DAFMAN 48-146 Occupational Health Program Management.pdf

DEPARTMENT OF THE AIR FORCE

HEADQUARTERS UNITED STATES AIR FORCE

Washington DC

DAFMAN48-146_DAFGM2025_01

12 MAY 2025

MEMORANDUM FOR DISTRIBUTION

MAJCOMs/FLDCOMs/FOAs/DRUs

FROM: HQ USAF/SG

1780 Air Force Pentagon Washington, DC 20330-1780

SUBJECT: Department of the Air Force Guidance Memorandum (DAFGM) to Department of the Air Force Manual (DAFMAN) 48-146, Occupational Health Program Management

By Order of the Secretary of the Air Force, this Department of the Air Force Guidance

Memorandum immediately implements changes to DAFMAN 48-146, Occupational Health Program Management, to reflect updated American Industrial Hygiene Association software tools to assess potential exposures to Airmen during industrial operations. These changes replace obsolete tools with the current optional software tools. Compliance with this Manual is mandatory. To the extent its directions are inconsistent with other Department of the Air Force publications, the information herein prevails, in accordance with Department of the Air Force Instruction (DAFI) 90-160, Publications and Forms Management.

DAFMAN 48-146 and this GM is applicable to the entire DAF, including all DAF civilian employees, all uniformed members of the Regular Air Force (RegAF), United States Space Force, Air Force Reserve and Air National Guard, as well as direct hire foreign nationals (as established by Status of Forces Agreements), and those with a contractual obligation to abide by the terms of DAF issuances. Specific changes are listed in the attachment; the paragraphs listed replace or update the corresponding paragraphs within DAFMAN 48-146.

This memorandum becomes void after one year has elapsed from the date of this memorandum, or upon publication of an IC or rewrite of DAFMAN 48-146, whichever is earlier.

JOHN J. DEGOES

Lieutenant General, USAF, MC, FS Surgeon General

Attachment:

Guidance Changes

DAFMAN48-146_DAFGM2025-01

Attachment

Guidance Changes

The below changes to DAFMAN 48-146, dated 1 December 2022, are effective immediately.

(Changed) 3.2.2.3.2.2. When no standardized weapon system HRA template is available, BE should use CHET or the AIHA Exposure Modeling Toolbox to screen chemicals and identify hazards to associate with workplace processes in DOEHRS. CHET uses the same matrix tables as the exposure assessment priority discussed in para 3.3.3.7. See Attachment 2 for additional guidance on determining if a chemical of concern should be entered in DOEHRS using CHET or the AIHA Exposure Modeling Toolbox. Chemicals regulated by an OSHA substance specific standard shall be entered in DOEHRS as a hazard regardless of the hazard determination calculation. (T-1)

(Changed) A5.4.1. The first step in assessing a potential hazard should be to model the exposure if possible. Modeling should be limited to standard Mass/Volume, Well Mixed Room (WMR), or Near Field/Mid Field (NF/MF) or Near Field/Far Field (NF/FF) models. These and other models are found in AIHA’s IHMOD 2.0 Microsoft Excel spreadsheet. Input values should be limited maximum values identified within the IHMOD 2.0 spreadsheet, however, consider using lower-bound estimates to provide conservative modeling results. If modeling is able to show exposure potential less than 10% of the OEL, then further assessment is not necessary. These would be labeled as acceptable exposure with high confidence.

BY ORDER OF THE

SECRETARY OF THE AIR FORCE

DEPARTMENT OF THE AIR FORCE

MANUAL 48-146

1 DECEMBER 2022

Aerospace Medicine

OCCUPATIONAL HEALTH PROGRAM

MANAGEMENT

COMPLIANCE WITH THIS PUBLICATION IS MANDATORY

ACCESSIBILITY: Publications and forms are available for downloading or ordering on the e-

Publishing website at www.e-publishing.af.mil/

RELEASABILITY: There are no releasability restrictions on this publication.

OPR: AFMRA/SG3PB Certified by: AF/SG3/4

(Maj Gen Sharon R. Bannister)

Supersedes: AFMAN48-146, 15 October 2018 Pages: 113

This manual implements requirements of Department of the Air Force Instruction (DAFI) 48-145, Occupational and Environmental Health and is consistent with Air Force Policy Document

(AFPD) 48-1, Aerospace & Operational Medicine Enterprise. It provides procedures for successful management and operation of an Air Force installation occupational health (OH) program. This publication applies to the entire Department of Air Force (DAF), including all civilian employees and uniformed members of the Regular Air Force, the United States Space

Force, Air Force Reserve, and the Air National Guard and those with a contractual obligation to abide by the terms of DAF issuances, except where noted otherwise. This instruction does not apply to DAF units receiving OH support from other military services under joint basing agreements. The lead service under the joint basing agreement will provide OH support according to their regulations and guidance. The supported unit is responsible for ensuring compliance with the tracking and completion of occupational health exams and training requirements. This manual does not apply to DAF contractor personnel and contractor operations. The contractor is directly responsible for safety and health risks to their personnel and the protection of the public, except where DAF has contractually agreed to assume responsibility for the protection of contract employee’s health and/or compliance with Occupational Safety and Health Administration

(OSHA) requirements. This instruction does not prohibit providing workplace sampling and survey information to contractors subject to local arrangements. This manual follows guidelines for exposure health strategies as described in the American Industrial Hygiene Association’s A

Strategy for Assessing and Managing Occupational Exposures (4th Edition). It also incorporates risk management (RM) principles into the OH program. Additionally, it specifies the exposure limits and hierarchy of controls that will be used in DAF workplaces. Compliance with the http://www.e-publishing.af.mil/

2 DAFMAN48-146 1 DECEMBER 2022

attachments is mandatory. Ensure all records generated as a result of processes prescribed in this publication adhere to Air Force Instruction (AFI) 33-322, Records Management and Information

Governance Program, and are disposed in accordance with the Air Force Records Disposition

Schedule, which is located in the Air Force Records Information Management System. Refer recommended changes and questions about this publication to the office of primary responsibility

(OPR) using the DAF Form 847, Recommendation for Change of Publication; route DAF Forms

847 from the field through the appropriate functional chain of command This manual may be supplemented with additional or more stringent criteria. The authorities to waive wing, unit, delta or garrison level requirements in this publication are identified with a Tier (“T-0, T-1, T-2, T-3”) number following the compliance statement. See DAF Manual (DAFMAN) 90-161, Publishing

Processes and Procedures, for a description of the authorities associated with the tier numbers.

