NPR 1800.1 NASA Occupational Health Program Procedures.pdf

NASA

Procedural Requirements

NPR 1800.1E

Effective Date: March 16, 2023

Expiration Date: March 16, 2028

Subject: NASA Occupational Health Program ProceduresResponsible Office: Office of the Chief Health & Medical Office Table of Contents

Preface

P.1 Purpose P.2 Applicability P.3 Authority P.4 Applicable Documents and Forms P.5 Measurement/Verification P.6 Cancellation

Chapter 1. General

1.1 Introduction

1.2 Designated Agency Safety and Health Official

1.3 Health and Medical Technical Authority

1.4 General Center Responsibilities

1.5 OSHA Annual Report

1.6 Drug Free Workplace

1.7 Credentialing, Education, and Training of Occupational Health Professionals

1.8 Website Initiatives and Capabilities

1.9 Support of Federal and Interagency Initiatives

1.10 Recordkeeping

Chapter 2. Occupational Medicine

2.1 General

2.2 Medical Quality Assurance

2.3 Disease and Primary Injury Prevention

2.4 Diagnosis and Treatment of Occupational Illness or Injury

2.5 Immunizations

2.6 Medical Support to Emergency Management Planning

2.7 Continuity of Operations Planning

2.8 Physical Examinations

2.9 Emergency Medical Services

2.10 Automated External Defibrillator Program

2.11 Bloodborne Pathogens

2.12 Infection Control

2.13 Medical Record Management

2.14 Shift Work and Balancing Work-Rest Cycles

2.15 Occupational Medicine and Support for Official OCONUS Travel

Chapter 3. Primary Prevention and Health Promotion

3.1 General

3.2 Physical Fitness

Chapter 4. Environmental Health

4.1 General

4.2 Occupational Exposure Limits

4.3 Occupational Exposure Assessment and Management

4.4 Sampling, Analytical Methods, and Equipment Calibration

4.5 Reproductive and Developmental Health

4.6 Nanotoxicology

4.7 Control of Hazardous Materials and Articles Acquisitions

4.8 Hearing Conservation

4.9 Ergonomics

4.10 Indoor Air Quality

4.11 Biosafety

4.12 Food Safety

4.13 Radiation, General

4.14 Radioactive Materials

4.15 Ionizing Radiation-Generating Equipment

4.16 Laser and Non-laser Optical Radiation

4.17 Electric, Magnetic, and Electromagnetic Radiation

Chapter 5. Employee Assistance Program

5.1 General

5.2 Responsibilities

5.3 EAP Clinician Certification, Licensure, and Training

5.4 EAP Confidentiality

5.5 EAP Record Access and Disclosure

5.6 EAP Program Elements

5.7 Critical Incident Stress Management

5.8 Workplace Violence Awareness and Prevention

5.9 Domestic Violence Awareness

5.10 Quality Assurance

5.11 Records Confidentiality, Maintenance, and Retention

5.12 EAP Reports

Chapter 6. Federal Workers’ Compensation Program

6.1 General

6.2 Employees and Right to File a Claim

6.3 Presidential Orders and Department of Labor Initiatives

6.4 Responsibilities

6.5 Records and Confidentiality

6.6 Recordkeeping, Retention, and Requests for Copies

6.7 Claim Processes and Procedures

Chapter 7. Occupational Health Review Process

7.1 General

7.2 Responsibilities

7.3 Requirements Related to Triennial Occupational Health Reviews and Annual Occupational Health Reviews

7.4 Triennial Occupational Health Reviews

7.5 Center Annual Occupational Health Reviews

7.6 Center Ad Hoc Visits

Appendix A. Definitions Appendix B. Acronyms Appendix C. Physical Examination Matrix Appendix D. References

Preface

P.1 Purpose

a. This NASA Procedural Requirements (NPR) describes Occupational Health (OH) Program (OHP) procedural requirements necessary to effectively carry out the mission of the Office of the Chief Health and Medical Officer (OCHMO) and ensure the scope and quality of services provided by the OHP employees at Centers are optimal. It provides direction to the OHP and allied health professionals throughout the Agency in accomplishing their daily tasks to ensure the health of employees and a safe work environment while allowing flexibility for establishment and implementation of local procedures and processes to meet needs specific to Center operations.

b. This NPR establishes minimum requirements for conducting OHP services which encompass seven discipline-specific areas: Occupational Medicine (OM), Industrial Hygiene (IH), Health Physics (HP), Health Promotion, Wellness, and Fitness (HPWF), Federal Workers' Compensation (FWC), Food Safety (FS), and Employee Assistance Program (EAP). This Preface, Chapter 1, General, and Chapter 7, Occupational Health Review Process, apply to all disciplines.

c. The OCHMO issues policy and provides guidance, technical support, and periodic reviews of Centers' OHPs. Periodic reviews are not considered direct oversight of Center programs and/or processes. Oversight and implementation of policies, set herein, are the responsibility of Centers, Component Facilities, Technical and Service Support Centers, other NASA installations, the NASA Office of Jet Propulsion Laboratory (JPL) Management and Oversight (NOJMO), and OCHMO for NASA Headquarters (HQ) (hereinafter, Centers). Similarly, in this document, the officials in charge of each of these entities are collectively referred to as Center Directors, and civil servant Medical Directors and the designated civil servant authority for a specific Center are collectively referred to as Medical Directors.

