Header:
TITLE 8. INDUSTRIAL RELATIONS
DIVISION 1. DEPARTMENT OF INDUSTRIAL RELATIONS
CHAPTER 4. DIVISION OF INDUSTRIAL SAFETY
SUBCHAPTER 7. GENERAL INDUSTRY SAFETY ORDERS
GROUP 16. CONTROL OF HAZARDOUS SUBSTANCES
ARTICLE 110. REGULATED CARCINOGENS
Date:
11/25/2013
Document:
ยง 5207. Cadmium
(a) Scope.
This standard applies to all occupational exposures to cadmium and cadmium compounds, in all forms, and in all industries except the construction-related industries, which are covered under section 1532.
(b) Definitions.
Action level (AL) is defined as an airborne concentration of cadmium of 2.5 micrograms per cubic meter of air (2.5 [mu] g/m<3>), calculated as an 8-hour time-weighted average (TWA).
Authorized person means any person authorized by the employer and required by work duties to be present in regulated areas or any person authorized by the Chief to be in regulated areas.
Chief means the Chief of the Division of Occupational Safety and Health, or designee.
Emergency means any occurrence such as, but not limited to, equipment failure, rupture of containers, or failure of control equipment which results in an unexpected and potentially hazardous release of Cadmium.
Employee exposure and similar language referring to the air cadmium level to which an employee is exposed means the exposure to airborne cadmium that would occur if the employee were not using respiratory protective equipment.
Final medical determination is the written medical opinion of the employee's health status by the examining phy-sician under subsections (l)(3)-(12) or, if multiple physician review under subsection (l)(13) or the alternative physician determination under subsection (l)(14) is invoked, it is the final, written medical finding, recommendation or deter-mination that emerges from that process.
High-efficiency particulate air [HEPA] filter means a filter capable of trapping and retaining at least 99.97 percent of mono-dispersed particles of 0.3 micrometers in diameter.
NIOSH means the National Institute for Occupational Safety and Health (NIOSH), U.S. Department of Health and Human Services, or designee.
Regulated area means an area demarcated by the employer where an employee's exposure to airborne concen-trations of cadmium exceeds, or can reasonably be expected to exceed the permissible exposure limit (PEL).
(c) Permissible Exposure Limit (PEL).
The employer shall assure that no employee is exposed to an airborne concentration of cadmium in excess of five micrograms per cubic meter of air (5 [mu] g/m<3>), calculated as an eight-hour time-weighted average exposure (TWA).
(d) Exposure Monitoring.
(1) General.
(A) Each employer who has a workplace or work operation covered by this section shall determine if any employee may be exposed to cadmium at or above the action level.
(B) Determinations of employee exposure shall be made from breathing zone air samples that reflect the moni-tored employee's regular, daily 8-hour TWA exposure to cadmium.
(C) Eight-hour TWA exposures shall be determined for each employee on the basis of one or more personal breathing zone air samples reflecting full shift exposure on each shift, for each job classification, in each work area. Where several employees perform the same job tasks, in the same job classification, on the same shift, in the same work area, and the length, duration, and level of cadmium exposures are similar, an employer may sample a repre-sentative fraction of the employees instead of all employees in order to meet this requirement. In representative sampling, the employer shall sample the employee(s) expected to have the highest cadmium exposures.
(2) Specific.
(A) Initial monitoring. Except as provided for in subsections (d)(2)(B) and (d)(2)(C), the employer shall monitor employee exposures and shall base initial determinations on the monitoring results.
(B) Where the employer has monitored after September 14, 1991, under conditions that in all important aspects closely resemble those currently prevailing and where that monitoring satisfies all other requirements, including the accuracy and confidence levels of subsection (d)(6), the employer may rely on such earlier monitoring results to satisfy the requirements of subsection (d)(2)(A).
(C) Where the employer has objective data, as defined in subsection (n)(2), demonstrating that employee expo-sure to cadmium will not exceed the action level under the expected conditions of processing, use, or handling, the employer may rely upon such data instead of implementing initial monitoring.
(3) Monitoring Frequency (periodic monitoring).
(A) If the initial monitoring or periodic monitoring reveals employee exposures to be at or above the action level, the employer shall monitor at a frequency and pattern needed to represent the levels of exposure of employees and where exposures are above the PEL to assure the adequacy of respiratory selection and the effectiveness of engineer-ing and work practice controls. However, such exposure monitoring shall be performed at least every six months. The employer, at a minimum, shall continue these semi- annual measurements unless and until the conditions set out in subsection (d)(3)(B) are met.