Submit requests for waivers through the chain of command to the appropriate Tier waiver approval authority, or alternately, to the requestor’s commander for non-tiered compliance items.

Supplements must be routed to the OPR of this publication for coordination prior to certification and approval. The use of the name or mark of any specific manufacturer, commercial product, commodity, or service in this publication does not imply endorsement by the DAF.

SUMMARY OF CHANGES

This publication is significantly revised and must be completely reviewed. Major changes include restricting this manual to Occupational Health (OH) program management and moving

Environmental Health program management requirements to a new and separate manual.

Additionally, new business practices are introduced for classifying high-risk industrial processes and defines new minimum health risk assessment (HRA) frequencies for all workplaces. These workplace HRAs are now aligned and executed by unit (e.g., squadron) with the aim of improved health risk communication to the commander as the risk acceptance authority. Furthermore, the time between qualitative unit comprehensive HRAs is lengthened, allowing OH resources to focus on prioritization and execution of quantitative workplace monitoring plan tasks (i.e., sampling) to increase confidence in hazard characterization, improve risk mitigation recommendations, and enhance exposure documentation in individual longitudinal exposure records. These changes increase the number of workplaces assessed (e.g., all workplaces in a squadron) but endeavor to reduce the administrative burden by limiting the number of workplaces that must be documented in the Defense Occupational and Environmental Health Readiness System. Furthermore, details on how to assign and manage health risk assessment codes are added to this manual as a companion to AFI 91-202, The US Air Force Mishap Prevention Program.

Chapter 1—INTRODUCTION 6

1.1. Overview

1.2. Applicability

1.3. Requirements Outlined

1.4. Goals of the Department of the Air Force Occupational Health Program

1.5. The Role of Occupational Health Risk Management at the Installation Level

Figure 1.1. The Occupational and Environmental Health Risk Management Cycle

DAFMAN48-146 1 DECEMBER 2022 3

Chapter 2—ROLES AND RESPONSIBILITIES 8

2.1. Medical Unit Commander

2.2. Chief of Aerospace Medicine (SGP)

2.3. Flight and Operational Medicine Clinic (FOMC) (or local equivalent)

2.4. Bioenvironmental Engineering (or local equivalent)

2.5. Public Health (PH) (or local equivalent)

2.6. Integrated Operational Support and Medical Treatment Facility Physical

Therapists (PTs) and Occupational Therapists (OTs)

2.7. Installation Occupational and Environmental Medicine Consultant (IOEMC)

2.8. Occupational and Environmental Health Working Group (OEHWG)

Chapter 3—OH RISK MANAGEMENT 14

3.1. Occupational Health Risk Management overview

3.2. Step 1. Anticipate and identify hazards

3.3. Step 2. Assess Hazards to Determine Risk

Figure 3.1. Industrial Hygiene Exposure Assessment Priority (EAP)

Table 3.1. Health Effects Rating

Table 3.2. Exposure Rating

Table 3.3. Uncertainty Rating

3.4. Step 3. Provide Control Plan

Figure 3.2. Strategy for Managing Occupational Health Exposures. (Adapted from AIHA, 2015)

Figure 3.3. Hierarchy of Controls. (AIHA, 2015)

3.5. Step 4. Report and Record Risk

3.6. Step 5. Supervise/Evaluate/Re-Evaluate

3.7. Applying the Occupational Health Risk Management Process to Emergency

Response

Chapter 4—CONDUCTING UNIT OCCUPATIONAL HEALTH ASSESSMENTS 32

4.1. Unit Occupational Health Assessments

Figure 4.1. Similar Exposure Group Health Risk Assessments

4.2. Annual High-Risk Process Health Risk Assessments

4.3. Unit Comprehensive Health Risk Assessments

4.4. Workplace Monitoring Plan (WMP)

Table 4.1. Exposure Assessment Priority and Assessment Timelines. (T-1)