P.2 Applicability

a. This directive is applicable to NASA Headquarters and NASA Centers, including Component Facilities and Technical and Service Support Centers.

b. This directive is applicable to the JPL, a Federally Funded Research and Development Center, only to the extent specified in the NASA/Caltech Prime Contract.

c. This directive is applicable to other contractors, recipients of grants or cooperative agreements, or parties to other agreements only to the extent specified in contracts, grants or cooperative agreement, or other agreements.

d. This NPR is applicable to all employees, both civil service and contractors, per their contract (hereafter, called employees). Where statements apply to only one group of employees, terms “civil service employee” and “contractor” are used.

e. Portions of this NPR, as specifically indicated in the text, are applicable to visitors.

f. The section of this NPR requiring the mandatory use of an Electronic Health Record System (EHRS) does not apply to JPL.

g. In this directive, all mandatory actions (i.e., requirements) are denoted by statements containing the term “shall.” The terms “may” or “can” denote discretionary privilege or permission, “should” denotes a good practice and is recommended, but not required, “will” denotes expected outcome, and “are/is” denotes descriptive material.

h. In this directive, all document citations are assumed to be the latest version unless otherwise noted.

P.3 Authority

a. Health Services Programs, 5 U.S.C. § 7901.

b. Occupational Safety and Health, 29 U.S.C. § 668.

c. National Aeronautics and Space Act, 51 U.S.C. § 20113(a).

P.4 Applicable Documents and Forms

a. Privacy Act of 1974, as amended, 5 U.S.C. § 552a.

b. Freedom of Information Act, 5 U.S.C. § 552.

c. The Federal Employees' Compensation Act, 5 U.S.C. § 8101, et seq.

d. Limitations on Right to Receive Compensation 5 U.S.C § 8116.

e. Drug-Free Workplace Act of 1988, 41 U.S.C. ch. 81.

f. Genetic Information Nondiscrimination Act of 2008, 42 U.S.C § 2000ff et seq.

g. Health Insurance Portability and Accountability Act of 1996, Pub. L. 104-191, 110 Stat. 1936 (1996).

h. Drug-Free Federal Workplace, E. O. 12564, 51 FR 32889, 3 CFR (1986).

i. Federal Employees’ Health, Counseling, and Work/Life Programs, 5 CFR § 792.

j. Conditions Requiring Individual Monitoring of External and Internal Occupational Dose, 10

CFR § 20.1502.

k. Surface Contamination Values, 10 CFR pt. 835, Appendix D.

l. Medical Standards and Certification, 14 CFR pt. 67.

m. Privacy Act - NASA Regulations, 14 CFR pt. 1212.

n. Claims for Compensation under the Federal Employees’ Compensation Act, as amended, 20 CFR pt. 10.

o. Compensation for Disability and Death of Noncitizen Federal Employees Outside the United States, 20 CFR pt. 25.

p. Recommendation for Quality Assurance Programs in Diagnostic Radiology Facilities, 21 CFR § 1000.55.

q. Performance Standards for Electronic Products: General, 21 CFR pt. 1010.

r. Performance Standards for Light-Emitting Products, 21 CFR pt. 1040.

s. Production or Disclosure of Information or Materials, 29 CFR pt. 70.

t. Protection of Individual Privacy and Access to Records Under the Privacy Act of 1974, 29 CFR pt. 71.

u. Occupational Safety and Health Standards, 29 CFR pt. 1910.

v. Occupational Health and Environmental Control, 29 CFR pt. 1910 subpt. G.

w. Examples of Conditions Which May Restrict or Limit Exposure to Hyperbaric Conditions, 29 CFR pt. 1910 subpt. T, Appendix A.

x. Special provisions for air contaminants, 29 CFR § 1910.19.

y. Calculations and Application of Corrections to Audiograms, 29 CFR § 1910.95, Appendix F.

z. Process Safety Management of Highly Hazardous Chemicals, 29 CFR § 1910.119.

aa. Respiratory Protection, 29 CFR § 1910.134.

bb. Fit Testing Procedures (Mandatory), 29 CFR § 1910.134, Appendix A.

cc. User Seal Check Procedures (Mandatory), 29 CFR § 1910.134, Appendix B-1.

dd. Respiratory Cleaning Procedures (Mandatory), 29 CFR § 1910.134, Appendix B-2.

ee. OSHA Respiratory Medical Evaluation Questionnaire (Mandatory), 29 CFR § 1910.134, Appendix C.

ff. (Mandatory) Information for Employees Using Respirators When Not Required Under the Standard, 29 CFR § 1910.134, Appendix D.

gg. Permit-Required Confined Spaces, 29 CFR § 1910.146.

hh. Powered Industrial Trucks, 29 CFR § 1910.178.

ii. Asbestos, 29 CFR § 1910.1001.

jj. Inorganic arsenic, 29 CFR § 1910.1018, Appendix. C.

kk. Beryllium, 29 CFR § 1910.1024.

ll. Lead, 29 CFR § 1910.1025.

mm. Chromium (VI), 29 CFR § 1910.1026.

nn. Cadmium, 29 CFR § 1910.1027.

oo. Benzene, 29 CFR § 1910.1028.

pp. Bloodborne Pathogens, 29 CFR § 1910.1030.

qq. Ethylene oxide, 29 CFR § 1910.1047.

rr. Formaldehyde, 29 CFR § 1910.1048.

ss. Methylenedianiline, 29 CFR § 1910.1050.

tt Methylene chloride, 29 CFR § 1910.1052.

uu. Respirable crystalline silica, 29 CFR § 1910.1053.

vv. Ionizing Radiation, OSHA 29 CFR § 1910.1096.

ww. Occupational Exposure to Hazardous Chemicals in Laboratories, 29 CFR § 1910.1450.

xx. Safety and Health Regulations for Construction, 29 CFR pt. 1926.

yy. Occupational Health and Environmental Control, 29 CFR pt. 1926 subpt. D.

zz. Motor Vehicles, Mechanized Equipment, and Marine Operations, 29 CFR pt. 1926 subpt. O.

aaa. General Safety and Health Provisions, 29 CFR § 1926.32.

bbb. Methylenedianiline, 29 CFR § 1926.60.

ccc. Lead, 29 CFR § 1926.62.

ddd. Asbestos, 29 CFR § 1926.1101.

eee. Chromium (VI), 29 CFR § 1926.1126.

