Attachment A - VOSH Program Directive 08-005A.pdf

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VOSH PROGRAM DIRECTIVE: 08-005A ISSUED: 01 September 2012

SUBJECT: CSHO/Inspector Medical Examination Program

Purpose: This Directive transmits to field personnel the Department’s CSHO/Inspector Medical

Examination Program for DOLI personnel who conduct occupational safety and health workplace inspections or public safety boiler and pressure vessel inspections.

It also specifies that the Department will provide a single, statewide provider of the medical services necessary to implement the requirements of this Program. It updates the existing VOSH Compliance Safety and Health Officer (CSHO) Medical Examination requirements for VOSH 23(g) and 21(d) grant personnel, adds boiler safety inspectors from the DOLI Division of Boiler and Pressure Vessel Safety and memorializes the medical examination program as a VOSH Program Directive. This Directive revises the scope of employees covered by the VOSH medical examination requirements and revises program elements to better match the occupational needs of covered employees.

Change I at Section I.B.2 is not substantive. It provides further clarification of the distinction between the “optional” annual examinations for directors and managers and the “voluntary” third year examinations for all other employees with possible prior exposures to potentially toxic chemicals and/or biologic or physical hazards.

This Program Directive is an internal guideline, not a statutory or regulatory rule, and is intended to provide instructions to VOSH personnel regarding internal operation of the Virginia Occupational Safety and Health Program and is solely for the benefit of the program. This document is not subject to the Virginia Register Act or the Administrative Process Act; it does not have general application and is not being enforced as having the force of law.

Scope: This Directive applies to VOSH personnel who conduct or may conduct occupational safety and health inspections and to DOLI Boiler Program personnel who conduct public safety boiler inspections. Participation in annual physical examination by the VOSH Medical Services Contract Provider (MSCP) is mandatory for covered VOSH staff and Boiler Inspectors. It may also include other individuals in optional positions as detailed in Section I. A. of this Directive. This Directive shall apply to two types of individuals:

1. Existing. DOLI personnel who conduct either VOSH occupational safety and health inspections or DOLI Boiler safety compliance inspections. Participation in the physical examination and interim medical evaluations requirements of the program are mandatory for all Boiler Inspectors, VOSH Compliance Officers, and optional for certain other VOSH and Boiler Division staff detailed in Section I. A. 1. of this Directive.

2. Pre-placement. Individuals who are either: 1.) Probable new hires by the Department for a covered position; or 2.) Existing DOLI personnel seeking to transfer from a position not covered by this Directive into a covered position.

Reference: OSHA Instruction PER 04-00-005 (22 August 2009)

Cancellation: VOSH Program Directive 08-005 (01 September 2011)

Effective Date: 01 September 2012 tyj69539 Stamp

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Expiration Date: Not Applicable

Action: Directors and Managers shall ensure that affected field personnel, other affected DOLI personnel and probable new hires understand and comply with the revised medical examination requirements included in this Directive.

Background: Administration of the prior CSHO medical exam requirement was subject to variations in compliance from one region to another. This Directive cancels the previous VOSH requirement for annual medical evaluations for VOSH inspection personnel and issues a CSHO/Inspector Medical Examination Program to revise the description of VOSH employees covered by the Medical Examination Program.

Summary: This Directive replaces the existing annual medical examination requirements with a new scope of applicability and other requirements for the new CSHO/Inspector Medical Examination Program to better match the occupational needs of covered employees. It also adds DOLI Boiler Safety Program inspectors to the VOSH CSHO medical examination requirements program.

Positions covered by the CSHO/Inspector Medical Examination Program are not necessarily the same as those covered under the previous annual medical examination requirements. The expanded scope now includes CSHOs, other VOSH personnel who perform field work that places them at risk for occupational exposures or other hazardous work conditions, and DOLI Boiler and Pressure Vessel Safety Program inspectors.

Therefore, the medical program title and scope now reflect the inclusion of personnel other than VOSH CSHOs. The revised schedule is based on recognition that certain medical testing or evaluations, when performed annually, are not significantly beneficial for some employees, particularly those younger than 50 years of age. Therefore, certain medical testing and other examination frequency beyond the standard medical examination will be aligned with age, individual medical conditions and occupational exposures, when applicable. The medical evaluation requirements mandated by VOSH standards will continue to be applied (see Appendix “B”). This directive allows the exercise of flexibility and practical judgment in determining the appropriate medical evaluation periodicity frequency for each covered employee.

The VOSH Medical Examination Program is based on a review of current medical literature, professional guidance, medical examination protocols in other agencies and non-occupational medical public health recommendations. Physical evaluation, or parts of the evaluation, may be amended by VOSH to include changes and updates issued by federal OSHA’s Office of Occupational Medicine (OOM) required for federal OSHA employees in accordance with prudent medical practice.