4 DAFMAN48-146 1 DECEMBER 2022

4.5. Summary of Unit Occupational Health Assessments

Table 4.2. Summary of Unit Occupational Health Assessments

Chapter 5—OCCUPATIONAL AND ENVIRONMENTAL MEDICINE 38

5.1. General Information

5.2. Eligibility

5.3. Occupational and Environmental Medicine Services Overview

5.4. Workplace Occupational and Environmental Medicine Evaluation

5.5. Epidemiology and Trend Analysis

Table 5.1. Records Review Matrix

5.6. Medical Examinations

5.7. Occupational Illnesses and Injuries

5.8. Occupational and Environmental Medicine Recordkeeping

5.9. Occupational and Environmental Medicine Consultative Services

5.10. Occupational and Environmental Medicine Civilian Federal Employee (CFE)

Examinations and Assessments that Exceed Local Medical Treatment Facility

Capability

5.11. DoD Expeditionary Civilian Workforce (DoD-EC)

5.12. Travel Medicine

5.13. Education and Training for DAF Providers, Nurses and Technicians

Attachment 1—GLOSSARY OF REFERENCES AND SUPPORTING INFORMATION 75

Attachment 2—DETERMINING IF A CHEMICAL OF CONCERN IS A HAZARD 88

Attachment 3—NANOMATERIALS 90

Attachment 4—ERGONOMICS ASSESSMENT 91

Attachment 5—EXPOSURE ASSESSMENT STRATEGY 94

Attachment 6—APPLYING OELS TO UNUSUAL WORK SCHEDULES 97

Attachment 7—DETERMINING CONFIDENCE IN OCCUPATIONAL HEALTH

EXPOSURE CHARACTERIZATION 99

Attachment 8—DETERMINING CONFIDENCE IN CONTROLS 100

Attachment 9—HEALTH RISK ASSESSMENT CODE (RAC) CALCULATIONS 102

Attachment 10—EXAMPLE ELECTION OF CARE PROVIDER STATEMENT 107

Attachment 11—EXAMPLE TRACKING WORKSHEET FOR CIVILIAN FEDERAL

EMPLOYEE EXAMINATION REQUESTS 108

DAFMAN48-146 1 DECEMBER 2022 5

Attachment 12—EXAMPLE REQUEST FOR COMMANDER’S AUTHORIZATION OF

PAYMENT FOR CIVILIAN MEDICAL EXAM 110

6 DAFMAN48-146 1 DECEMBER 2022

Chapter 1

INTRODUCTION

1.1. Overview. This manual addresses OH program management requirements in the identification, evaluation and control of workplace hazards. It outlines OH program roles and responsibilities and should be read in conjunction with DAFI 48-145, Occupational and

Environmental Health. This manual focuses on OH program management as a subset of the larger occupational and environmental health (OEH) program. DAFI 48-145 defines basic concepts of the OEH management system: the Plan, Do, Check, Act cycle. While most of DAFI 48-145 describes the AF OEH program from a policy (the “plan” portion of the management system cycle) and programmatic level (the “check” and “act” portions of the management system cycle), this manual’s primary purpose is to specifically inform OH program management at the installation level (the “do” portion of the management system cycle). This manual provides implementing guidance for the use of the Defense Occupational and Environmental Health Readiness System-

Industrial Hygiene (DOEHRS-IH), hereafter referred to as DOEHRS.

1.2. Applicability. The roles and responsibilities section in Chapter 2 and the supporting details in the remaining chapters of this DAFMAN largely focus on the medical unit execution and management of the OH program. Broader OEH roles and responsibilities of non-medical mission partners are covered in DAFI 48-145.

1.3. Requirements Outlined. The requirements outlined in this manual apply at Department of the Air Force installations overseas, including deployed locations, so long as the requirements do not conflict with applicable provisions from any of the following: international agreements, the

Overseas Environmental Baseline Guidance Document, country-specific final governing standards, geographic combatant command policy, and annexes to operational orders, operational plans, other operational directives, or joint basing requirements.(Exception: requirements outlined in this manual relative to Environment, Safety, and Occupational Health (ESOH) Council and

Occupational and Environmental Health Working Group (OEHWG) do not apply in deployed environments.)

1.4. Goals of the Department of the Air Force Occupational Health Program.

1.4.1. Protect the health and welfare of our workforce and ensure adherence to regulatory requirements (e.g., Occupational Safety and Health Administration (OSHA) standards).

1.4.2. Deliver accurate exposure assessments, correct longitudinal exposure records and optimal medical care.

1.4.3. Provide DAF leaders effective options to control OH risk while optimizing operational performance.

1.4.4. Communicate risk, enabling DAF personnel to appropriately understand OH hazards and risk management opportunities.

1.5. The Role of Occupational Health Risk Management at the Installation Level.

1.5.1. As stated in DAFI 48-145, OH risks are communicated through the OEH risk management (RM) process to engage installation leadership in OH hazard reduction and resource prioritization. The overall OH program contribution to the supported organization’s

RM process is depicted in Figure 1.1, reprinted from DAFI 48-145.

DAFMAN48-146 1 DECEMBER 2022 7

Figure 1.1. The Occupational and Environmental Health Risk Management Cycle.

1.5.2. Risk management, in the traditional sense, is described in detail in AFI 90-802, Risk

Management. OH risk management follows the same framework with key members of the Air

Force Aerospace and Operational Medicine Enterprise (e.g., flight and operational medicine clinic (FOMC), bioenvironmental engineering (BE), and public health (PH)) taking a targeted approach to preventing and managing risks from potential health hazards. The OEH risk management cycle in Figure 1.1 depicts how installations execute the “do” portion of the plan, do, check, act management system cycle and is the focus of this DAFMAN.

8 DAFMAN48-146 1 DECEMBER 2022

Chapter 2

ROLES AND RESPONSIBILITIES

2.1. Medical Unit Commander. For Regular Air Force and Space Force medical units, this is the medical treatment facility (MTF) Commander, who is dual-hatted, and in that capacity, executes the duties, authorities, and responsibilities of both the MTF Director and the service commander. The Air Reserve Component (ARC) equivalent is a Guard Medical Unit Commander

(GMU Commander) or a Reserve Medical Unit Commander (RMU Commander) (or local equivalent).

2.1.1. Directs the installation OH program and ensures it is supported with adequate resources and staffing to implement the responsibilities outlined in this DAFMAN. (T-1)

2.1.2. Ensures all medical staff who examine patients are aware of illnesses and injuries that may have a correlation to hazardous OH exposures. (T-1)

2.1.3. Assigns a physician in writing to serve as the Installation Occupational and

Environmental Medicine Consultant (IOEMC) as well as the Chair, Occupational and

Environmental Health Working Group (OEHWG). (T-1) An occupational medicine physician

(44UX) should be appointed as IOEMC if one is available.

2.2. Chief of Aerospace Medicine (SGP).

2.2.1. Provides direction and oversight of the installation OH program. (T-1)

2.2.2. Ensures MTF medical providers are aware (or familiar with) the spectrum of potential occupational injuries and illnesses based on health risks associated with the installation. (T-1)

2.3. Flight and Operational Medicine Clinic (FOMC) (or local equivalent). This section may be executed by the FOMC Flight Commander, Director of Occupational Medicine Services

(OMS), Base Operational Medicine Clinic (BOMC) Flight Commander or local equivalent as determined by the MTF commander.