fff. Cadmium, 29 CFR § 1926.1127.

ggg. Basic Program Elements for Federal Employee Occupational Safety and Health Programs and Related Matters, 29 CFR pt. 1960.

hhh. Financial Management, 29 CFR § 1960.7.

iii. Assignment and Utilization of Space - Fitness Centers, 41 CFR § 102-79.35.

jjj. Confidentiality of Substance Use Disorder Patient Records, 42 CFR pt. 2.

kkk. Medical Certification, 46 CFR pt. 10 subpt. C.

lll. NASA Federal Acquisition Regulation (FAR) Supplement, 48 CFR §1852.242-78.

mmm. Commercial Driver’s License Standards; Requirements and Penalties, 49 CFR pt. 383.

nnn. Criteria for Vision and Hearing Acuity Data, 49 CFR § 240.121.

ooo. Operator Training, Certification, and Evaluation, 49 CFR § 1926.1427.

ppp. NPR 1382.1, NASA Privacy Procedural Requirements.

qqq. NPR 1441.1, NASA Records Management Program Requirements.

rrr. NPR 1850.1, Quality Assurance of the NASA Medical Care.

sss. NPR 9780.1 Payment of Expenses Connected with the Death of Certain Employees.

ttt. NRRS 1441.1, NASA Record Retention Schedules.

uuu. NASA STD 8719.9, Lifting Standard.

vvv. NASA-STD-8719.25, Range Flight Safety Requirements.

www. OCHMO-STD-1880.1, NASA Aviation Medical Certification Standards.

https://www.nasa.gov/sites/default/files/atoms/files/ochmo-std- 1880.1_nasa_aviation_med_cert_stds_-_signed_7-22-19b.pdf https://www.nasa.gov/sites/default/files/atoms/files/ochmo-std-1880.1_nasa_aviation_med_cert_stds_-_signed_7-22-19b.pdf https://www.nasa.gov/sites/default/files/atoms/files/ochmo-std-1880.1_nasa_aviation_med_cert_stds_-_signed_7-22-19b.pdf

xxx. NASA-EHRS-RMP-000, Records Management Plan for the NASA Electronic Health Record System.

yyy. ANSI/AIAA G-095, Guide to Safety of Hydrogen and Hydrogen Systems.

zzz. ANSI/HPS N43.3, For General Radiation Safety - Installations Using Non-Medical X-Ray and Sealed Gamma-Ray Sources, Energies up to 10 MeV. https://infostore.saiglobal.com/en-us/Standards/ANSI-HPS-N43-3-2008-R2018--558723_SAIG_HPS_HPS_2727272/ aaaa. ANSI Z136.1, Appendix F, American National Standard for Safe Use of Lasers.

https://www.lia.org/resources/laser-safety-information/laser-safety-standards/ansi-z136-standards/z136-1 bbbb. ASME B30.3, Tower Cranes cccc. ASME B30.5, Mobile and Locomotive Cranes. https://www.asme.org/codes-standards/find-codes-standards/b30-5-mobile-locomotive-cranes dddd. AWS D17.1 Specification for Fusion Welding for Aerospace Applications.

eeee. NSF/ANSI 49, Biosafety Cabinets Design and Performance. https://blog.ansi.org/nsf-ansi- 49-2020-biosafety-cabinets-bscs/ ffff. FECA Circular No. 22-09, Employees’ Compensation Operations and Management Portal (ECOMP) Form Retention. FECA Circulars | U.S. Department of Labor (dol.gov) gggg. FDA IFS17, Food Code, 2017 Recommendations of the United States Public Health Service. https://www.fda.gov/food/fda-food-code/food-code-2017 hhhh. Memorandum of Understanding between Office of Workers’ Compensation Programs (OWCP) Division of Federal Employees’, Longshore and Harbor Workers’ Compensation (DFELHWC) and National Aeronautics and Space Administration (NASA).

iiii. Exemptions from Electronic Product Regulations, A Compilation of Exemptions for Electronic Production Found in 21 CFR Chapter I, Sub-Chapter J – Radiological Health Parts 1000 – 1050. https://www.fda.gov/radiation-emitting-products/electronic-product-radiation-control-program-industry-guidance/exemptions-electronic-product-regulations jjjj. AWS D17.1 Specification for Fusion Welding for Aerospace.

https://pubs.aws.org/Download_PDFS/AWS_D17_1M_D17_1_2017_AMD2_PV.pdf

P.5 Measurement/Verification

The CHMO will measure and verify compliance with this directive by assessing the results of the Triennial OH reviews and Center Annual OH reviews.

P.6 Cancellation https://infostore.saiglobal.com/en-us/Standards/ANSI-HPS-N43-3-2008-R2018--558723_SAIG_HPS_HPS_2727272/ https://infostore.saiglobal.com/en-us/Standards/ANSI-HPS-N43-3-2008-R2018--558723_SAIG_HPS_HPS_2727272/ https://www.lia.org/resources/laser-safety-information/laser-safety-standards/ansi-z136-standards/z136-1 https://www.lia.org/resources/laser-safety-information/laser-safety-standards/ansi-z136-standards/z136-1 https://www.asme.org/codes-standards/find-codes-standards/b30-5-mobile-locomotive-cranes https://www.asme.org/codes-standards/find-codes-standards/b30-5-mobile-locomotive-cranes https://blog.ansi.org/nsf-ansi-49-2020-biosafety-cabinets-bscs/ https://blog.ansi.org/nsf-ansi-49-2020-biosafety-cabinets-bscs/ https://www.dol.gov/agencies/owcp/FECA/regs/compliance/DFECfolio/FECAcirculars#CIRCULAR202209 https://www.fda.gov/food/fda-food-code/food-code-2017 https://www.fda.gov/radiation-emitting-products/electronic-product-radiation-control-program-industry-guidance/exemptions-electronic-product-regulations https://www.fda.gov/radiation-emitting-products/electronic-product-radiation-control-program-industry-guidance/exemptions-electronic-product-regulations https://pubs.aws.org/Download_PDFS/AWS_D17_1M_D17_1_2017_AMD2_PV.pdf

NPR 1800.1D, NASA Occupational Health Program Procedures, dated October 6, 2009.

