Occupational Medicine · Medical Surveillance & Monitoring
Once an exposure crosses the line, the standard has already written the exam. We run it.
Silica, lead, asbestos, noise, respirators, HAZWOPER. Each OSHA standard spells out who gets examined, what the exam includes, and how often it repeats. ICA builds the protocol from the standard, performs the exams and reads the monitoring between them, and sends you the written opinion your file needs.
What it is
A physical is about the person. Surveillance is about the exposure.
A pre-placement physical asks whether someone can do the job. Medical surveillance asks a different question, over and over: is this job starting to affect them? It is triggered by what an employee is exposed to, not by when they were hired, and the standard that governs the exposure sets the exam, the cycle and the paperwork.
Monitoring is the part that happens between exams: blood lead and ZPP every six months, an annual audiogram compared against a baseline, urine cadmium. A single result can shorten the cycle or trigger medical removal, so someone has to be reading them as they come in.
We do both from one chart: the same clinic performs the exam, reads each result against the baseline, and signs the written opinion.
What triggers a program
- Exposure at or above an action levelYour air sampling or exposure assessment puts a role over the threshold the standard names, usually for 30 or more days a year.
- Required respirator useAnyone who must wear a respirator needs a medical evaluation first; under silica and asbestos, 30 days of required use starts surveillance.
- A hazardous-waste or emergency-response roleHAZWOPER crews and designated responders are examined on assignment, on a cycle, and at termination.
- A contract or insurer asks for itGeneral contractors and facility owners increasingly want proof of surveillance before a crew is badged on site.
Not sure whether a role is over the line? Bring us your exposure data and we will tell you which standards apply before any exam is scheduled.
By exposure
What each standard asks for
Summaries of the federal requirement, so you know what you are signing up for. Your exposure levels, state rules and contract terms can add to this — confirming that is the first thing we do together.
29 CFR 1926.1153 · 1910.1053
Respirable crystalline silica
Who is covered: Employees required to wear a respirator for 30 or more days a year because of silica exposure.
Concrete cutting, drilling, demolition, masonry and countertop fabrication are the usual sources. The standard requires a chest X-ray read by a NIOSH-certified B Reader and spirometry by a certified technician. We perform the spirometry, coordinate the imaging at a partner facility, and read the B Reader report into the exam.
Specialist referral details and most findings go to the employee; the employer opinion covers respirator limitations only unless the employee authorizes more.
29 CFR 1910.1025 · 1926.62
Lead
Who is covered: Employees exposed at or above the action level of 30 µg/m³ for more than 30 days a year.
Bridge and tank painting, battery work, radiator and firing-range roles. Lead is the clearest example of monitoring driving the schedule: a single blood level over 40 µg/dL moves draws to every two months and adds an annual exam; higher still triggers medical removal with pay protection.
Removal thresholds differ between general industry and construction; we apply the one that governs your work.
29 CFR 1910.1001 · 1926.1101
Asbestos
Who is covered: Employees exposed at or above the PEL or excursion limit, or who wear negative-pressure respirators for asbestos work.
Abatement, renovation of older buildings, brake and gasket work. The exam leans on respiratory history and pulmonary function; chest imaging is at the physician’s discretion rather than every visit.
Termination exam applies under the general industry standard.
29 CFR 1910.95
Occupational noise
Who is covered: Employees exposed at or above an 8-hour time-weighted average of 85 dBA.
Production floors, saw shops, airports and most heavy equipment. The whole program hinges on a clean baseline, which needs 14 hours away from workplace noise first, and on someone comparing every annual against it for a standard threshold shift.
A persistent shift is recordable on the OSHA 300 log when it meets the recording criteria; we flag it so you can decide.
29 CFR 1910.134
Respirator use
Who is covered: Anyone required to wear a respirator, before they are fit tested or wear it on the job.
The medical evaluation uses the OSHA Appendix C questionnaire and is reviewed by a licensed provider; a follow-up exam happens only if the answers call for one. It does not repeat annually by regulation, but it must be redone when the job, the mask or the employee’s health changes.
Many employers pair the evaluation with the annual fit test so both records share a date.
29 CFR 1910.120
HAZWOPER
Who is covered: Hazardous-waste operations and emergency-response employees exposed above PELs or wearing respirators 30 or more days a year, and HAZMAT team members.
Cleanup contractors, environmental services, treatment and storage facilities, and designated response teams. The physician can extend the cycle to two years when the exposure history supports it.
Exam content is set by the physician around the specific agents on your site.
Cadmium · Benzene · Hexavalent chromium
Other regulated substances
Who is covered: Employees over the action level named in each substance-specific standard, typically for 30 or more days a year.
Plating shops, welding on stainless, chemical handling. Each standard has its own biological monitoring: urine and blood cadmium with beta-2 microglobulin, a complete blood count for benzene, and the exam schedule the chromium standard sets.
If a substance you work with is not listed here, send us the SDS and we will tell you whether a standard applies.
How it runs
From your exposure data to a protocol you can run your calendar on
- 1
First call
Tell us what your people are exposed to
Your exposure assessment, air sampling results, or simply the tasks and materials involved. If you have not sampled yet, we can tell you which standards are likely in play and what to measure.
- 2
Next
We write the protocol
For each covered role: the standard that applies, the exam components it requires, the monitoring between exams, and the cycle. You see it in writing before anyone is examined.
- 3
Setup
Baselines first
Everyone currently exposed gets an initial exam. Noise baselines are scheduled after a quiet period; silica and asbestos files start with spirometry and the imaging referral the standard requires.