Annual physical examinations to be performed by the DOLI Medical Services Contract Provider (MSCP) remain mandatory for all covered employees.

Significant Changes: ● The existing and long standing CSHO requirement for medical examinations is now updated and memorialized in a program directive for all personnel assigned to field duties in which there is reasonable anticipation of encountering physical, chemical and/or biological hazards including employees whose duties require on-site inspections, on-site evaluations and/or on-scene emergency response functions.

● Chest X-rays are now voluntary after the initial pre-placement examination unless the employee has experienced an occupational exposure that triggered the medical surveillance requirements of a VOSH standard. If an exposure does trigger the requirements of a standard, the schedule for chest X-rays established by that standard will be followed.

● Members of any special task forces or regional or specialized response teams must meet the medical qualifications of this program as long as they participate on these teams.

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● Regional Directors, Compliance Managers, Boiler Safety Program Director or their designees are now required to notify the DOLI Director of the Division of Human Resources (DHR) when they become aware of an employee exposure that reaches an action level required in VOSH standards or another occupational exposure of concern. In addition, they are to notify DHR of employee hospitalizations, significant surgeries, or periods of medical restrictions exceeding one month, since these situations may signal a need for more frequent or additional medical evaluations.

● Regional Directors, Compliance Managers, Boiler Safety Program Director or their designees are also required to consult with DOLI Director of DHR and put a temporary duty restriction in place within 10 working days of notification that an employee does not meet the medical and/or physical requirements of the positions.

● Boiler and Pressure Vessel Safety Inspectors are included in the covered positions under the Program.

Courtney M. Malveaux Commissioner

Attachment: None.

Distribution: Commissioner of Labor and Industry Cooperative Programs Director & Manager

Assistant Commissioner - Programs VOSH Compliance & Cooperative Programs Staff

VOSH Directors and Managers OSHA Region III & OSHA Norfolk Area Offices

VOSH Legal Support & IT Staff i

TABLE OF CONTENTS

I. Application

A. Covered Positions

1. General Application

2. Response Team Members

3. Apprentices or Trainees

B. Medical Evaluation

1. Mandatory Examinations 2 Voluntary Examinations

C. Purpose of Medical Evaluation

1. Fitness for Duty

2. Complying with VOSH Standards

II. Background

A. Determination of Medical Evaluation Requirements B. Protecting Employee Health and Safety

III. Medical Appointments

IV. Definitions and Frequency of Examinations

A. Initial Examination for Anticipated Hires and Transfers

B. Mandatory Annual Physical Examination

C. Options

1. Hepatitis “B” Vaccinations

2. Post-exposure prophylaxis (PEP) for Bloodborne Pathogens

D. Voluntary Physical Examination

1. Components Included

2. Frequency

3. Scheduling

E. Self-Contained Breathing Apparatus (SCBA) Medical Clearance

1. Components Included

2. Frequency

V. Additional Medical Information

A. Additional MSCP Services

B. Medical Specialist Opinions

1. Selection of Consulting Physician

2. Payment for Consulting Physician and/or Additional Tests

3. Medical Specialist Opinion

C. Timeliness

VI. Incomplete Medical Examinations VII. Accommodations

A. Overview B. Interim Work Restrictions C. Director of DHR and Supervisor Consultation ii

D. Request for Accommodation E. Medical Review F. Coordination of Accommodation Plan G. Limited Duty

VIII. Workers’ Compensation and Other Employee Benefits

IX. Medical Recordkeeping

A. Custody of Summary Results B. Medical Records from MSCP C. Results of Annual Physical Examination D. Request for Medical Records for Current Employees by the Employee

X. Appendices

Appendix A. – VOSH Medical Examination Program ..................................................................................... A-1

I. Purpose ................................................................................................................................. A-1 II. Rationale for the Necessity of Physical Requirements ......................................................... A-1 III. Medical Examinations ........................................................................................................... A-1 IV. Medical Examination Parameters ......................................................................................... A-2

A. Vision ....................................................................................................................... A-2 B. Hearing ..................................................................................................................... A-2 C, Musculoskeletal........................................................................................................ A-2 D. Cardiopulmonary ...................................................................................................... A-3 E. General Medical ....................................................................................................... A-3

Appendix B. – Medical Evaluation Requirements of OSHA Standards .......................................................... B-1

Appendix C. – Protecting Employee Health and Safety ................................................................................. C-1

I. Annual Evaluations ............................................................................................................... C-1 II. Regulatory Requirements ..................................................................................................... C-1

Appendix D1. – Components of Medical Examinations .................................................................................. D1-1

I. General ................................................................................................................................. D1-1 II. Medical History ...................................................................................................................... D1-1 III. Specific Examination Tests and Requirements .................................................................... D1-1 IV. Tests and Requirements for Examinations/Evaluations ....................................................... D1-2