(B) If the initial monitoring or the periodic monitoring indicates that employee exposures are below the action level and that result is confirmed by the results of another monitoring taken at least seven days later, the employer may discontinue the monitoring for those employees whose exposures are represented by such monitoring.
(4) Additional Monitoring.
The employer also shall institute the exposure monitoring required under subsections (d)(2)(A) and (d)(3) when-ever there has been a change in the raw materials, equipment, personnel, work practices, or finished products that may result in additional employees being exposed to cadmium at or above the action level or in employees already exposed to cadmium at or above the action level being exposed above the PEL, or whenever the employer has any reason to suspect that any other change might result in such further exposure.
(5) Employee Notification of Monitoring Results.
(A) Within 15 working days after the receipt of the results of any monitoring performed under this section, the employer shall notify each affected employee individually in writing of the results. In addition, within the same time period the employer shall post the results of the exposure monitoring in an appropriate location that is accessible to all affected employees.
(B) Wherever monitoring results indicate that employee exposure exceeds the PEL, the employer shall include in the written notice a statement that the PEL has been exceeded and a description of the corrective action being taken by the employer to reduce employee exposure to or below the PEL.
(6) Accuracy of Measurement.
The employer shall use a method of monitoring and analysis that has an accuracy of not less than plus or minus 25 percent (+ 25%), with a confidence level of 95 percent, for airborne concentrations of cadmium at or above the action level, the permissible exposure limit (PEL), and the separate engineering control air limit (SECAL).
(e) Regulated Areas.
(1) Establishment.
The employer shall establish a regulated area wherever an employee's exposure to airborne concentrations of cadmium is, or can reasonably be expected to be in excess of the permissible exposure limit (PEL).
(2) Demarcation.
Regulated areas shall be demarcated from the rest of the workplace in any manner that adequately establishes and alerts employees of the boundaries of the regulated area.
(3) Access.
Access to regulated areas shall be limited to authorized persons.
(4) Provision of Respirators.
Each person entering a regulated area shall be supplied with and required to use a respirator, selected in accord-ance with subsection (g)(2).
(5) Prohibited Activities.
The employer shall assure that employees do not eat, drink, smoke, chew tobacco or gum, or apply cosmetics in regulated areas, carry the products associated with these activities into regulated areas, or store such products in those areas.
(f) Methods of Compliance.
(1) Compliance Hierarchy.
(A) Except as specified in subsections (f)(1)(B), (C) and (D) the employer shall implement engineering and work practice controls to reduce and maintain employee exposure to cadmium at or below the PEL, except to the extent that the employer can demonstrate that such controls are not feasible.
(B) Except as specified in subsections (f)(1)(C) and (D), in industries where a separate engineering control air limit (SECAL) has been specified for particular processes (See Table 1), the employer shall implement engineering and work practice controls to reduce and maintain employee exposure at or below the SECAL, except to the extent that the em-ployer can demonstrate that such controls are not feasible.
TABLE I
Separate Engineering Control Airborne Limits (SECALs)
for Processes in Selected Industries
Industry Process SECAL
([mu] g/m<3>)
Nickel Cadmium Battery
Plate making, plate preparation 50
All other processes 15
Zinc/Cadmium Refining*
Cadmium refining, casting, melting,
oxide production, sinter plant 50
Pigment Manufacture
Calcine, crushing, milling & blending 50
All other processes 15
Stabilizers*
Cadmium oxide charging, crushing,
drying & blending 50
Lead Smelting*
Sinter plant, blast furnace,
baghouse & yard area 50
Plating*
Mechanical plating 15
*Processes in these industries that are not specified in this table must achieve the PEL using engineering controls and work practices as required in subsection f(1)(A).
(C) The requirement to implement engineering and work practice controls to achieve the PEL or, where applicable, the SECAL does not apply where the employer demonstrates the following:
1. the employee is only intermittently exposed; and
2. the employee is not exposed above the PEL on 30 or more days per year (12 consecutive months).
(D) Wherever engineering and work practice controls are required and are not sufficient to reduce employee ex-posure to or below the PEL or, where applicable, the SECAL, the employer nonetheless shall implement such controls to reduce exposures to the lowest levels achievable. The employer shall supplement such controls with respiratory protection that complies with the requirements of subsection (g) and the PEL.