2.3.1. Ensures execution of medical exams according to Chapter 5 of this DAFMAN. (T-1)

2.3.2. Coordinates workplace visits with BE and PH. (T-3)

2.3.3. Ensures medical surveillance exams (MSEs) are conducted based upon recommendations from the OEHWG as determined by the IOEMC. (T-2)

2.3.4. Ensures occupational and environmental health exposure data (OEHED) and clinical occupational health exam requirements (COHER) are filed in patient's medical record (hard copy or uploaded to electronic health record (EHR)) for shops with MSE requirements that are more than an annual audiogram. (T-0)

2.3.5. Schedules required MSE follow-ups and monitors until completion. (T-2)

2.3.6. Ensures abnormalities identified during the MSE are appropriately addressed and documented in the individual’s medical record. (T-1)

2.3.7. Provides MSEs for medical aid station personnel and geographically separated units without assigned medical personnel as well as limited scope medical treatment facilities

(LSMTF) without credentialed providers. (T-2) Ensures a flight surgeon or occupational

DAFMAN48-146 1 DECEMBER 2022 9

health physician reviews all MSEs performed at supported LSMTF if no flight surgeon or occupational health physician is assigned to the LSMTF. (T-2)

2.3.8. Performs duties as outlined in the Base Operational Medicine Clinic Operating Plan

(available on the BOMC Kx website). (T-2)

2.4. Bioenvironmental Engineering (or local equivalent).

2.4.1. Conducts unit OH assessments according to Chapter 3 and Chapter 4. (T-1)

2.4.2. In coordination with PH, provides unit commanders an out-brief after completion of unit comprehensive HRAs. (T-3) Commander out-briefs shall be conducted by a fully qualified

BE Officer (43E3X/43E4X), BE Craftsman (4B071), or civilian equivalent. (T-3)

2.4.3. Identifies, prioritizes, and executes workplace monitoring plan (WMP) tasks according to Chapter 4. (T-1)

2.4.4. Adds OH assessments defined in Chapter 4 to the Master Schedule in DOEHRS. (T-

3) Assigns projected due dates for each task based on the timelines in Chapter 4. (T-3)

2.4.5. Utilizes standardized OH assessment letter templates and supporting DOEHRS reports developed by the USAF School of Aerospace Medicine (USAFSAM). (T-3) Note: Air Logistic

Complexes (ALCs) may use alternate OH assessment templates approved by AFMC/SGPB.

2.4.6. Calculates exposure assessment priorities (EAP) following procedures in Chapter 3 for all health risk assessments. (T-1)

2.4.7. For airborne hazards, employs the lognormal 95th percentile of the Time Weighted

Average (TWA) as the exposure level in SEG assessments with three or more samples, unless an exposure determination can be made in accordance with the DAF Exposure Assessment

Strategy (DAF EAS) in Attachment 5. (T-1) See AFI 48-127, Hazardous Noise and Hearing

Conservation Program for details on employing the DAF noise EAS.

2.4.8. Establishes and leads a cross-functional team to identify, evaluate, and document all feasible engineering and work practice controls when workplace exposure(s) are greater than the Occupational Exposure Limit (OEL) and required by OSHA substance specific standards.

See paragraph (para) 3.4.1.3 for additional details. (T-1)

2.4.9. At a minimum, updates workplace personnel rosters in DOEHRS during unit OH assessments. (T-1) Deployment and short tour locations (i.e., locations with higher rotation frequencies) shall establish local procedures to ensure rosters are updated in DOEHRS at an appropriate frequency (i.e., once per tour) to populate members’ exposure records in DOEHRS which will be viewable in the Individual Longitudinal Exposure Record (ILER) system. (T-1)

2.4.10. Produces an updated workplace-specific OEHED summary from DOEHRS for each

Similar Exposure Group (SEG) reviewed at the OEHWG. (T-1)

2.4.11. Annually provides a list of workplaces and SEGs in DOEHRS to PH to reconcile the list of workplaces and Potentially Exposed Groups (PEGs) in Aeromedical Services

Information Management System (ASIMS). (T-1)

2.4.12. Documents OH exposures in DOEHRS (T-0) and ensures unit provided upgrade and home station training for BE personnel includes DOEHRS data entry. Guidance on this requirement can be found in BE Career Field Education and Training Plan (CFETP). (T-1)

10 DAFMAN48-146 1 DECEMBER 2022

Leverages the DOEHRS training and demonstration website as necessary to maintain system proficiency (https://doehrs-ih-demo.csd.disa.mil). (T-3)

2.4.13. Plans and programs for resources to support OH mission requirements. (T-1) Specific resources the BE shall purchase include (but is not limited to) the current versions of the

American Conference of Governmental Industrial Hygienist’s (ACGIH) Threshold Limit

Value (TLV) and Biological Exposure Indices (BEIs), ACGIH’s Documentation of the TLVs and BEIs, Patty’s Industrial Hygiene, Industrial Ventilation: A Manual of Recommended

Practices, SAX’s Dangerous Properties of Industrial Materials, and the American Industrial

Hygiene Association’s (AIHA) A Strategy for Assessing and Managing Occupational

Exposures. (T-3)

2.5. Public Health (PH) (or local equivalent).

2.5.1. Ensures workplace supervisors have access to standardized training materials, reviews workplace training to ensure compliance with regulatory requirements (shop specific processes added to standardized training material) (T-0). Assesses employees' OH training knowledge during workplace visits. (T-2)

2.5.2. In coordination with BE, provides unit commanders an out-brief and a written report after completion of the unit comprehensive HRAs. (T-3) Commander out-briefs shall be attended by a PH Officer (43HX), PH Craftsman (4E071), or civilian equivalent. (T-3)