Table 1 – Elements of Physical Examinations and Medical Evaluations .............................. D1-3 Table 2 – Elements of Physical Examinations and Medical Evaluations .............................. D1-4 Table 3 – Elements of Physical Examinations and Medical Evaluations .............................. D1-5

Appendix D2. – Audiometric Testing Program ................................................................................................ D2-1

I. General ................................................................................................................................. D2-1 II. Scheduling ............................................................................................................................ D2-1

A. Baseline Audiogram ................................................................................................. D2-1 B. Annual Audiogram ................................................................................................... D2-1 C. Notification of Audiogram Results ............................................................................ D2-1 D. Retest Audiogram .................................................................................................... D2-1 E. Revised Baseline Audiogram ................................................................................... D2-2 F. Standard Threshold Shift ......................................................................................... D2-2

Appendix E. – Pre-Placement Examination for Anticipated Hires and Transfers ........................................... E-1

I. Pre-placement Examination .................................................................................................. E-1 II. Failure to Meet Requirements ............................................................................................... E-1 iii

III. Scheduling ............................................................................................................................ E-1 IV. Elements of the Initial Examination ....................................................................................... E-1 V. Location of the Initial Examination ........................................................................................ E-1 VI. Cost of Examination .............................................................................................................. E-1 VII. Records Management ........................................................................................................... E-2

Appendix F. – Comprehensive Reference List ............................................................................................... F-1

Appendix G. – Pre-placement and Annual Physical Examination Forms ....................................................... G-1

Appendix H. – VOSH Respirator Medical Evaluation Questionnaire .............................................................. H-1

Appendix I. – Audiogram History/Report and Sample Notification Letters ..................................................... I-1

I. Application.

A. Covered Positions.

1. General Application. This Directive applies to VOSH and the Boiler and Pressure Vessel Safety Division positions for which there is reasonable anticipation of encountering physical, chemical and/or biological hazards. This includes employees whose duties require on-site inspections, on-site evaluations and/or on-scene emergency response functions.

a. Covered Positions . The CSHO/Inspector Medical Examination Program includes, but is not limited to, DOLI employees in the following positions for whom annual examinations are required:

Safety Compliance Officer Apprentice Industrial Hygienist Compliance Apprentice

Safety Consultant Apprentice Health Consultant Apprentice Safety Consultant Industrial Hygienist Compliance Safety Compliance Officer Health Consultant Safety Compliance Lead Industrial Hygienist Lead Safety Compliance Senior Industrial Hygienist Compliance Senior Safety Consultant Senior Health Consultant Senior Safety Senior Compliance Engineer Health Senior Compliance Engineer Safety Senior Consultant Engineer Health Senior Consultant Engineer Boiler Inspector Senior Boiler Inspector

VPP Coordinator

All DOLI Employee Work Profiles (EWPs) developed or maintained by DHR for the above covered positions shall include a requirement for an annual physical examination by the MSCP under contract with the Department.

b. Optional Positions . The Medical Examination Program annual physical examinations are optional for the following positions DOLI Regional Director Consultation Program Manager

VOSH Program Directors VOSH Compliance Manager Director of Cooperative Programs Boiler Safety Program Director

2. Response Team Members. Members of regional response teams and specialized response teams must meet the minimum medical/physical requirements of this program prior to Response Team assignment and for the duration of that assignment. They are required to complete the physical examinations and interim medical evaluations specified under this Directive.

3. Apprentices or Trainees. VOSH Apprentices or any other form of VOSH trainee or intern are covered under this Directive if their tenure with the Department is expected to exceed a one-year period from their pre-placement examination and there is reasonable anticipation of encountering physical, chemical and/or biological hazards.

B. Medical Evaluation.

1. Mandatory Examinations. All covered employees are required to complete the annual physical examinations and interim medical evaluations as specified under this Directive.

2. Voluntary Examinations. For employees not covered under Section I.A.1.b. “optional positions” for receiving annual examinations and whose past work assignments required them to make regular or occasional visits to establishments or other worksites where they may have been exposed to potentially toxic chemicals and/or biologic or physical hazards and whose job descriptions do not now require them to go into the field are eligible for a voluntary physical examination every three years.

C. Purpose of Medical Evaluation.

1. Fitness for Duty. Medical evaluations under this Program are required in order for VOSH, the Boiler and Pressure Vessel Safety Division, and the Department to determine if covered employees are physically and medically capable of performing the essential duties of the position efficiently and without posing a hazard to themselves or others.

2. Complying with VOSH Standards. Multiple VOSH standards require routine medical tests in order to monitor the health of employees who are reasonably anticipated to experience exposures to potentially hazardous substances or physical hazards and who must be physically capable of safely utilizing personal protective equipment. Under this program, VOSH and the Boiler and Pressure Vessel Safety Division will comply with medical requirements of existing VOSH standards as they pertain to covered employees.