(E) The employer shall not use employee rotation as a method of compliance.
(2) Compliance Program.
(A) Where the PEL is exceeded, the employer shall establish and implement a written compliance program to re-duce employee exposure to or below the PEL by means of engineering and work practice controls, as required by subsection (f)(1). To the extent that engineering and work practice controls cannot reduce exposures to or below the PEL, the employer shall include in the written compliance program the use of appropriate respiratory protection to achieve compliance with the PEL.
(B) Written compliance programs shall include at least the following:
1. A description of each operation in which cadmium is emitted; e.g., machinery used, material processed, controls in place, crew size, employee job responsibilities, operating procedures, and maintenance practices;
2. A description of the specific means that will be employed to achieve compliance, including engineering plans and studies used to determine methods selected for controlling exposure to cadmium, as well as, where necessary, the use of appropriate respiratory protection to achieve the PEL;
3. A report of the technology considered in meeting the PEL;
4. Air monitoring data that document the sources of cadmium emissions;
5. A detailed schedule for implementation of the program, including documentation such as copies of purchase orders for equipment, construction contracts, etc.;
6. A work practice program that includes items required under subsections (h), (i), and (j);
7. A written plan for emergency situations, as specified in subsection (h); and
8. Other relevant information.
(C) The written compliance programs shall be reviewed and updated at least annually, or more often if necessary, to reflect significant changes in the employer's compliance status.
(D) Written compliance programs shall be provided upon request for examination and copying to affected em-ployees, designated employee representatives as well as to the Chief, and NIOSH.
(3) Mechanical Ventilation.
(A) When ventilation is used to control exposure, measurements that demonstrate the effectiveness of the system in controlling exposure, such as capture velocity, duct velocity, or static pressure shall be made as necessary to maintain its effectiveness.
(B) Measurements of the system's effectiveness in controlling exposure shall be made as necessary within five working days of any change in production, process, or control that might result in a significant increase in employee exposure to cadmium.
(C) Recirculation of air. If air from exhaust ventilation is recirculated into the workplace, the system shall have a high efficiency filter and be monitored to assure effectiveness.
(D) Procedures shall be developed and implemented to minimize employee exposure to cadmium when mainte-nance of ventilation systems and changing of filters is being conducted.
(g) Respiratory Protection.
(1) General.
For employees who are required to use respirators by this section, the employer must provide respirators that comply with the requirements of this subsection. Respirators must be used during:
(A) Periods necessary to install or implement feasible engineering and work practice controls when employee ex-posure levels exceed the PEL;
(B) Maintenance and repair activities and during those brief or intermittent operations where exposures exceed the PEL and engineering and work practice controls are not feasible or are not required;
(C) Activities in regulated areas, specified in subsection (e);
(D) Work operations for which the employer has implemented all feasible engineering and work practice controls and such controls are not sufficient to reduce exposures to or below the PEL;
(E) Emergencies;
(F) Work operations for which an employee who is exposed to cadmium at or above the action level requests a respirator;
(G) Work operations for which an employee is exposed to cadmium above the PEL and engineering controls are not required under subsection (f)(1)(B).
(2) Respirator program.
(A) The employer must implement a respirator program in accordance with section 5144(b) through (d) (except (d)(1)(C)), and (f) through (m).
(B) No employees must use a respirator if, based upon their most recent examination, the examining physician determines that they will be unable to continue to function normally while using a respirator. If the physician deter-mines the employee must be limited in, or removed from their current inability to use a respirator, the limitation or removal must be in accordance with subsections (l)(11) and (12).
(C) If an employee exhibits breathing difficulty during a fit test or respirator use, the employer must provide the employee with a medical examination in accordance with subsection (l)(6)(B) to determine if the employee can use a respirator while performing the required duties.
(3) Respirator Selection.
(A) The employer shall select, and provide the appropriate respirators specified in Section 5144(d)(3)(A)1.
(B) The employer shall provide a powered, air-purifying respirator (PAPR) in lieu of a negative pressure respirator wherever:
1. An employee entitled to a respirator chooses to use this type of respirator; and
2. This respirator will provide adequate protection to the employee.
(C) Employers shall provide employees with full facepiece respirators when they experience eye irritation.
(D) Employers shall provide HEPA filters for powered and non-powered respirators.
(h) Emergency Situations.