Chapter 1. General

1.1 Introduction

1.1.1 NASA strives, through its OHP, to ensure, to the maximum extent possible, the health and productivity of NASA’s workforce and compliance with all applicable laws and regulatory requirements, professional standards, and NASA program requirements pertaining to OH, across all program disciplines (i.e., occupational medicine, industrial hygiene, health physics, physical fitness and health promotion, federal workers’ compensation, food safety, and employee assistance), domestically and on international travel and assignment. This document describes the process and procedures for accomplishing this goal.

1.1.2 The document is organized with a chapter for each discipline except for chapter 4 which encompasses the disciplines falling under Environmental Health (EH) – industrial hygiene, health physics, and food safety.

1.1.3 This introductory chapter describes requirements and responsibilities for specific initiatives and functions within the scope of the OHP which are relevant to all the program disciplines to increase clarity and reduce redundancy throughout the document.

1.2 Designated Agency Safety and Health Officer

1.2.1 The CHMO, as the final authority on the applicability of all OH requirements throughout the Agency, is the Designated Agency Safety and Health Officer (DASHO), liaison to the Department of Labor (DOL).

1.2.2 Centers shall inform the CHMO immediately via phone or encrypted email (confirmation of email is necessary to ensure receipt) of any of the following OH-related incidents at Centers:

a. Death of a civil service or contractor employee while on official NASA duty.

b. Death of a member of the public while on NASA property or caused by NASA property or action.

c. Cluster investigations.

d. Infectious disease outbreaks.

e. Automatic External Defibrillator (AED) use and outcome.

f. Quality of care issues.

g. Workplace violence.

h. Medical incident or evacuation of civil service employees on official Outside the Continental United States (OCONUS) travel.

Note: Additional information on mishap reporting can be found in NPR 8621.1, NASA Procedural Requirements for Mishap and Close Call Reporting, Investigating, and Recordkeeping, and the appropriate Center mishap preparedness and contingency plan.

1.2.3 Centers shall notify the DASHO of a pre-scheduled inspection or visit, or within one hour when Occupational Safety and Health Administration (OSHA), the Nuclear Regulatory Commission (NRC), or other Federal or state occupational safety or health regulatory inspectors arrive on a Center or facility to conduct an inspection or visit.

1.3 Health and Medical Technical Authority

NPR 7120.11, NASA Health and Medical Technical Authority (HMTA) Implementation describes the roles, responsibilities, and procedural requirements for implementing the HMTA to protect the health and lives of all individuals on an aircraft or a spacecraft from hazards associated with performing flight missions and associated testing and training. The CHMO and HTMA will collaborate to produce applicable evaluations and develop medical requirements and standards in cases where there is not currently Federal or industry standard surveillance.

1.4 General Center Responsibilities

1.4.1 Center Directors shall:

a. Advocate for their OHP budget and resources to ensure compliance with OSHA, state, and local regulations, and NASA requirements.

b. Coordinate with the CHMO, as soon as possible, if a reduction in budget is anticipated to have a significant impact on the delivery of OH services.

c. Ensure all pertinent OH requirements are included in commercial partners, Space Act, other Federal agencies, international parties, and tenant agreements, including provision of supporting documentation to NASA to affirm these partners OHPs are in compliance with all applicable portions of this document.

d. During the transition period between contracts for ongoing support services, ensure communication to all former and successor employers of the right to occupational exposure and medical surveillance data documented by the previous employer as required by Occupational Safety and Health Standards, 29 CFR pt. 1910.

Note: OSHA defines a successor employer as a new employer that continues its predecessor’s business in substantially unchanged form and hires employees of the predecessor as a majority workforce.

1.4.2 Centers shall:

a. Establish a master schedule for the review of IH workplace exposure surveillance data and OM medical surveillance requirements for each workplace/exposure group. The frequency at which each workplace/exposure group is reviewed will be based upon a hazard risk assessment, but no less frequently than every three years.

Note: The most protective requirements apply where conflicts exist between NASA health and safety requirements, OSHA requirements, and other Federal, state, or local regulations.

b. Implement effective OHPs as measured by the Agency's OH review process.

c. Use the designated Agency EHRS, unless an OCHMO waiver is approved, in accordance with NPR 1441.1, NASA Records Management Program Requirements.

1.4.4 Purchase requesters/requirements initiators shall coordinate with Centers to ensure requirements documents include all pertinent OH requirements.

1.4.5 Procurement organizations shall work with Centers and purchase requesters/requirements initiators to ensure all pertinent OH Federal and Agency provisions/clauses are included in contracts.

1.4.6 Practitioners (e.g., physicians, physician assistants, nurse practitioners, nurses, industrial hygienists, health physicists, and physical fitness professionals) shall be familiar with Center employees' tasks and work environment to better understand specific OH issues and cases, as well as the mechanism of injury, exposure, or illness; and evaluate safety and OH concerns.

1.5 OSHA Annual Report

1.5.1 NASA is required to submit an annual report to the Secretary of Labor containing the status of NASA's Safety and Health Programs during the preceding year, goals and objectives for the current year, and a plan for achieving those goals. The procedure for collecting the requisite data will be as follows:

a. Each year the OCHMO and Office of Safety and Mission Assurance (OSMA) electronically forward the OSHA Annual Report format to the Centers with a prescribed deadline for submission of the OSHA-requested information to the OCHMO and OSMA.

b. The Safety and Health organizations at Centers jointly complete the form, provide the associated documentation, and return all OSHA requested information to the OCHMO and the OSMA in the prescribed format and electronic media by the designated deadline.

c. Other NASA organizations support information compilation, editing, and writing of the OSHA Annual Report effort as needed.

d. The OCHMO and OSMA jointly prepare the report which is signed by the DASHO and the Director, Safety and Assurance Requirements Division, and submitted to OSHA.