II. Background.

A. Determination of Medical Evaluation Requirements.

This Directive establishes medical history and physical examination requirements based on specific characteristics of the affected positions. These requirements are consistent with the practices of federal OSHA and other federal agencies and accepted public health practices. The medical evaluation requirements mandated by VOSH/OSHA standards will continue to be applied to covered employees (Appendix B).

This directive allows for flexibility and clinical judgment in determining the appropriate medical evaluation periodicity for each covered employee. Each employee will receive an annual examination and will receive a notification regarding the type of exam that will be performed the following year.

B. Protecting Employee Health & Safety.

Although the VOSH and Boiler and Pressure Vessel Safety Division medical examination program does change the frequency of the extensive medical questionnaire and physical examination, it provides a timely, annual occupational medicine evaluation for all covered employees. It is also aligned with current standards of occupational medicine and preventive medicine practices that are updated from the federal CSHO Medical Program. Appendix C summarizes the supporting logic for changes in the program.

III. Medical Appointments. A mandatory annual physical examination with the VOSH Medical Services Contract

Provider (MSCP) is authorized and provided to all employees in covered positions.

A. Examinations will be conducted during the employee’s normal duty hours and will be provided free of charge to the employee.

B. Physical examinations and medical evaluations will be scheduled by the employee after notification to the individual by the DOLI DHR.

C. Whenever possible, appointments should be scheduled within 3 calendar days of notification by the DOLI DHR and completed within 30 calendar days.

D. Once the appointment has been scheduled, the employee should notify DOLI DHR and their supervisor of the date, time and location.

E. Employees shall notify their supervisors, the DOLI DHR and the MSCP clinic personnel at least 24 hours in advance if they are unable to attend the examination at the scheduled time.

F. All employees who receive an examination must complete and submit a DOLI / MSCP feedback form providing comments on the MSCP experience. The form shall be forwarded by the employee to DHR within two (2) business days of the appointment. All forms will be reviewed by DHR. All complaints of a serious nature will receive Agency follow-up and an annual summary provided by DHR to the Assistant Commissioner-Programs and the MSCP.

G. Annual physical examinations will follow the requirements of Appendices “D1” and “D2” of this Directive.

IV. Definitions and Frequency of Examinations.

A. Initial Examination for Anticipated Hires and Transfers. For an external candidate or a current DOLI employee whose hiring or transfer into a covered position is anticipated by the Department, an initial medical history and initial physical examination where the candidate successfully meets all requirements of the covered position is required in order to complete the hiring process.

Such initial medical history and initial physical examination should be scheduled prior to the initiation of any work in the position. If this is not feasible, in no case shall it occur later than 60 days following the initiation of work in the position. The candidate shall be advised in advance that the formal hiring process is not complete until the results of the examination indicate that the candidate successfully meets all medical/physical requirements of the position. Appendix E provides additional policy and procedural information related uniquely to such initial examinations.

B. Mandatory Annual Physical Examination. There is a mandatory medical history and physical examination for all covered employees (see Appendix “A”). Components: Appendix “D1”, Table 1 provides a list of the components of the Physical Examination. Appendix “D2” provides the audiometric testing procedures for pre-placement and interim medical evaluations.

C. Options. As part of the medical examination program, employees shall be offered the following options:

1. Hepatitis “B” Vaccinations. This vaccination series shall be offered as an option to all employees as part of the annual physical examination. Employees who do not wish to receive the vaccinations must sign a waiver provided by the program indicating their voluntary decision not to receive the Hepatitis “B” Vaccination series. Upon completion, this waiver shall be placed in the employee’s medical file. If an employee initially declines the hepatitis B vaccination but at a later date while still covered under the standard decides to accept the vaccination, the hepatitis B vaccination will be made available at that time.

2. Post-exposure prophylaxis (PEP) for Bloodborne Pathogens. A post-exposure evaluation and follow-up shall immediately be made available to covered employees following a report of an exposure incident. The medical evaluation and follow-up will be conducted either through the State’s workers’ compensation process or by the MSCP. The hepatitis B vaccination series will be offered to unvaccinated employees. Employees must sign the waiver provided by the program if they decline the hepatitis B vaccination series. A copy of the waiver shall be maintained in the employee's medical file.

D. Voluntary Physical Examination. An optional medical examination offered to employees whose past work assignments with VOSH and Boiler and Pressure Vessel Safety Division would have required them to make visits to establishments or other worksites where they may have been exposed to chemical, physical or biological hazards and whose current job descriptions no longer require them to perform field duties. These examinations provide continued medical surveillance for conditions with a long latency period.

1. Components Included. Appendix D1, Table 1 provides a list of the components of the Voluntary

Physical Examination.