2.5.3. Identifies appropriate MSEs triggered by regulatory authority, exposure, and risk assessment on the OEHED. (T-0)

2.5.3.1. Produces an updated COHER document using the ASIMS web application. (T-1)

2.5.3.2. Briefs the COHER for the SEG in conjunction with the OEHED at the OEHWG after completion of unit OH assessments or when changes are made to the COHER. (T-1)

2.5.3.3. Following the OEHWG, modifies the COHER if necessary and coordinates it for final approval by the IOEMC. (T-1)

2.5.4. Ensures providers completing the MSE are aware/trained on how to access updated copies of the COHER and OEHED (e.g., how to navigate within IT systems, or where current documents are stored on a secure shared drive). (T-2)

2.5.5. Tracks MSE completion rates and reports this information to OEHWG, AMC, and

ESOHC (or equivalent) (T-1). As needed, works with the Group Practice Manager (GPM) to review Occupational Health no-show appointments. (T-3)

2.5.6. Reports SEGs with less than 90% Medical Surveillance Exams (MSE) currency to the unit commander and SEG supervisor monthly (or as locally determined). (T-2)

2.5.7. Provides a copy of the current COHER exam requirements and training requirements to the SEG supervisor. (T-0)

2.5.8. Ensures OEHED and COHERs are filed in patient's medical record (hard copy or uploaded to EHR) for shops without MSE requirements and shops with only an audiogram

MSE requirement. (T-0)

2.5.9. Annually reconciles the list of workplaces and PEGs in ASIMS with BE’s listing of workplaces and SEGs in DOEHRS. (T-1) https://doehrs-ih-demo.csd.disa.mil/

DAFMAN48-146 1 DECEMBER 2022 11

2.5.10. Conducts OH epidemiological analysis and provides this data to the OEHWG, to include as a minimum, a description of trends in:

2.5.10.1. Audiogram significant threshold shifts (STS); (T-2)

2.5.10.2. Permanent threshold shifts (PTS); (T-2)

2.5.10.3. Abnormal MSE results (based on a records review); (T-2)

2.5.10.4. Trends in exposure incidents, injuries, clinic visits by type/Air Force Specialty

Code (AFSC)/workplace, adverse pregnancy outcomes, etc. as deemed necessary and appropriate by the OEHWG. (T-3)

2.5.11. Conducts visits to workplaces requiring investigation or supervisor and/or worker education based on adverse epidemiological findings and adverse health events. (T-2) For example, workplaces with a higher than expected number or proportion of workers with STS and/or PTS should receive a visit from PH. This visit should be coordinated with BE, SGP or

FOM provider, or other specialty as appropriate and available (e.g., audiologist for hearing conservation issue; physical therapist for ergonomic issue).

2.6. Integrated Operational Support and Medical Treatment Facility Physical Therapists

(PTs) and Occupational Therapists (OTs).

2.6.1. Collaborates with BE to conduct workplace ergonomic assessments and make control recommendations following the process in Attachment 4. (T-3)

2.6.2. Attends the OEHWG, as required, to provide consultation on musculoskeletal injuries and illnesses. (T-3)

2.7. Installation Occupational and Environmental Medicine Consultant (IOEMC).

2.7.1. Chairs the OEHWG. (T-1)

2.7.1.1. Ensures OEHWG membership includes representatives from BE, PH, FOMC (or equivalent), and occupational safety as principal members. (T-1)

2.7.1.2. Ensures workplace supervisors are invited to attend when their workplace MSE requirements are under review. (T-3)

2.7.1.3. Invites other representatives such as Injury Compensation Specialist, civil engineering, Public Affairs, judge advocate (JA)/base legal office, etc., to the OEHWG, where warranted. (T-3)

2.7.2. Ensures medically appropriate risk assessment and medical surveillance activities are conducted. (T-1) Risk assessments should be based on specific hazards found within the workplace. Developing and administering occupational medical examinations based on OSHA regulatory requirements and Department of Defense Manual (DoDM) 6055.05, Occupational

Medical Examinations: Medical Surveillance and Medical Qualification, will satisfy the basic medical surveillance requirements prescribed in Department of Defense Instruction (DoDI)

6055.05, Occupational and Environmental Health (OEH).

2.7.3. Ensures medical examinations are performed according to Chapter 5 of this manual.

(T-1)

12 DAFMAN48-146 1 DECEMBER 2022

2.7.4. Approves (by signing and dating) the COHER used to conduct MSEs. This cannot be delegated and should be completed within 15 days following the OEHWG completion or next unit training assembly (UTA) or regularly scheduled drill (RDS) for ARC units. (T-1)

2.7.5. Ensures current OEHED and COHER are filed in hard copy occupational health record

(or uploaded to the electronic occupational health record if resources allow) for all workers enrolled in OH program. (T-0) Guidance on documentation being entered in the occupational health record or electronic occupational health record can be in found in AFMAN 41-210, TRICARE Operations and Patient Administration.

2.7.6. Reviews reported and suspected OH illnesses and provides necessary feedback to BE, PH, FOMC, and the injury compensation specialist as required. (T-1) If an occupational injury or illness is confirmed, follow paragraph (para) 5.7.

2.7.7. Annually briefs or schedules another qualified flight surgeon to brief the professional staff on occupational illness and injury trends and related issues (e.g., recognition, prevention, care and reporting) based on local needs and frequency of staff turnover. (T-1)

2.8. Occupational and Environmental Health Working Group (OEHWG).

2.8.1. Meets at least six times per year (e.g., once every two months) for Active Duty MTFs and at least four times per year (e.g., quarterly) for ANG and AFR MTFs. Meetings are encouraged to meet face-to-face but may use other avenues, such as virtually. (T-1)

2.8.2. Acts as cross-functional forum to discuss OEH hazards, risks, mitigation measures, and medical surveillance to protect military and civilian employee health. (T-1)

2.8.3. Reviews DOEHRS OEHED documents provided by BE and corresponding ASIMS

COHER provided by PH to ensure appropriate MSEs are included. (T-1) OEHED and COHER documents will be reviewed at the OEHWG:

2.8.3.1. At the completion of a unit comprehensive HRA (i.e., every 36 months). (T-1)

2.8.3.2. At the completion of an annual high-risk process HRA (i.e., every 12 months). (T-

1)

2.8.3.3. The next OEHWG following the completion of a WMP task that results in a change to the workplace exposure profile. (T-1)

2.8.4. Recommends MSE requirements to the IOEMC; documents determinations in the

OEHWG minutes. (T-1)

2.8.5. Implements procedures to investigate and report suspected OH-related illness or injury.

(T-0) Guidance on this requirement is found in DoDI 6055.01 and DODM 6055.05.