1.6 Drug Free Workplace

1.6.1 The Office of the Chief Human Capital Officer has overall responsibility for NASA's Drug Free Workplace Program (DFWP) in accordance with Drug-Free Federal Workplace, E. O.

12564, (1986), and Drug-Free Workplace, 41 U.S.C. ch. 81. See NPR 3792.1, NASA’s Plan for a Drug Free Workplace, for specific details.

1.6.2 The Agency Medical Review Officer is located at the NASA Shared Services Center and is assigned to all Centers.

1.6.3 The OCHMO supports the DFWP by:

a. Reviewing Agency EAPs to confirm their support of program requirements.

b. Developing the NASA EAP policies described in chapter 5.

1.7 Credentialing, Education, and Training of Occupational Health Professionals

1.7.1 Credentialing and privileging of all licensed medical practitioners and non-licensed healthcare support employees providing healthcare for Agency employees is documented in NPR 1850.1, Quality Assurance of the NASA Medical Care. Centers shall:

a. Comply with Federal, state, and professional requirements applicable to all OH professional disciplines, including OM, IH, HP, FS, EAP, FWC, and HPWF.

b. Ensure credentialing and privileging of all licensed medical practitioners and non-licensed health-care support employees providing healthcare for Agency employees.

c. Establish and maintain effective organizations to fulfill OH requirements using professionally qualified persons.

d. Ensure discipline-specific professional licensures, certifications, and accreditations necessary for operations are sustained.

e. Ensure every clinic has a least one individual, other than the Medical Director, with sufficient expertise in using the Agency's EHRS to assist other users with training, troubleshooting and to act as a liaison with the Agency EHRS helpdesk.

f. Ensure hiring policies comply with Federal and NASA credentialing requirements and with state licensure statutes such that, OH professionals have experience and credentials commensurate with program requirements.

g. Ensure OH civil service employees are current with relevant education, training, and credentialing requirements.

h. Ensure OH program contracts require personnel to be current and obtain education, training, and credentialing at their company’s cost, since appropriated funds cannot be used for contractor training activities.

i. Conduct assessments of OH professional and career development needs to determine the training required of OH professionals and communicate these needs to Center management to meet professional OH licensure and certification.

1.8 Website Initiatives and Capabilities

1.8.1 The OCHMO websites include the following:

a. An internal website designed for use by OH professionals that provides resources, tools, and policy information.

b. An internal website for NASA general workforce users that serves as a hub for OH information, events, and resources related to health promotion, preventive health, mental health, physical fitness, and other similar topics.

c. A public-access website to provide general information about OCHMO programs, divisions, employees, and how OCHMO contributes to NASA’s mission.

1.9 Support of Federal and Interagency Initiatives

1.9.1 The OCHMO shall coordinate and collaborate with various Federal agencies (e.g., the Office of Personnel Management (OPM), U.S. Department of Health and Human Services (DHHS), and DOL) on health and work/life policies and initiatives.

1.9.2 Centers shall adopt policies and implement programs in support of a healthy work environment as directed by the OCHMO, based on guidance from other Federal authorities pertaining to OH, work/life, and similar issues.

1.10 Recordkeeping

1.10.1 Centers shall:

a. Ensure OH contracts expressly require keeping all records containing employee health information as per NASA and Center requirements.

b. Ensure each new OH contract or contract renewal contains specific language on recordkeeping requirements.

c. Safeguard, maintain, and disposition records for all OHP discipline-specific areas in accordance with Genetic Information Nondiscrimination Act of 2008, 42 U.S.C § 2000ff et seq., Privacy Act of 1974, as amended, 5 U.S.C. § 552a, NPR 1382.1, NASA Privacy Procedural

Requirements, NPR 1441.1, NRRS 1441.1, NASA Record Retention Schedules, and NASA- EHRS-RMP-000, Records Management Plan for the NASA Electronic Health Record System.

Chapter 2. Occupational Medicine

2.1 General

2.1.1 General

Clinics shall meet all applicable requirements of Federal and, where applicable, state regulations, professional standards, and other NASA program requirements.

2.1.2 Responsibilities

2.1.2.1 The CHMO shall establish policy requirements for the OM programs.

2.1.2.2 The OCHMO shall:

a. Ensure the oversight and advocacy of Center OM programs through periodic reviews.

b. Review any significant request for a change or relief of OH policy.

2.1.2.3 Centers shall:

b. Notify the CHMO when a Medical Director change occurs at their Center.

c. Train OM staff for the tasks they are required to perform and ensure OM staff meets all regulatory and NASA training requirements.

2.1.2.5 Medical Directors shall:

a. Ensure the program meets all Federal, state, and NASA requirements for that jurisdiction.

b. Ensure physicians and other healthcare providers (e.g., nurse practitioners and physician assistants) are appropriately credentialed in compliance with the requirements of NPR 1850.1.

c. Ensure physicians and other healthcare providers (e.g., nurse practitioners and physician assistants) are privileged in compliance with the requirements in NPR 1850.1.

d. Ensure employees who administer spirometry testing maintain certification from a National Institute for Occupational Safety & Health (NIOSH) approved course, as required by OSHA.

2.2 Medical Quality Assurance

2.2.1 General

Clinics shall establish a medical quality assurance (QA) program that meets these requirements and those found in NPD 1850.1, NASA Medical System Quality Assurance and NPR 1850.1.

2.2.2 Responsibilities

2.2.2.1 The CHMO shall establish medical QA program policy.

2.2.2.2 The OCHMO shall ensure compliance with medical QA policy through regular periodic reviews.

2.2.2.3 Centers shall develop a comprehensive set of policies and procedures to meet the quality-of-care standards. See NASA Occupational Health Employee-Directed Principles and Management-Directed Principles located on the Agency OH website.