2. Frequency. A Voluntary Physical Examination can be obtained every 3 years.

3. Scheduling. Voluntary Physical Examinations must be scheduled and completed during the fiscal year in which the exam was approved.

E. Self-Contained Breathing Apparatus (SCBA) Medical Clearance. Normally, VOSH employees would not be assigned to duties that would require the use of a self-contained breathing apparatus. However, if an employee is assigned a duty that would require the use of a self-contained breathing apparatus, a mandatory medical evaluation must be performed in addition to the periodic and interim evaluations, that determines an employee’s ability to safely wear a Self-Contained Breathing Apparatus (SCBA).

1. Components Included. Appendix “D1”, Table 1 provides a list of the additional medical services associated with SCBA clearance. Most significantly, SCBA clearance requires a cardiac stress test for employees age 40 or older. A cardiac stress test may be required for employees age 35 or older based on cardiac risk factors.

2. Frequency. The appropriate frequency for SCBA medical clearance renewal is individualized for each employee and is determined by a reviewing physician each time the medical evaluation is performed. The frequency is determined by the opinion of the reviewing physician, based on the individual’s health risks and the Elements of Physical Examination and Medical Evaluations listed in Table 1 for SCBA Clearance (Appendix “D1”). Individuals over 40 years of age must have a physical examination at least every two years. The SCBA clearance can be performed as part of the Periodic Physical Examination or the Interim Medical Evaluation.

V. Additional Medical Information. In response to the written report by the MSCP resulting from either an annual physical examination or an interim medical evaluation, additional medical information may be required to assess an employee’s medical condition(s) before determining medical fitness to perform required duties. In these situations, both the employee and the Director of DHR will be notified in writing by the MSCP that additional services are required and will so advise the DOLI Assistant Commissioner-Programs. These additional tests and evaluations are considered a continuation of the scheduled examination/evaluation.

A. Additional MSCP Services. Either while still at the clinic or subsequently, additional tests that are part of the regular services provided by the MSCP may be authorized by the DOLI Assistant Commissioner- Programs. For example, a review of a respiratory protection questionnaire may reveal an issue that requires spirometry. Costs associated with these VOSH and Boiler and Pressure Vessel Safety Division authorized services by the contract physician will be covered by the Department under the agreement with the MSCP.

B. Medical Specialist Opinions. When a covered employee does not meet the established criteria for fitness for duty, but the MSCP is unable to render a medical opinion as to detailed aspects of the employee’s fitness to perform his or her job functions, the employee and the Regional Office will be informed, in writing, that a specialist’s medical evaluation, limited to the area(s) of concern, is required upon authorization by the DOLI Assistant Commissioner-Programs. The employee must comply with this written notification from the MSCP in a timely manner, usually within thirty (30) calendar days of employee receipt of the notification.

1. Selection of Consulting Physician. When the need for additional medical information requires the use of a medical specialist, after consultation with the MSCP regarding the appropriate specialty of the medical specialist physician advised by the MSCP, the employee selects a qualified specialist physician. This consulting physician should be board certified in the area of the potentially disqualifying condition (e.g., selection of a cardiologist to consult on cardiovascular conditions). The employee shall notify the Director of DHR when an appointment has been scheduled.

2. Payment for Consulting Physician and/or Additional Tests. The Department is responsible for the payment of the cost of medical specialist opinions and associated medical tests specified by the MSCP. Additional testing requested by a consulting physician must be approved by the Assistant Commissioner – Programs prior to authorization for payment by the Department. The Director of DHR will approve payment certifying only that the employee had an appointment and that the Director of DHR has received the certification from MSCP. It does not act as evidence of medical procedures performed.

If additional tests are completed which are NOT approved by the Assistant Commissioner -

Programs based on the recommendation of the VOSH Medical Services Contract Provider (MSCP), the employee is responsible for payment. If this occurs, employees should consult with the DOLI Division of Accounting and Finance for guidance on how to arrange payment.

3. Medical Specialist Opinion. The medical specialist’s opinion will be used in reassessing the individual’s medical qualifications for duty and in determining if specific tasks can be safely performed (e.g., using a negative pressure respirator, carrying 40 lbs. of equipment, driving, etc.). This medical information may be shared with the VOSH contract physician, if needed, for future medical clearances. The MSCP or the Director of DHR will notify the employee and Regional Director/Compliance Manager or designee if there is any failure to meet medical requirements and will advise the Regional Director or Compliance Manager or his/her designee regarding job restrictions as appropriate.

C. Timeliness. When additional services are required, the employee must comply with the written notification from the MSCP in a timely manner, usually within thirty (30) calendar days of employee receipt of the notification. Communication with the Director of DHR is required to obtain an extension. If the MSCP has not received pertinent additional medical information within the agreed upon time, notice will be sent to the Regional Director or Compliance Manager or his/her designee so that appropriate administrative action may be taken.

