible health effects due to occupational exposures; 2) post-exposure medical evaluations for exposure from biological mishaps; 3) exposure-driven immunizations to protect against occupationally acquired diseases; and 4) medical evaluations to meet implemented medical standards and physical requirements.
2. Scope. This chapter applies to U.S. Geological Survey (USGS) employees and volunteers who are required to receive medical evaluations based on exposure risk. The term “employees” in this chapter includes USGS employees and others for whom the Government assumes workers’ compensation liability. This chapter does not apply to employees participating in drug screening or wellness programs.
A. Executive Order 12196, Occupational Safety and Health Programs for Federal Employees; February 26, 1980.
B. Title 29, Code of Federal Regulations (29 CFR), Parts 1910, 1915, 1917, 1918, and 1926.
C. Department of the Interior (DOI) Manual, Part 485, Safety and Occupational Health Program, Chapter 17, Industrial Hygiene Program, and Chapter 18, Occupational Medicine Program.
D. Department of the Interior (DOI) Occupational Medicine Program Handbook, latest revision.
E. Occupational Safety and Health Administration (OSHA) Publication 3162, Screening and Surveillance: A Guide to OSHA Standards.
F. Centers for Disease Control and Prevention Yellow Book, Health Information for International Travel, latest revision.
G. Advisory Committee on Immunization Practices, Recommended Adult Immunization Schedule (current year).
H. Survey Manual 370.792.1 - Preventive Medical Treatment
(1) Medical evaluations include physical evaluations and clinical laboratory testing. Medical evaluations must be performed by an occupational medicine physician or other licensed health care professional under the direction of an occupational medicine physician, as described in the DOI Occupational Medicine Program Handbook.
(2) Employee participation in medical evaluations is mandatory when required by OSHA standards, federal regulations, or DOI policies; or when determined necessary by an occupational medicine physician or a licensed health care professional and USGS.
(3) Medical evaluations shall be provided to employees at no cost.
(4) Cost centers are authorized to designate an occupational medicine provider for medical evaluations. The cost center shall consider any medical documentation the employee wants to submit from a personal physician in accordance with 5 CFR 339.303. If an occupational medicine provider is not available (e.g., remote locations), employees may use the services of their personal physician, as described in the DOI Occupational Medicine Program Handbook. USGS Survey Manual 370.792.1 – Preventive Medical Treatment, contains for directions on obtaining reimbursement for the services of a personal physician.
B. Medical Surveillance.
(1) Medical surveillance utilizes clinical laboratory tests and physical examinations to medically screen for abnormal biological effects before clinical symptoms appear. The purpose of medical surveillance is to look for abnormal trends in the health status of employees exposed to chemical or physical hazards, in order to implement corrective action to prevent or limit disease progression by controlling exposures or providing medical intervention.
(2) Employees must be included in a medical surveillance program when required by an OSHA specific substance standard. Refer Appendix A listing medical surveillance requirements in the OSHA specific substance standards.
(3) In the absence of OSHA-mandated medical surveillance, if exposure monitoring reveals that personal exposures routinely exceed OSHA Permissible Exposure Limits or American Conference of Governmental Industrial Hygienists Threshold Limit Values, and the exposure levels cannot be controlled through engineering controls, work practices, or administrative controls, employees must be enrolled in a medical surveillance program as determined by the occupational medicine physician or licensed health care professional, an industrial hygienist, and employee management. (NOTE: When exposure cannot be controlled by engineering controls, work practices, or administrative controls the use of appropriate personal protection equipment, such as respirators and hearing protection, is required. Medical surveillance is still required regardless of the use of respirators. Refer to SM 445-2-H, Chapter 18 – Respiratory Protection Program and Chapter 19 - Hearing Conservation Program.
(4) Employees who experience signs or symptoms of exposure to chemical or physical hazards or are involved in an exposure incident must be provided an opportunity for a medical evaluation.
(5) The physician’s written opinion, of an abnormal medical evaluation relevant to an exposure, must be reported to employee management in addition to the employee. The employee management must inform and provide the written opinion to the responsible safety office and the industrial hygienist for the purpose of investigating the cause of an abnormal medical evaluation result, and to assist in mitigating the cause. Requirements of the Privacy Act and the Health Insurance Portability and Accountability Act must be followed when communicating a physician opinion.
(6) When medical surveillance is required, it must include a baseline medical evaluation conducted prior to assignment to a task and followed by periodic examinations. The frequency of periodic examinations shall be determined by the appropriate OSHA standard. Where OSHA standards are not available, the periodicity shall be determined by the occupational medicine physician or occupational health care professional.
(7) A termination examination is only required if specified in an OSHA standard.
(8) Periodic medical evaluations are not required for routine work with infectious agents; however, it may be appropriate to offer targeted periodic evaluations to workers with substantial risk of exposure to infectious agents to detect preclinical or subclinical evidence of an occupationally acquired infection. A risk assessment should be conducted by the laboratory manager or a knowledgeable subject matter expert, such as, but not limited to a microbiologist or Biosafety Officer, to assess the necessity of periodic medical evaluations based on potential risk of occupational exposure to infectious agents. The DOI Medical Officer may be contacted directly or through the Occupational Safety and Health Management Branch for guidance on periodic medical evaluations for working with infectious agents. Refer to the guidance in the Biosafety in Microbiological and Biomedical Laboratories,5th edition.
(9) Employees under the age of 18 will not be permitted to perform activities requiring medical surveillance as a result of employee exposures.