2.8.6. Ensures all OH-related training requirements are identified and communicated to workplace supervisors by BE or PH. (T-1)

2.8.7. Tracks HAF, Major Command (MAJCOM), Field Command (FLDCOM), and installation-specific OH performance measures to assess the effectiveness of the installation

OEH Program. (T-0) This requirement is found in DODI 6055.01, AFI 48-101, Aerospace

Medicine Enterprise and DAFI 48-145.

2.8.8. Assists the installation Environment, Safety and Occupational Health (ESOH) Council with identifying and prioritizing requirements to optimize mission performance and minimize

DAFMAN48-146 1 DECEMBER 2022 13

ESOH risk and cost. (T-1) This requirement is found in AFI 90-801, Environment, Safety, and

Occupational Health Councils.

2.8.9. Provides for a collaborative process of assessment, planning, facilitation, and advocacy for options and services to meet an ill or injured worker’s health needs through communication and coordination of care to minimize delays in diagnosis, treatment, and return-to-work. (T-3)

14 DAFMAN48-146 1 DECEMBER 2022

Chapter 3

OH RISK MANAGEMENT

3.1. Occupational Health Risk Management overview. The main objective of the OH program is to identify, assess and evaluate process hazards to characterize comprehensive worker exposures in the occupational workplace and determine if control recommendations are needed and/or adequately implemented. As discussed in Chapter 1, OH risk management is part of the larger

OEH Risk Management Cycle and is broken down in five steps: 1) anticipate and identify hazards,

2) assess hazards to determine risk, 3) develop controls and make risk decision, 4) implement risk controls and 5) supervise, evaluate & confirm controls in place.

3.2. Step 1. Anticipate and identify hazards.

3.2.1. Identify and Establish Occupational Workplaces. A workplace is where employees perform operations, processes, and tasks under the direction of a supervisor at one or more locations. A workplace may be administrative, industrial, or both. It also includes non-traditional workplaces, such as the flight line, inside of an aircraft, or other service vehicles.

Additionally, a workplace may not be located on the installation. For example, a workplace may be located at a geographically separated unit or at a test/training range that is separate from the main installation. BE, in coordination with their ESOH partners, is responsible for determining workplaces for OH purposes. (T-1)

3.2.1.1. Industrial workplaces are periodically evaluated for occupational health hazards per the frequencies identified in Chapter 4; administrative workplaces are evaluated for occupational health hazards in response to specific health concerns (i.e., workplace supervisor’s request for admin workstation ergonomic assessment, referral from safety assessor due to health concerns identified during annual safety inspection). (T-1)

3.2.1.2. When a workplace evaluation indicates DAF personnel are exposed to toxic substance(s) or harmful physical agent(s), the workplace will be added to DOEHRS to build a comprehensive longitudinal exposure record for DAF personnel. (T-0) Note:

workplaces without exposures to toxic substance(s) or harmful physical agent(s) do not need added to DOEHRS, see para 4.2.5 and para 4.2.6 for additional details.

3.2.1.3. When establishing or verifying a workplace in DOEHRS:

3.2.1.3.1. Add the workplace geographical-coordinates to the shop detail page to aid in visualizing OH hazards and workplace locations in the Air Force Geographical

Information Management System (AFGIMS) which is commonly known as and hereafter referred to as “GeoBase”. (T-3)

3.2.1.3.2. Add the applicable standard workplace identification code (WIC) in the

DOEHRS “shop code” field using the standard WIC list. (T-2) The standard WIC list is available on the ESOH Service Center, https://hpws.afrl.af.mil/dhp/OE/ESOHSC/pages/index.cfm?id=751.

3.2.1.3.3. Establish shop names in line with their career field designation or applicable

Technical Orders. (T-2) Examples of workplaces where occupational health exposures may occur are provided below:

3.2.1.3.3.1. Aircraft Structural Maintenance (ASM): ASM may consist of https://hpws.afrl.af.mil/dhp/OE/ESOHSC/pages/index.cfm?id=751

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corrosion control, fiberglass, sheet metal, composite material, and welding processes. If the corrosion control process has a dedicated supervisor, office symbol, funding account, etc., and dedicated personnel are assigned, it may be appropriate to establish corrosion control as a separate workplace in DOEHRS, with its own WIC. However, if personnel assigned to ASM collectively perform corrosion control, fiberglass, sheet metal, composite material, and welding processes, ASM should be designated as the workplace. The listed processes

(priming, painting, composite repair, etc.) are identified in DOEHRS and assigned to an appropriate SEG within the ASM workplace. Ensure personnel are assigned to the appropriate SEG as opposed to assigning all personnel to all SEGs within the workplace. (T-0)

3.2.1.3.3.2. Hazardous Material (HAZMAT) Response Team: A single lead organization on an installation is typically in charge of incident/spill responses involving specific substances of concern (e.g., hydrazine, composite fibers, fuel, etc.) although personnel from different organizations (e.g., fire and emergency services, water and fuel system maintenance, aircraft maintenance, etc.) may be involved in the incident responses. For the purpose of health risk assessment, the lead organization of the specific HAZMAT response team should be designated as the workplace/shop, since the team typically maintains common equipment, staged at a common facility, and has a dedicated supervisor with associated organizational authority/accountability.