- 4
Ongoing
You send people when they are due
Six-month lead draws, annual audiograms, three-year silica exams: the protocol tells your coordinator what repeats and when. Send the employee in, and the exam is read against everything already in the chart.
- 5
Every result
Monitoring is read, not filed
A provider compares each result against the baseline and the standard’s thresholds. If a result shortens the cycle or requires removal, you hear from us with the written determination as soon as it is made.
- 6
Year round
Records and written opinions stay current
Each exam produces the physician’s written opinion for your file. The full medical record stays with us for the retention period, and comes out when an auditor, an employee or OSHA asks for it.
Monitoring
The results between exams are where the program earns its keep
Most surveillance standards do not wait for the next exam. A blood lead level, a threshold shift on an audiogram, or a change in pulmonary function can change the cycle immediately, and in some cases the employee’s assignment.
Every result that comes back to ICA is read by a provider against the employee’s baseline and the standard’s thresholds, not just filed. When something moves, you hear from us as soon as the provider has made the determination.
- Biological monitoringBlood lead and ZPP, urine and blood cadmium, CBC for benzene. Drawn on the cycle and compared against the action thresholds in the standard.
- Audiometric comparisonEvery annual read against the baseline. Standard threshold shifts confirmed by retest, then reported with the recordability question answered.
- Pulmonary function trendsSpirometry tracked over years for silica, asbestos and fume exposures, so a decline shows up before it becomes a diagnosis.
- Medical removal and returnWhen a level crosses the removal threshold we document it, advise on reassignment, and set the retest schedule that clears the employee to return.
- Cycle changes flagged for youWhen a result moves someone from six-month to two-month draws, the written determination says so and names the new interval, so your calendar changes with it.
The written opinion
What lands in your file, and what does not
Surveillance standards are specific about this. The employer gets a physician’s written opinion limited to the exposure in question. Everything else the exam turns up goes to the employee and stays in the medical record.
You receive
- The physician’s written opinion for each exam, dated, stating the exam met the standard
- Any limitation on the employee’s exposure or on respirator use
- Medical removal determinations and return-to-exposure clearances
- Standard threshold shift notices with the recordability question addressed
- A roster of who is current, on request
Stays in the medical record
- Diagnoses and medical conditions not related to the exposure
- Imaging reports, lab values and spirometry detail beyond what the opinion requires
- Specialist referral information, unless the employee authorizes release
- The full medical record, retained for the period the access-to-records rule sets
Recordkeeping
How long each record has to exist
Surveillance records outlive the job, the clinic contract and often the company. We retain them on our side for the full period and produce them when an employee, an auditor or OSHA asks.
30 yrs
Medical records
Duration of employment plus 30 years for employees with more than one year of service.
30 yrs
Exposure records
Air sampling, biological monitoring and material safety data tied to an exposure.
Employment
Audiometric test records
Kept for the duration of the employee’s employment under the noise standard.
2 yrs
Noise exposure measurements
The sampling that established who is in the hearing conservation program.
Common questions
How do we know whether surveillance is required at all?
It turns on exposure, not job title. Each standard names an action level and, usually, a 30-days-per-year threshold. If you have air sampling data we can read it against those thresholds; if you do not, we can tell you which tasks commonly cross them and what to measure first.
Can you do the silica exam, including the B Reader chest X-ray?
Yes. The silica standard requires chest imaging interpreted by a NIOSH-certified B Reader and spirometry by a certified technician. We perform the spirometry in the clinic, order the imaging at a partner facility, follow up on the report and read it into the exam. You do not need to arrange the imaging yourself; we do not perform it on site.
What exactly do we get after an exam?
The physician’s written opinion the standard describes: the date, a statement that the exam met the requirements, and any limitation on exposure or respirator use. Clinical findings go to the employee. This is deliberate and it is how the standards are written.
What happens if a blood lead level comes back high?
We notify you with the written determination as soon as the provider makes it. Over 40 µg/dL, draws move to every two months and an annual exam is added. At the removal threshold for your industry the employee has to come off exposure with medical removal protection, and the determination names the retest that clears them to return.
Do audiogram shifts have to go on the OSHA 300 log?
Sometimes. A standard threshold shift that meets the recording criteria is recordable. We confirm the shift by retest, tell you whether the criteria are met, and leave the recording decision with you.
Who keeps the records?
We retain the full medical record for the period the access-to-records rule requires, which for most surveillance is 30 years past employment. You keep the written opinions and your exposure data. Either side can produce them when an employee, an auditor or OSHA asks.
Can monitoring happen at our site?
Hearing tests, respirator evaluations and fit testing can run at your location under our on-site plans; which other components can depends on the exam. Imaging is always referred out, and the report comes back to us. Worth discussing when pulling a crew off the floor is the real cost.
Can this run alongside our other ICA services?
Yes. Surveillance sits inside your employee health program with physicals and testing, on the same account and the same contact. If we also treat your injuries, the surveillance baselines are in the same chart.
What does it cost?
It depends on the standards involved and headcount. Your coordinator quotes per-component rates against the written protocol so you can see the annual cost per covered employee before anything starts.
Next step
Send us your exposure data. We will send back the protocol.
A coordinator and a provider will review which standards apply to your roles and come back with the exam components, the cycle, and what it costs to run. If no surveillance is required, we will tell you that too.
Surveillance can run as one part of an employee health program, alongside physicals and testing, on the same account.