C. Post-Exposure Evaluation.
(1) For employees that work in endemic areas or handle potentially diseased wildlife or infectious agents, post-exposure evaluations, conducted by an occupational medicine physician or licensed health-care professional, shall be offered to employees who were exposed to an infectious agent during an incident or to employees who show signs or symptoms of exposure. The post-exposure evaluation should be conducted by a physician or licensed health-care professional with knowledge of infectious diseases.
(2) Employees that are exposed to blood or other infectious materials from a human source shall follow the exposure incident protocol in SM 445-2-H.25, Human Bloodborne Pathogens Protection Program.
Employees that can be potentially exposed to infectious diseases shall be offered the appropriate vaccination, when available, prior to assignment of work. For specific vaccinations, refer to the Centers for Disease Control and Prevention (CDC) list of Vaccines Used in the United States or contact your servicing occupational medicine provider. For international travel, refer to the CDC website tool, “Travelers’ Health,” which lists the recommended vaccinations per country. Refer to the Office of Human Capital policy, Survey Manual 370.792.1 – Preventive Medical Treatment, for procedures for obtaining vaccinations.
E.) Medical Clearance for Established Medical Standards and Physical Requirements.
(1)) Certain job positions within DOI have established medical standards and physical requirements developed by DOI to determine if applicants and incumbents can safely perform the essential functions of the position. These positions have medical clearance exam requirements to determine if the individual meets the established medical standards requirements for the position. Tabs 8 and 12 of the DOI Occupational Medicine Program Handbook provide a list of job positions with developed Medical Standards.
(2) Cost Centers have the authority to establish fitness for duty and/or physical requirements for certain positions that are determined to be arduous and hazardous. This process shall be initiated by the affected Cost Center Director in collaboration with the Office of Human Capital.
(1) Employee medical records must be maintained in accordance with the Office of Human Capital policies and procedures. Contact your servicing Human Resources Specialist for instructions on forwarding and requesting medical records.
(2) Medical records must be maintained for the duration of employment plus 30 years. (NOTE: SM 432-1-S1, General Records Disposition Schedule provides medical records retention and disposition schedules.)
(3) Employees have the right to access their medical records in accordance with 29 CFR 1910.1020 and must be provided access to their medical records in accordance with Office of Human Capital policies.
(4) When employees use a personal physician to administer medical evaluations, as part of the requirements of the job position, medical information relevant to their position shall be submitted to the USGS or designated representative and maintained in accordance with the Office of Human Capital policy governing employee medical records.
A. Director. Directs Occupational Medicine Program activities through the Designated Agency Safety and Health Official.
B. Designated Agency Safety and Health Official/Associate Director for Administration.
(1) Exercises the authority of the Director to establish, develop, direct, and manage an effective Occupational Medicine Program.
(2) Assigns Occupational Medicine Program authority to the Chief, Office of Management Services, for program management and administration.
(3) Assigns responsibility for development of policy and management of employee medical records to the Chief, Office of Human Capital.
C. Associate Directors and Regional Directors. Ensure that respective region, mission area, or office implements and complies with Occupational Medicine Program requirements.
D. Chief, Office of Management Services. Assigns Occupational Medicine Program responsibilities to the Chief, Occupational Safety and Health Management Branch, for program management and administration.
E. Chief, Occupational Safety and Health Management Branch.
(1) Ensures the establishment, oversight, and assessment of the Occupational Medicine Program.
(2) Ensures the development of the Occupational Medicine Program policy.
F. USGS Industrial Hygienist.
(1) Develops Occupational Medicine Program policy, guidance, and protocols; proposes bureau-wide program goals, objectives, and initiatives.
(2) Monitors the implementation and effectiveness Occupational Medicine Program policies, guidelines, and processes through program evaluation to ensure the integrity of the program.
(3) Provides technical assistance and guidance regarding the Occupational Medicine Program.
(4) Acts as liaison to the DOI Industrial Hygiene Working Group and other DOI bureaus, representing USGS interests in the Occupational Medicine Program.
(5) Establishes and monitors Occupational Safety and Health Management Branch contracts and interagency agreements for occupational medicine services.
G. Regional Safety Managers.
(1) Ensure local implementation of the Occupational Medicine Program when required.
(2) Validate through inspections and audits that required elements of the Occupational Medicine Program are implemented in accordance with policy and regulations. Tracks and ensures abatement of findings in the Inspection and Abatement System (IAS).
(3) Assist management and Collateral Duty Safety Program Coordinators in obtaining occupational medicine services.
H. Science Center Directors, Cost Center Managers, and Project Chiefs.
(1) Ensure that adequate funding and resources are provided to implement elements of the Occupational Medicine Program.
(2) Ensure that a significant illness diagnosed by a physician or other licensed health care professional is entered into the Safety Management Information System, and the cause is investigated and mitigated.
(3) Ensure that investigation findings, program inspections findings, and audits findings are entered into IAS.
(4) Ensure that medical records are handled, transferred, and maintained in accordance with the Office of Human Capital policy.
(5) Ensure that employees are informed of their rights to access their exposure and medical records, upon initial employment and annually thereafter, in accordance with 29 CFR 1910.1020.
(6) Ensure that employees receive medical surveillance baseline evaluations, medical clearances, and pre-employment or pre-placement medical evaluations prior to assignment to positions requiring medical evaluation.
I. Collateral Duty Safety Program Coordinators.
(1) Assist managers and supervisors in the implementation of the Occupational Medicine Program.
(2) Assist managers and supervisors in establishing occupational medicine services.
(3) Assist managers and supervisors in identifying employees who require participation in the Occupational Medicine Program.
(1) Comply with requirements to the Occupational Medicine Program.
(2) Report to their supervisors or Collateral Duty Safety Program Coordinators any concerns regarding exposures, exposure events, and illnesses.