3.2.2. Basic OH Characterization. Personnel shall follow and utilize the most recent technical guides, standardized weapon system HRA templates (when available), and the industrial hygiene risk assessment methodology (IH RAM) located on the ESOH Service Center for detailed instructions on how to perform assessments. (T-1)

3.2.2.1. Pre-planning Activity.

3.2.2.1.1. Conduct a comprehensive OH records review (i.e., pre-survey) prior to a scheduled OH assessment. (T-3) This provides good background and foundational knowledge regarding workplace locations, processes, potential hazardous exposures, and existing hazard controls. Furthermore, health-based outcome data (e.g., OEHWG epidemiological analysis results or injury/illness investigations) may provide insight on the adequacy of current OH hazard characterization and effectiveness of existing controls. BE should collaborate with FOMC and PH (during or between OEHWG meetings) to ascertain any potential trends in OH-related illnesses or injuries related to a specific workplace. Note: Hazards may be present even in the absence of trends.

3.2.2.1.2. Use information related to unit mission, operational tempo, and OH impacts/concerns for assigned personnel to determine the scope of required OH support. (T-3) This is especially critical when new workplaces/processes are identified.

Minimum information that should be collected during pre-planning includes, as applicable: organization name, parent command/headquarters, mission description, description of operations performed, name of workplace supervisor (or equivalent), contact information, location, and potential exposure locations (e.g., subordinate units, area on installation).

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3.2.2.1.3. A qualified reviewer should review previous OH assessment activities to determine an appropriate strategy for the pending assessment. A qualified reviewer is a fully qualified BE Officer (43E3X/43E4X), BE Craftsman (4B071), or civilian equivalent. The pre-survey preparation may include a study of DOEHRS data, prior survey letters, and DOEHRS business object reports, and should include sending an email to the workplace supervisor requesting anything needed in advance of the assessment (e.g., personnel roster, chemical inventory, PPE listing, etc.) Note: See the

IH RAM for DOEHRS reports available to assist the reviewer during this review process.

3.2.2.1.4. Contact the workplace supervisor (or equivalent), as appropriate, to explain the purpose of the OH risk assessment and identify workplace processes that need to be evaluated. (T-3) This should be accomplished at least a week prior to the month of the scheduled assessment. This will ensure the shop supervisor has sufficient time to schedule and prepare for the visit. Minimum information that should be conveyed includes:

3.2.2.1.4.1. The scope of and schedule for completing the workplace HRA.

3.2.2.1.4.2. Status of previously identified findings.

3.2.2.1.4.3. Adverse trends in clinical surveillance or OH-related illnesses.

3.2.2.1.4.4. Any information needed by BE in advance of the assessment.

3.2.2.2. Identify Processes.

3.2.2.2.1. A process is the lowest level of work that may pose a risk, and may require evaluation and control to ensure human health is adequately protected. The terms activity and process are synonymous. All processes are associated with a physical location, but it does not necessarily have to correlate with the facility in which the shop resides. (For example, a maintenance shop might have processes indoors in the maintenance hangar, but performing the same processes outdoors or in a non-specific location, such as on the flight line, may constitute a separate process.) Examples of some OH processes are provided below:

3.2.2.2.1.1. Aircraft painting is divided into distinct processes such as primer application, top-coat application, and stenciling operations. It may be beneficial to identify the location of each specific process (e.g., priming specific aircraft part in a paint booth versus priming the aircraft in the hangar.)

3.2.2.2.1.2. A single “painting” process established under ASM is inappropriate due to the unique health hazards and PPE requirements associated with clearly distinct processes, e.g., pneumatic sanding, spray priming, roll-on painting, applying top-coat, etc. A better convention would be to name each specific process.

3.2.2.2.1.3. Multiple plating tanks in a workplace create potential exposures for personnel who move between tanks to accomplish work. This may be defined as a single process, unless there are significant exposure differences or PPE/control requirements among the tanks.

3.2.2.2.2. Assign an appropriate name to each process, and provide a clear description.

(T-1) As standard weapon system HRA templates are completed and available from

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USAFSAM, BE shall apply the templates to include standardized process names during unit OH assessments. (T-1) BE shall validate the template process names; however, an addition to a standardized process name may be necessary to match unit vernacular

(i.e., adding the local term to the end in parentheses, such as depainting/desealing mechanical (“racetracking”) or apply low observable coating-spray (“silver coating”)).

(T-1)

3.2.2.2.2.1. When no standardized HRA is available, the workplace supervisor (or equivalent) or the OH hazard source owner can aid in effectively naming and describing each process or pathway. For processes not already under the standard naming convention for DOEHRS, examples of how to name a process are included below.

3.2.2.2.2.2. “Riveting” is too general as a description to identify the scope of this process; “removing and replacing B-52 rivets” is a better and more descriptive name that conveys the scope of the process.

3.2.2.2.2.3. Separating a process into multiple sub tasks that the workers think of as a single process is inappropriate.

3.2.2.2.2.4. Weapon system-related processes and description shall be based upon technical order (TO) verbiage (usually the -1 (“dash one”) that is determined by system operators and maintainers). (T-3)

3.2.2.2.2.5. Each applicable weapon system shall be added to the “Weapon

Systems Information” area in DOEHRS for each process when applicable (e.g., Fixed Wing Aircraft, F-16A/B/C/D Fighting Falcon added to a

“depainting/desealing mechanical” process.) (T-3)

3.2.2.3. Associate OH Hazards with Processes.

3.2.2.3.1. Identify potentially hazardous chemical, physical and biological agents in the workplace and associate the hazard with the process in DOEHRS. (T-0) For each health hazard, physical properties, routes of exposure, and potential health effects should be gathered. A workplace’s chemical inventory and associated safety data sheets (SDSs) shall be the foundation for identifying chemical health hazards but special consideration should be made to process generated hazards that may not be listed on a SDS (e.g., silica and/or particulate generation from saw cutting concrete, beryllium and/or cadmium exposure when cutting/grinding metal components, etc.)