The employer shall develop and implement a written plan for dealing with emergency situations involving sub-stantial releases of airborne cadmium. The plan shall include provisions for the use of appropriate respirators and personal protective equipment. In addition, employees not essential to correcting the emergency situation shall be restricted from the area and normal operations halted in that area until the emergency is abated.
(i) Protective Work Clothing and Equipment.
(1) Provision and Use.
If an employee is exposed to airborne cadmium above the PEL or where skin or eye irritation is associated with cadmium exposure at any level, the employer shall provide at no cost to the employee, and assure that the employee uses, appropriate protective work clothing and equipment that prevents contamination of the employee and the em-ployee's garments. Protective work clothing and equipment includes, but is not limited to:
(A) Coveralls or similar full-body work clothing;
(B) Gloves, head coverings, and boots or foot coverings; and,
(C) Face shields, vented goggles, or other appropriate protective equipment that complies with Article 10.
(2) Removal and Storage.
(A) The employer shall assure that employees remove all protective clothing and equipment contaminated with cadmium at the completion of the work shift and do so only in change rooms provided in accordance with subsection (j)(1).
(B) The employer shall assure that no employee takes cadmium- contaminated protective clothing or equipment from the workplace, except for employees authorized to do so for purposes of laundering, cleaning, maintaining, or disposing of cadmium contaminated protective clothing and equipment at an appropriate location or facility away from the workplace.
(C) The employer shall assure that contaminated protective clothing and equipment, when removed for launder-ing, cleaning, maintenance, or disposal, is placed and stored in sealed, impermeable bags or other closed, impermeable containers that are designed to prevent dispersion of cadmium dust.
(D) The employer shall assure that bags or containers of contaminated protective clothing and equipment that are to be taken out of the change rooms or the workplace for laundering, cleaning, maintenance or disposal shall bear labels in accordance with subsection (m)(3).
(3) Cleaning, Replacement, and Disposal.
(A) The employer shall provide the protective clothing and equipment required by subsection (i)(1) in a clean and dry condition as often as necessary to maintain its effectiveness, but in any event at least weekly. The employer is re-sponsible for cleaning and laundering the protective clothing and equipment required by this subsection to maintain its effectiveness and is also responsible for disposing of such clothing and equipment.
(B) The employer also is responsible for repairing or replacing required protective clothing and equipment as needed to maintain its effectiveness. When rips or tears are detected while an employee is working they shall be im-mediately mended, or the worksuit shall be immediately replaced.
(C) The employer shall prohibit the removal of cadmium from protective clothing and equipment by blowing, shaking, or any other means that disperses cadmium into the air.
(D) The employer shall assure that any laundering of contaminated clothing or cleaning of contaminated equipment in the workplace is done in a manner that prevents the release of airborne cadmium in excess of the permissible exposure limit prescribed in subsection (c).
(E) The employer shall inform any person who launders or cleans protective clothing or equipment contaminated with cadmium of the potentially harmful effects of exposure to cadmium and that the clothing and equipment should be laundered or cleaned in a manner to effectively prevent the release of airborne cadmium in excess of the PEL.
(j) Hygiene Areas and Practices.
(1) General.
For employees whose airborne exposure to cadmium is above the PEL, the employer shall provide clean change rooms, handwashing facilities, showers, and lunchroom facilities that comply with Article 9.
(2) Change Rooms.
The employer shall assure that change rooms are equipped with separate storage facilities for street clothes and for protective clothing and equipment, which are designed to prevent dispersion of cadmium and contamination of the employee's street clothes.
(3) Showers and Handwashing Facilities.
(A) The employer shall assure that employees who are exposed to cadmium above the PEL shower during the end of the work shift.
(B) The employer shall assure that employees whose airborne exposure to cadmium is above the PEL wash their hands and faces prior to eating, drinking, smoking, chewing tobacco or gum, or applying cosmetics.
(4) Lunchroom Facilities.
(A) The employer shall assure that the lunchroom facilities are readily accessible to employees, that tables for eating are maintained free of cadmium, and that no employee in a lunchroom facility is exposed at any time to cadmium at or above a concentration of 2.5 [mu] g/m<3>.
(B) The employer shall assure that employees do not enter lunchroom facilities with protective work clothing or equipment unless surface cadmium has been removed from the clothing and equipment by HEPA vacuuming or some other method that removes cadmium dust without dispersing it.
(k) Housekeeping.