2.2.2.5 OM staff shall implement a medical QA program including establishing and monitoring medical QA program metrics to evaluate the program effectiveness based on the Center’s policies and procedures.

2.3 Disease and Primary Injury Prevention

2.3.1 General

NASA OHPs will encompass primary prevention, health promotion, and a comprehensive safety program that impacts both individual health and Agency wellness.

2.3.2 Responsibilities

2.3.2.1 The OCHMO and Centers shall implement Health Promotion Programs through both Agency-directed and Center-planned activities and document appropriately selected metrics for benchmarking, continuous improvement of programs, and resource allocation, as a means of demonstrating the efficacy of primary prevention activities.

2.3.2.2 OH professionals shall provide prevention services such as medical examinations, health and wellness promotions, immunizations, food safety and sanitization services, assorted health screenings, and control of chemical and physical hazards.

2.4 Diagnosis and Treatment of Occupational Illness or Injury

2.4.1 General

Centers shall ensure timely diagnosis and treatment of occupational injuries and illnesses and act to minimize the recurrence of a similar problem in other coworkers and those in similar jobs.

2.4.2 Responsibilities

2.4.2.1 The CHMO shall set policy and provide oversight of clinical activities.

2.4.2.2 The OCHMO shall conduct regular periodic reviews to ensure the appropriate delivery of diagnostic and treatment services.

2.4.2.3 Centers shall:

a. Ensure when diagnosing and treating occupational illnesses and injuries they:

(1) Conduct an OH history for the assessment of work-related health problems and include total employment and general health histories, with a review of systems and determination of any pre-existing conditions to achieve an accurate medical diagnosis.

(2) After a health history is taken, perform an appropriate physical examination with a detailed specific organ or system examination as related to the chief complaint. Laboratory and radiological testing may be used to complement the history and physical examination and to aid in the diagnosis and treatment of the condition.

Note: Pre-approval may be required for procedures not routinely performed in the OH Clinic.

(3) Via the Medical Director, or qualified designee, when the Medical Director is unavailable, review the care of employees for appropriateness with current standards of care, utilizing published clinical practice guidelines.

(4) Via the Medical Director, or qualified designee, document any inconsistencies with a work-related injury or illness and report these to a safety and health representative for further evaluation of the injury mechanism and circumstances.

(5) Via OM staff or a safety and health representative, perform an assessment of the workplace to reinforce the importance of injury prevention and implementation of approved reasonable accommodations.

(6) Coordinate with OSMA regarding any occupational illness or injury as required by NPR 8621.1.

b. Report any developing trends in occupational injury and illness to the CHMO.

2.4.2.4 Medical Directors shall:

a. Ensure accurate diagnosis, timely treatment, and appropriate follow-up of all occupational injuries and illnesses in employees seen in Clinics and report all work-related injuries and illnesses to Center employees responsible for OSHA recordkeeping.

b. Monitor occupational injuries and illnesses for trends, analysis, and Corrective Actions (CA).

2.4.2.5 Practitioners shall become familiar with employees' work and the environment in which they work. To better understand specific medical issues and cases, it may be necessary for the medical staff to visit the workplace to better understand the mechanism of injury and evaluate health, safety, and ergonomic concerns.

2.4.2.6 OM staff shall coordinate and communicate with NASA FWC Injury Compensation Specialists (ICS) to provide claim-related documents generated at the OH Clinic, assist with an explanation of occupational-related illnesses and injuries for which a claim is being made, and make recommendations about employee return-to-work options.

2.5 Immunizations

2.5.1 General

Maintaining immunity will be an integral part of NASA's disease prevention and infection control programs to reduce potential health effects related to exposure to vaccine-preventable infectious agents.

Note: The number and types of immunizations required per employee will vary based upon exposure risk.

2.5.2 Responsibilities

2.5.2.1 The CHMO shall establish an Agency immunization policy.

2.5.2.2 The OCHMO shall ensure Center immunization policies are in place and the medication management process is sound, properly documented, and meets NASA QA Program elements through regular periodic reviews.

2.5.2.3 Medical Directors shall:

a. Establish immunization policies and procedures and ensure immunization services are available in such areas as international travel, medical surveillance/job certification, occupational injuries/illnesses, and preventive medicine.

b. Ensure the medication management process is sound, properly documented, meets NASA QA Program elements, and follows the most current Centers for Disease Control and Prevention (CDC) recommendations.

2.5.3 Process

2.5.3.1 Employees with a reasonable risk of occupational exposure to vaccine-preventable diseases such as tetanus or hepatitis A or B, will be offered appropriate vaccinations if they lack documented immunity in accordance with Bloodborne Pathogens, 29 CFR § 1910.1030.

2.5.3.2 Employees who decline the hepatitis B vaccination are required to sign a declaration form acknowledging the vaccination is a vital element of prevention against exposure to bloodborne pathogens.

2.5.3.3 Tetanus and diphtheria status will be reviewed during each employee evaluation and immunization made available for all employees with tetanus prone injuries at work and those requiring routine boosters if the time since the last immunization exceeds the current guidelines.

2.5.3.4 The employee will be provided an opportunity to discuss any questions about the immunization procedure prior to vaccine administration.

2.5.3.5 An immunization record will be maintained for each employee, reviewed as part of each employee encounter, reflect documented disease and immunization histories, as well as immunizations administered during employment, and updated at each immunization encounter.

2.6 Medical Support to Emergency Management Planning

2.6.1 General

Centers shall determine the roles and responsibilities of OH disciplines based on specific needs at each of the Centers.

2.6.2 Responsibilities

2.6.2.1 The CHMO shall:

a. Provide technical support and policy guidance to the Centers to effectively negotiate and delineate the roles and responsibilities of OH in relation to the Center-specific emergency management plan.

b. Provide guidance documents and contribute suggestions to improve medical response.