VI. Incomplete Medical Examinations.

When components of a mandatory medical examination or any additional examination are not completed as requested, Director of DHR will notify the Regional Director or Compliance Manager or his/her designee that the MSCP is unable to render a medical opinion as to the fitness of the employee to perform his or her job functions.

The Regional Director or Compliance Manager or his/her designee will take appropriate administrative action to ensure that VOSH medical evaluations are completed. The Boiler and Pressure Vessel Safety Division Director will take appropriate administrative action to ensure that Boiler Enforcement Division medical evaluations are completed.

VII. Accommodations.

NOTE: The use of the term Aaccommodation@ in this Directive does not refer to Areasonable accommodation@ under the Americans with Disabilities Act (42 U.S.C. § 12101 et seq.).

A. Overview. Upon notification that an employee does not meet one or more medical/physical requirements of his/her position, the Regional Director or Compliance Manager, Boiler Safety Program Director or his/her designee will confer with the MSCP and the Director of DHR to consider an appropriate accommodation plan.

The process of accommodating an employee involves job reassignment, job modification or job restriction. An employee’s job accommodation is designed to avoid the aggravation of an existing medical condition and to avoid placing an employee in an occupational situation that is unsafe due to the presence of one or more medical conditions. Only DOLI management may seek accommodation of employees under this program. Accommodation plans are proposed by Regional Director or Compliance Manager, Boiler Safety Program Director, or his/her designee and are reviewed and concurred on by the Director of DHR, applicable VOSH Program Director and the Assistant Commissioner - Programs. Duty restrictions may be temporary, as in the case of a correctable condition, or they may be permanent.

Accommodations for permanently restrictive conditions will be made on a case-by-case basis.

B. Interim Work Restrictions. In order to ensure that employees are not put at risk between the time they are found not to meet one or more medical/physical requirements of their positions and final accommodation, Regional Director or Compliance Manager or his/her designee shall consult with the Director of DHR and then put in place, within 10 working days of notification by the MSCP of the employee’s condition, temporary working restriction(s) limiting work assignments and/or working conditions until accommodations are finalized.

C. Director of DHR and Supervisor Consultation. The Director of DHR and the affected employee's supervisor, i.e., Regional Director or Compliance Manager, Boiler Safety Program Director, or his/her designee shall confer with the MSCP to determine what restrictions or limitations should be placed on an individual employee. This will ensure that restrictions and limitations are pertinent to currently assigned duties and potential future duties.

D. Request for Accommodation. The accommodation plan shall include the specific details describing how the employee will be accommodated, i.e., job restriction or job reassignment. The final terms of the accommodation plan proposals will be made by the Regional Director or Compliance Manager, Boiler Safety Program Director, or his/her designee who shall forward the proposed accommodation plan to the Director of DHR.

E. Medical Review. The Director of DHR shall review the request and confer with the MSCP to ensure that the terms of the accommodation plan are medically appropriate.

F. Coordination of Accommodation Plan. The Director of DHR will coordinate review and concurrence of the accommodation plan with the MSCP, the applicable VOSH Program Director or Boiler Safety Program Director and the Assistant Commissioner--Programs. The purpose of the review is to ensure Departmental consistency of application. Accommodation requests will generally be reviewed on a monthly or bimonthly basis. The Director of DHR will notify the Regional Director or Compliance Manager, Boiler Safety Program Director, or his/her designee when their accommodation plans are scheduled for review. In order to expedite resolution of issues, Regional Directors, Compliance Managers, Boiler Safety Program Director, or their designees will be invited to join the meeting.

G. Limited Duty. This program does not change procedures that regional and field offices are presently using to provide limited duty for an employee with a temporary condition such as a broken leg or pregnancy. If an adverse medical condition is correctable, i.e., hernia or high blood pressure, VOSH may require medical attention for that condition and establish a reasonable deadline by which time the condition must be corrected or controlled, in order to meet medical requirements.

VIII. Workers’ Compensation and Other Employee Benefits. None of the policies or procedures in this Directive affects existing employee options or benefits for VSDP, disability retirement, Workers’ Compensation, and/or any other employment benefit programs.

IX. Medical Recordkeeping.

A. Custody of Summary Results. The summary results of all evaluations provided under this program and its predecessor, whether mandatory or voluntary, forwarded to DHR are to be maintained by DHR and are safeguarded in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Public Law 104-191, other applicable state and federal statutes and regulations, and VOSH standard Part 1910.1020)

B. Medical Records from MSCP. Upon completion of the physical examination or medical evaluation, the

MSCP shall forward to DHR the fitness for duty records of each applicable employee’s physical examination and interim medical evaluation. The employee’s complete medical record, including all files and records for that employee, shall be maintained by the MSCP in accordance with the terms of the contract for services with the Department.