(1) All surfaces shall be maintained as free as practicable of accumulations of cadmium.
(2) All spills and sudden releases of material containing cadmium shall be cleaned up as soon as possible.
(3) Surfaces contaminated with cadmium shall, wherever possible, be cleaned by vacuuming or other methods that minimize the likelihood of cadmium becoming airborne.
(4) HEPA-filtered vacuuming equipment or equally effective filtration methods shall be used for vacuuming. The equipment shall be used and emptied in a manner that minimizes the reentry of cadmium into the workplace.
(5) Shoveling, dry or wet sweeping, and brushing may be used only where vacuuming or other methods that minimize the likelihood of cadmium becoming airborne have been tried and found not to be effective.
(6) Compressed air shall not be used to remove cadmium from any surface unless the compressed air is used in conjunction with a ventilation system designed to capture the dust cloud created by the compressed air.
(7) Waste, scrap, debris, bags, containers, personal protective equipment, and clothing contaminated with cad-mium and consigned for disposal shall be collected and disposed of in sealed impermeable bags or other closed, im-permeable containers. These bags and containers shall be labeled in accordance with subsection (m) of this section.
(l) Medical Surveillance.
(1) General.
(A) Scope.
1. Currently exposed - The employer shall institute a medical surveillance program for all employees who are or may be exposed to cadmium at or above the action level unless the employer demonstrates that the employee is not, and will not be, exposed at or above the action level on 30 or more days per year (twelve consecutive months); and,
2. Previously exposed - The employer shall also institute a medical surveillance program for all employees who prior to the effective date of this section might previously have been exposed to cadmium at or above the action level by the employer, unless the employer demonstrates that the employee did not prior to the effective date of this sec-tion work for the employer in jobs with exposure to cadmium for an aggregated total of more than 60 months.
(B) To determine an employee's fitness for using a respirator, the employer shall provide the limited medical ex-amination specified in subsection (l)(6).
(C) The employer shall assure that all medical examinations and procedures required by this standard are per-formed by or under the supervision of a licensed physician, who has read and is familiar with the health effects section of Appendix A, the regulatory text of this section, the protocol for sample handling and laboratory selection in Appen-dix F, and the questionnaire of Appendix D. These examinations and procedures shall be provided without cost to the employee and at a time and place that is reasonable and convenient to employees.
(D) The employer shall assure that the collecting and handling of biological samples of cadmium in urine (CdU), cadmium in blood (CdB), and beta-2 microglobulin in urine ([BETA]<2>-M) taken from employees under this section is done in a manner that assures their reliability and that analysis of biological samples of cadmium in urine (CdU), cad-mium in blood (CdB), and beta-2 microglobulin in urine ([BETA]<2>-M) taken from employees under this section is performed in laboratories with demonstrated proficiency for that particular analyte. (See Appendix F.)
(2) Initial Examination.
(A) The employer shall provide an initial (preplacement) examination to all employees covered by the medical surveillance program required in subsection (l)(1)(A). The examination shall be provided to those employees within 30 days after initial assignment to a job with exposure to cadmium or no later than 90 days after the effective date of this section, whichever date is later.
(B) The initial (preplacement) medical examination shall include:
1. A detailed medical and work history, with emphasis on: past, present, and anticipated future exposure to cad-mium; any history of renal, cardiovascular, respiratory, hematopoietic, reproductive, and/or musculo-skeletal system dysfunction; current usage of medication with potential nephrotoxic side-effects; and smoking history and current status; and
2. Biological monitoring that includes the following tests:
a. Cadmium in urine (CdU), standardized to grams of creatinine (g/Cr);
b. Beta-2 microglobulin in urine ([BETA]<2>-M), standardized to grams of creatinine (g/Cr), with pH specified, as described in Appendix F; and
c. Cadmium in blood (CdB), standardized to liters of whole blood (lwb).
(C) Recent Examination: An initial examination is not required to be provided if adequate records show that the employee has been examined in accordance with the requirements of subsection (l)(2)(B) within the past 12 months. In that case, such records shall be maintained as part of the employee's medical record and the prior exam shall be treated as if it were an initial examination for the purposes of subsections (l)(3) and (4).