2.6.2.2 The OCHMO shall ensure Clinics have addressed emergency management specific to their structure and operations through regular periodic reviews.

2.6.2.3 Centers shall:

a. Keep the OCHMO current on any Center specific emergency events or any significant modifications to the Emergency Management Plan as they relate to OH roles and responsibilities.

b. Serve as an advocate for OH disciplines to ensure assigned roles and responsibilities are sound, obtain management support as needed, and keep the lines of communication viable between the stakeholders.

c. Ensure the OH roles and responsibilities in the Center emergency management plan are reasonable and clearly stated.

d. Ensure OH disciplines are fairly and consistently represented in the planning process and in drills and simulations with their comments and concerns considered for incorporation into the plan.

e. Ensure management support is solicited for appropriate funding for supplies, staff training, and skill mix and number.

2.6.2.4 Medical Directors shall:

a. Establish procedures to meet the medical expectations of the emergency management plan including, but not limited to, skill mix and number, employee training and drills, equipment, and supplies.

b. Establish measures to safeguard and retrieve medical records in paper or electronic format per 5 U.S.C. § 552a, Health Insurance Portability and Accountability Act of 1996, Pub. L. 104-191, (1996), (HIPAA), where applicable, and NPR 1441.1.

c. Ensure OM staff are appropriately trained, and adequate supplies are readily available.

d. Support other OH disciplines in meeting their respective requirements in disaster management such as supporting the EAP in Critical Incident Stress Management (CISM) training and debriefing.

2.6.2.5 Clinics shall:

a. In addition to the Center-wide plan, address emergency management specific to their structure and operations.

b. Have emergency management policies and procedures in place for emergency operation of the Clinic and support of the Center emergency management plan.

c. Integrate their roles and responsibilities into the Center emergency management plan.

2.7 Continuity of Operations Planning

2.7.1 General

Clinics shall support the Center in formulating their Continuity of Operations Plan (COOP).

2.7.2 Responsibilities

2.7.2.1 The CHMO shall provide technical support and written policy direction to OM staff in support of the Center COOP.

2.7.2.2 The OCHMO shall ensure support is provided to Centers in formulating their COOP and Clinics have programs in place to direct OM staff in support of Center emergency management plans through regular periodic reviews.

2.7.2.3 Medical Directors shall provide expert consultation to the COOP manager and Center management on related public health and medical issues.

2.7.2.4 Clinics shall:

a. Support formulation of a Center COOP which should be designed as a supplement to the Center's emergency management plan and address the hazards appropriate to the Center, such as pandemics, hurricanes, earthquakes, or other major disasters. The COOP can be an annex to the Center emergency management plan or a stand-alone plan.

b. Ensure communication with HQ emergency management throughout all phases of emergency response.

2.8 Physical Examinations

2.8.1 General

Medical surveillance protocols will be used at all Centers. The Physical Examination Requirements (Appendix C) provides examination procedure requirements for most routine and specialty examinations performed at Centers.

Note: The categories of physical examinations provided at Clinics are listed in Appendix C, Physical Examination Requirements. Appendix C will be updated via the NODIS administrative change process, as necessary.

2.8.2 Responsibilities

2.8.2.1 The CHMO shall establish policy, provide requirements and oversight, and review Center physical examination programs.

2.8.2.2 The OCHMO shall ensure oversight of Center physical examinations through regular periodic reviews.

2.8.2.3 Centers shall utilize medical surveillance protocols as detailed in the Physical Examination Requirements (Appendix C).

2.8.2.4 Medical Directors shall ensure the overall quality of care provided by all healthcare providers. In all situations where the decision regarding medical qualification or certification is unclear, the Medical Director, or qualified designee when the Medical Director is unavailable, is responsible for reviewing the clinical information and making the final decision.

2.8.2.5 Evaluating physicians shall:

a. Interpret all physical examination test results and determine their significance. Findings will be reviewed, and employees will be informed and advised if additional follow-up is recommended. Clinically significant or critical test results will be conveyed to the employee and documented as per local critical values policy. If the examinations are not performed onsite, the Medical Director, or qualified designee, when the Medical Director is unavailable, will review the results before final clearance is issued to perform the required task.

b. Prepare any required healthcare professional's written opinion for the pertinent standard, within the specified timeframe.

2.8.2.6 Clinics shall:

a. Develop and maintain effective systems for managing abnormal employee results including prompt review by the evaluating provider and notification to the employee consistent with the significance of the finding.

b. Ensure the protocol requirements for the following job categories:

(1) Specific potentially hazardous exposures.

(2) Hazardous environments/workplace examinations.

(3) Certification examinations.

(4) Flight activities.

(5) Special administrative examinations.

(6) Voluntary health maintenance examinations.

2.8.3 Process

2.8.3.1 Placement of employees in the various physical examination programs is determined by job category, workplace surveys, and specific exposure events.

2.8.3.2 Special administrative examinations and health maintenance examinations are offered according to Agency and Center policies.

2.8.3.3 Typically, employees whose jobs are associated with exposures to hazards with regulatory requirements established by OSHA or NASA are placed in medical surveillance.

2.8.3.4 Some programs have specific guidance for placement (e.g., asbestos, organophosphates pesticide workers, hearing conservation, and radiation workers).

2.8.3.5 If insufficient monitoring data or no data is available, individuals will be placed in medical surveillance based on potential exposures and job title. When this occurs, individuals are to be reassessed as work-site monitoring data becomes available.

2.8.3.6 When an employee is no longer actively exposed to a hazard, as confirmed by the supervisor, the employee will be removed from that medical surveillance group unless the physician determines the employee should remain in a monitoring status.

2.8.3.7 Physical examinations will conform to the requirements delineated in the Appendix C, Physical Examination Requirements, OCHMO-STD-1880.1, NASA Aviation Medical Certification Standards, and the pertinent Federal regulations.