An employee’s complete medical record shall be marked “CONFIDENTIAL” and the package shall include:

1. Completed medical/occupational history forms including OSHA -179 form;

2. Completed physical examination forms, including the OSHA -178 form;

3. All laboratory, audiometric, visual, EKG, skin test and other medical test results;

4. Chest X-ray (radiograph and interpretation); and,

5. Pulmonary function test.

C. Results of Annual Physical Examination. The MSCP shall send each employee a copy of his/her medical examination report within two weeks of each examination or evaluation. If the employee does not receive a timely report, the employee shall follow up with the MSCP facility where the examination was performed. A feedback form detailing the failure shall be sent to DHR if the report is not received within one week of contacting the MSCP regarding the late report.

D. Request for Medical Records for Current Employees by the Employee.

Requests for Medical Records for Current Employees shall be directed, in writing to the MSCP by mail or by fax to the MSCP address or fax number provided by the DOLI Division of General Services and such requests shall include the following:

Dates of examinations for which records are being requested;

Full name and date of birth of the VOSH or Boiler and Pressure Vessel Safety Division employee submitting the request;

Home address and phone number to allow for express mailing;

Work phone number; and, An original signature of the VOSH or Boiler and Pressure Vessel Safety Division employee whose records are being requested.

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A-1

Appendix A

VOSH Medical Examination Program

I. Purpose.

VOSH and Boiler and Pressure Vessel Safety Division personnel conduct on-site inspections, on-site evaluations and/or on-scene emergency response functions at commercial establishments, industrial establishments and other worksites to observe and evaluate conditions to which employees or the public are exposed. During these inspections, VOSH and Boiler and Pressure Vessel Safety Division in covered or optional positions may be exposed to potentially hazardous situations and substances. The application of a single medical requirements standard to all affected employees administered by a single medical services provider (MSCP) ensures that the health of these employees will be at a level that permits them to perform job-related assignments safely, effectively, and without health or other hazard to themselves or others.

II. Rationale for the Necessity of Physical Requirements.

The following is a general description of the physical requirements of the positions affected by the VOSH Medical

Examination Program.

A. The duties of these positions require employees to perform under conditions that vary from sedentary to maximum exertion. Normal working conditions also require the employee to perform in a reliable manner under adverse conditions. Employees examine and report on potentially hazardous worksite conditions.

This may include working at heights, underground, in confined spaces, in poorly lighted facilities, in emergency situations, and work in environments with chemical, physical, and biological hazards which are regulated by Title 40.1 of the Code of Virginia and the federal OSH Act.

B. Many of the hazards that VOSH and Boiler and Pressure Vessel Safety Division employees may face are regulated by established regulatory standards which require the use of personal protective equipment

(PPE) and/or routine medical monitoring. The proper use of personal protective equipment requires an evaluation of the wearer’s ability to utilize the equipment safely and without adverse effect to the wearer’s health. Adverse conditions sometime occur unexpectedly, while others are anticipated and appropriate steps can be taken in an orderly and controlled manner to protect oneself and safely leave the hazard area.

III. Medical Examinations.

A. As part of the hiring process, selected applicants must undergo a pre-placement medical examination by the MSCP and be physically and medically capable of performing the essential duties of the position efficiently and without hazard to themselves or others.

B. Routine medical evaluations by the MSCP serve to monitor the employee’s health status to ensure that he or she maintains physical capabilities to meet the qualifications of his/her position. In addition, routine medical surveillance uncovers conditions which may develop as a result of occupational exposures which have long latency periods for symptom development.

C. Failure to meet the physical and medical requirements of pre-placement examinations will be considered to disqualify an applicant for employment for a covered position.

D. Failure to meet the physical and medical requirements of annual physical examinations will be considered disqualifying, except when, in the determination of the applicable VOSH Program Director and the Boiler

A-2 and Pressure Vessel Safety Division Director, in consultation with the Assistant Commissioner-Programs, there is sufficient evidence that individuals can perform the essential functions of the job efficiently and without risk to themselves or others, with or without appropriate accommodation.

IV. Medical Examination Parameters.

A. Vision.

1. Physical Requirement. Distant visual acuity must be at least 20/40 in each eye separately, with or without corrective lenses. Distant binocular acuity must be at least 20/40 with or without corrective lenses. Near visual acuity must be at least 20/40 in each eye separately, with or without corrective lenses. Near binocular acuity must be at least 20/40 with or without corrective lenses. Field of vision must be 85 degrees in the horizontal meridian in each eye. The ability to distinguish the colors red, amber, and green is required for the pre-placement examination.

2. Work Activity. Routinely assigned to areas where: the reading of comprehensive literature is necessary; both near and far visual acuity are necessary for hazard recognition; potentially life-threatening environments exist (therefore, accurate reading of PPE labeling is required); color coded warning signs represent hazardous conditions; or must perform routine utilization of finely calibrated equipment.