3.2.2.3.2. When establishing standardized weapon system HRA templates, USAFSAM identifies the chemical, physical, and biological hazards for each process.

To aid in screening chemicals of concern, USAFSAM created the Chemical Hazard

Evaluation Tool (CHET) to aid in the identification of chemical inhalation, contact, absorption, and ingestions hazards for further evaluation and entry in DOEHRS.

3.2.2.3.2.1. For standardized weapon systems, BE shall associate all applicable hazards listed in the standardized HRA templates with the associated weapon system processes in DOEHRS. (T-1) If information provided by the workplace indicates additional hazards (i.e., not included in the template) are present, these hazards should also be added to DOEHRS.

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3.2.2.3.2.2. When no standardized weapon system HRA template is available, BE should use CHET or the AIHA Qualitative Assessment Checklist to screen chemicals and identify hazards to associate with workplace processes in DOEHRS.

CHET uses the same matrix tables as the exposure assessment priority discussed in para 3.3.3.7 See Attachment 2 for additional guidance on determining if a chemical of concern should be entered in DOEHRS using CHET or the AIHA

Qualitative Assessment Checklist. Chemicals regulated by an OSHA substance specific standard shall be entered in DOEHRS as a hazard regardless of the hazard determination calculation. (T-1)

3.2.2.3.3. See Attachment 3 and Attachment 4 for specific details on identifying and assessing nanomaterial and ergonomic hazards respectively.

3.2.2.4. Establishing SEGs.

3.2.2.4.1. SEGs establish a link between a group of individuals and OH exposures.

Exposure data recorded in the SEG in DOEHRS represent the occupational health data that will populate a service member’s longitudinal exposure record in the ILER system.

It is very important to record accurate and representative data. Representative and/or individual exposure assessment data are applied to personnel assigned to SEGs. A SEG can be established by: (1) observing work practices, (2) accomplishing OH hazard characterization/assessment and using exposure monitoring data to define the SEG, or

(3) a combination of both activities. Reference Chapter 4 of AIHA’s A Strategy of

Assessing and Managing Occupational Exposures, for additional information on establishing SEGs.

3.2.2.4.2. A single SEG is adequate if all individuals assigned to a workplace encounter the same OH hazards and have the same exposure potential. Multiple SEGs are necessary to accurately reflect “representative” exposures for workers assigned to the same workplace, but who are exposed to different hazards and/or potential exposures (i.e., different exposure level, duration, frequency, etc.).

3.2.2.4.3. Personnel may be assigned to multiple SEGs and/or assigned to a SEG outside their assigned unit. For example, an individual may be assigned to a HAZMAT response team, which is composed of individuals from various workplaces, such as fire department, emergency management, explosive ordinance disposal, and BE.

3.2.2.4.4. Workplace rosters shall be collected and documented in DOEHRS for both home station and deployed locations, to ensure an accurate exposure record is created for all DAF personnel. (T-0) Manual roster updates are expected until a software solution is possible linking rosters which are maintained by workplace supervisors

(e.g., ASIMS) to DOEHRS rosters.

3.2.2.4.4.1. BE shall request updated personnel rosters from workplace supervisors and indicate “start date” or “stop date” for identified personnel in the applicable shop, process, process controls, and SEG in DOEHRS anytime an OH assessment is completed (e.g., unit comprehensive HRA, annual high-risk process HRA, or

WMP task) to ensure a complete exposure record for assigned members. (T-1)

3.2.2.4.4.2. Rosters for workplaces enrolled on the respiratory protection program shall be updated more frequently (i.e., continuously) to ensure accurate fit test

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reporting, see AFI 48-137, Respiratory Protection Program. (T-1)

3.2.2.4.4.3. Locations with high turnover (e.g., short tours and deployments) shall develop local procedures to ensure all members are captured in appropriate SEGs.

(T-1)

3.3. Step 2. Assess Hazards to Determine Risk. As part of the basic characterization, an initial exposure assessment of the hazard is required. (T-1) This assessment will often be qualitative in nature using existing data and observations and shall be documented as a SEG assessment in

DOEHRS. Additional detailed quantitative assessments are conducted as part of the WMP as required.

3.3.1. Assign Assessment Start and Stop Dates. The first date of the process’s/exposure’s applicability is the first date any member of the workplace/SEG was exposed under the current process parameters (e.g., hazardous material, frequency, duration, environmental conditions, controls, etc.). This first date of applicability is not the date BE conducts monitoring. The first date of applicability shall be used as the start date for all assessments, to include start dates prior to the sampling event. (T-1) Changes in applicability are determined by significant changes in determinants of exposure (e.g., equipment/airframe, chemicals, engineering controls). A change in PPE would not constitute a change in applicability due to no modification of underlying exposure potential. Note: Accurate assessment dates are critical to tracking exposure in each worker’s longitudinal exposure record.

3.3.2. Identify Occupational Exposure Limits (OEL). An OEL that is the most conservative of the OSHA Permissible Exposure Limit (PEL) or American Conference of Governmental

Industrial Hygienists (ACGIH) Threshold Limit Value (TLV) shall be used unless a specific

OEL is designated in DoD policy or by the BE Associate Corps Chief. (T-1) Each OEL may have three subcategories including an 8-hour time weighted average (TWA), 15-minute Short

Term Exposure Limit (STEL), or ceiling. Although the 8-hour TWA is the most common way of assessing airborne exposure and is the focus of the DAF EAS, BE should be familiar with and apply STEL and ceiling limits when appropriate (See Attachment 1 for expanded definitions). At this time, surface limits are not recognized DAF OELs. OELs for physical hazards are established elsewhere in hazard specific policies (e.g., hazardous noise in AFI 48-

127, thermal stress in DAFI 48-151, Thermal Stress Program, ergonomics in Attachment 4, etc.) Note: See para 3.7 for OELs during emergency responses.

3.3.3. Characterize Exposure.