2.8.3.8 Physical examination frequency varies and includes:

a. Baseline evaluation.

(1) This evaluation should ideally be performed before the employee starts work in a position with a potential for hazardous exposure.

(2) This evaluation provides information necessary to determine if the employee is qualified to perform the job. It also provides a baseline against which changes can be compared.

(3) Baseline evaluations and certifications will be performed prior to engaging in any activity that could be hazardous to the employee or other employees working near or adjacent to them or in contact with them.

b. Periodic evaluation.

(1) This evaluation will be performed periodically during the time an employee is employed in a job requiring an examination.

(2) The frequency and extent of periodic evaluations may vary depending on the work being performed, pertinent regulations, findings from previous examinations, the history of exposure, and/or the age and gender of the employee.

c. Variable or exposure-determined evaluation.

(1) These evaluations will be conducted in response to a specific hazardous exposure incident and prompt the examination of all individuals with the suspected exposure, not just those already in the surveillance program.

(2) These evaluations may vary significantly from routine medical surveillance protocols, are usually exposure specific, and include biological monitoring tests.

d. Exit/reassignment evaluation.

(1) This evaluation will be performed when the employee terminates employment or the job position or is permanently removed from a position which has a potential for hazardous exposure.

(2) Documentation of the employee’s state of health at the termination of employment or exposure is essential for comparison purposes if the employee later develops medical problems that could be attributed to past occupational exposures.

(3) This evaluation is not required if a periodic evaluation has occurred within the prior six months.

2.8.3.9 If a physical examination has been conducted within the previous six months and has been duly recorded in the employee's health record, it may, at the discretion of the examining physician, be accepted in whole or in part as the requested medical examination so long as the workplace hazards have not changed.

2.8.3.10 A physical examination conducted for one purpose will be valid for any other purpose within the prescribed validity period if that physical contains the proper data, in accordance with the following:

a. If the examination is deficient in scope, only those tests and procedures necessary to meet the additional requirements will be performed.

b. The results will be recorded, and appropriate approval provided by the examining physician.

2.8.3.11 A clear determination of medically qualified vs. medically certified or medically disqualified vs. not medically certified will be made.

2.8.3.12 As appropriate for the type of examination, any limiting factors or restrictions will be noted so reasonable accommodations for employees may be considered by the Agency. For additional information, see NPR 3713.1, NASA Policy on Reasonable Accommodation, Americans with Disabilities Act of 1990, 42 U.S.C. § 12101, and Rehabilitation Act of 1973, 29 U.S.C. § 701 et seq.

2.8.3.13 If additional tests or other actions are needed for qualification or certification (e.g., failed vision because corrective lenses are not available, additional tests are needed, or a temporary condition exists like a cold or the flu) and the condition represents a potentially immediate hazard to the employee, fellow employees, or the success of the project/mission, the employee will be placed on a modified duty status and a follow-up appointment made to either qualify or disqualify the employee.

2.8.3.14 Where no written standard has been established for a function, providers shall use best medical judgment to determine whether a disqualifying impairment exists. The Medical Director is responsible for review and final recommended work status in these cases.

2.8.3.15 Appeal or second opinions will be handled at the lowest level of authority at the Center.

2.8.3.16 When a standard written medical opinion is required by regulation, but no standard format is established by Occupational Safety and Health Standards, 29 CFR 1910 as in the case for lead, bloodborne pathogens, respiratory protection, silica, beryllium and asbestos, the format in Figure 2-1, Standard Written Medical Opinion, will be used.

Standard Written Medical Opinion

1. A medical condition has [has not] been detected that would place the employee at an increased risk of material impairment of the employee's health from [specific hazard] exposure-related disease or injury.

2. There are [are no] limitations on the employee or on the employee's use of personal protective equipment, including respirators.

3. The employee has been informed of the results of the medical examination and of any medical conditions related to [specific hazard] exposure that would require further explanation, evaluation, or treatment.

4. The employee [name] is certified for work as [occupation] with [without] Personal Protective Equipment (PPE) limitations.

Healthcare Provider Name:

Signature: Date:

Figure 2-1 Standard Written Medical Opinion

2.8.3.17 The employer, NASA or contractor, per the contract, shall provide a copy of the written opinion to the affected employee.

2.8.3.18 Unless otherwise noted, the standard written medical opinion will be sent within 14 days of completion of the physical examination and receipt of laboratory studies.

2.9 Emergency Medical Services

2.9.1 General

Initial Clinic response in an emergency to stabilize the patient until the emergency transport to appropriate medical facilities arrives. Clinics are not designated emergency facilities and do not provide emergency medical care as part of their regular scope of services. After stabilization, Emergency Medical Services (EMS), per their contract, if necessary, shall transport emergent and urgent patients to the nearest appropriate emergency facility, and not to an OH Clinic.

2.9.2 Responsibilities

2.9.2.1 The CHMO shall provide policy guidance and technical support to ensure all Centers have emergency medical response capability that is consistent with published guidelines.

2.9.2.2 The OCHMO shall ensure appropriate OH response in an emergency medical situation through regular periodic reviews.

2.9.2.3 Center Directors shall provide oversight of all NASA and NASA-contracted EMS providers. This oversight involves administrative and medical review of all runs, provision of standing orders, and ensuring the EMS are adequately staffed and equipped and comply with all

NASA, state, and local EMS requirements as practical given contract and locality-specific requirements.

2.9.2.4 Medical Directors shall ensure a first responder program that includes AED capability according to the Center-wide AED policy, collaborating with other Center stakeholders as appropriate.

2.9.2.5 EMS, per their contract, as necessary, shall ensure the following minimal requirements:

a. Ambulance and EMS requirements adhere to all state and local regulations, where applicable.

b. Advanced life support capability with a response time within eight minutes, at least 90 percent of the time.

c. First responders…