3. Rationale. Covered employees under this program inspect workplaces or boiler and pressure vessel installations where potential safety and health hazards exist or can spontaneously occur. Once these hazards occur, inspection personnel must be capable of determining what actions are appropriate in order to safeguard the safety and health of themselves and others. These actions will always require both near and far visual acuity. For example, employees may need to quickly ascertain the condition of a respirator for use in the case of an emergency egress situation. (This requires reading finely calibrated air gauges.) While making routine inspections, a compliance officer may encounter situations where full field of vision will be necessary in order to avoid a serious accident. For example, while working on high scaffolding, it may be necessary to rapidly descend. Normal field of vision is necessary to perform this activity safely.

B. Hearing.

1. Requirement. Average hearing loss in the better ear cannot be greater than 40 decibels at 500 Hz, 1,000 Hz, and 2,000 Hz, with or without a hearing aid.

2. Work Activity. Covered employees are routinely assigned to areas where a broad spectrum of physical hazards exists, including environmental noise levels above 90 decibels.

3. Rationale. It is important that a covered employee maintain adequate auditory acuity to communicate and give instructions in a noisy environment. During the course of daily activities, it is important for employees to hear instructions and communications in order to ensure safety. A greater than 40 decibel loss of auditory acuity in the speech frequencies in the better ear may interfere with the employee’s ability to communicate under noisy conditions.

C. Musculoskeletal.

1. Requirements. Employees must have: a.) The functional use of both hands, arms, legs, and feet; b.)

No impairment of the use of a leg, a foot, an arm, a hand, the fingers, back or neck which would most likely interfere with the functional requirements of this position; and, c.) No established medical history

A-3 or clinical diagnosis of rheumatic, arthritic, orthopedic, muscular, neuromuscular, or vascular disease which would interfere with the ability to perform the functional requirements of this position.

2. Work Activity. A covered employee is required to perform moderate lifting, carrying, walking and standing. A covered employee will routinely be required to ascend or descend heights in order to safely egress from a potentially hazardous area. During routine activities, a covered employee must carry portable scientific equipment.

3. Rationale. It is imperative that a covered employee have no impairment of the hands, arms, legs, feet, back or neck which would prevent performing the functional requirements of moderate lifting, carrying, reaching above the shoulder, standing, walking and climbing. An established medical history of arthritis or muscular pathology that would interfere with these functional requirements could cause a potentially hazardous situation in the workplace.

D. Cardiopulmonary.

1. Requirement. No current clinical diagnosis of myocardial infarction, angina pectoris, coronary insufficiency, atherosclerosis, thrombosis, or any other cardiovascular or cardiopulmonary disease that would likely cause syncope, dyspnea, collapse, or cardiac failure. No established medical history or clinical diagnosis of cardiac or respiratory dysfunction likely to interfere with the ability to wear a respirator, if required.

2. Work Activity. A covered employee will routinely be required to: perform moderate lifting, carrying, walking and standing; ascend or descend heights in order to safely egress from a potentially hazardous area; wear a negative pressure air-purifying respirator; and operate a motor vehicle.

3. Rationale. Since covered employees may need to rapidly egress from heights or depths, it is imperative that no established medical history of significant cardiac or pulmonary disease exists. It is known that carrying heavy equipment while ascending or descending great heights places an excess burden on the cardio-pulmonary system. Therefore, it is imperative that the cardio-vascular system be without significant pathology. Since a covered employee may be required to wear a negative pressure respirator, it is imperative and required by VOSH Standard 1910.134 that a physician has medically qualified the employee to wear such a respirator. It is known that pre-existing cardiac or respiratory disease can prevent an individual from wearing such a respirator.

E. General Medical.

1. Requirement. No diagnosis of a medical condition that is likely to cause significantly impaired performance or sudden incapacitation, e.g., uncontrolled seizures, use of prescription medication that causes significant sedation, or other significant impairment. When, in the opinion of the VOSH MSCP, it is determined that for a given individual, the sedative properties of that employee's required medication poses an unacceptable risk, the employee will not receive full medical clearance.

Appropriate job restrictions will be considered. This does not apply to use of over-the-counter medications.

2. Work Activity. Covered employees work in locations with known physical, chemical and biological hazards. Covered employees often work alone in isolated locations, may be required to work at heights, and often drive for long periods of time in the course of their duties.

A-4

3. Rationale. Covered employees must work in an environment where sudden incapacitation might endanger themselves or others. Therefore, covered employees must be free of known medical conditions that are anticipated to cause significantly impaired performance or sudden incapacitation.

B-1

Appendix B

Medical Evaluation Requirements of OSHA Standards

Certain VOSH standards have medical surveillance requirements at prescribed intervals. For example, the Occupational

Hearing Conservation standard (Part 1910.95) requires an annual audiogram for…