(3) Actions Triggered by Initial Biological Monitoring:
(A) If the results of the initial biological monitoring tests show the employee's CdU level to be at or below 3 mg/g Cr, [BETA]<2>-M level to be at or below 300 [mu]g/g Cr and CdB level to be at or below 5 [mu]g/lwb, then:
1. for currently exposed employees, who are subject to medical surveillance under subsection (l)(1)(A)1., the em-ployer shall provide the minimum level of periodic medical surveillance in accordance with the requirements in sub-section (l)(4)(A); and
2. for previously exposed employees, who are subject to medical surveillance under subsection (l)(1)(A)2., the employer shall provide biological monitoring for CdU, [BETA]<2>-M, and CdB one year after the initial biological mon-itoring and then the employer shall comply with the requirements of subsection (l)(4)(E).
(B) For all employees who are subject to medical surveillance under subsection (l)(1)(A), if the results of the initial biological monitoring tests show the level of CdU to exceed 3 [mu]g/g Cr, the level of [BETA]<2>-M to exceed 300 [mu]g/g Cr, or the level of CdB to exceed 5 [mu]g/lwb, the employer shall:
1. within two weeks after receipt of biological monitoring results, reassess the employee's occupational exposure to cadmium as follows:
a. reassess the employee's work practices and personal hygiene;
b. reevaluate the employee's respirator use, if any, and the respirator program;
c. review the hygiene facilities;
d. reevaluate the maintenance and effectiveness of the relevant engineering controls;
e. assess the employee's smoking history and status;
2. within 30 days after the exposure reassessment, specified in (l)(3)(B)1., take reasonable steps to correct any de-ficiencies found in the reassessment that may be responsible for the employee's excess exposure to cadmium; and,
3. within 90 days after receipt of biological monitoring results, provide a full medical examination to the employee in accordance with the requirements of subsection (l)(4)(B). After completing the medical examination, the examin-ing physician shall determine in a written medical opinion whether to medically remove the employee. If the physician determines that medical removal is not necessary, then until the employee's CdU level falls to or below 3 [mu]g/g Cr, [BETA]<2>-M level falls to or below 300 [mu]g/g Cr and CdB level falls to or below 5 [mu]g/lwb, the employer shall:
a. Provide biological monitoring in accordance with subsection (l)(2)(B)2. on a semiannual basis; and
b. Provide annual medical examinations in accordance with subsection (l)(4)(B).
(C) For all employees who are subject to medical surveillance under subsection (l)(1)(A), if the results of the initial biological monitoring tests show the level of CdU to be in excess of 15 [mu]g/g Cr, or the level of CdB to be in excess of 15 [mu]g/lwb, or the level of [BETA]<2>-M to be in excess of 1,500 [mu]g/g Cr, the employer shall comply with the requirements of subsections (l)(3)(B)1.-2. Within 90 days after receipt of biological monitoring results, the employer shall provide a full medical examination to the employee in accordance with the requirements of subsection (l)(4)(B). After completing the medical examination, the examining physician shall determine in a written medical opinion whether to medically remove the employee. However, if the initial biological monitoring results and the biological monitoring results obtained during the medical examination both show that: CdU exceeds 15 [mu]g/g Cr; or CdB ex-ceeds 15 [mu]g/lwb; or [BETA]<2>-M exceeds 1500 [mu]g/g Cr, and in addition CdU exceeds 3 [mu]g/g Cr or CdB ex-ceeds 5 mg/liter of whole blood, then the physician shall medically remove the employee from exposure to cadmium at or above the action level. If the second set of biological monitoring results obtained during the medical examination does not show that a mandatory removal trigger level has been exceeded, then the employee is not required to be removed by the mandatory provisions of this subsection. If the employee is not required to be removed by the man-datory provisions of this subsection or by the physician's determination, then until the employee's CdU level falls to or below 3 [mu]g/g Cr, [BETA]<2>-M level falls to or below 300 [mu]g/g Cr and CdB level falls to or below 5 [mu]g/lwb, the employer shall:
1. Periodically reassess the employee's occupational exposure to cadmium;
2. Provide biological monitoring in accordance with subsection (l)(2)(B)2. on a quarterly basis; and
3. Provide semiannual medical examinations in accordance with subsection (l)(4)(B).
(D) For all employees to whom medical surveillance is provided, beginning on January 1, 1999, and in lieu of sub-sections (l)(3)(A)-(C):
1. If the results of the initial biological monitoring tests show the employee's CdU level to be at or below 3 [mu]g/g Cr, [BETA]<2>-M level to be at or below 300 [mu]g/g Cr and CdB level to be at or below 5 [mu]g/lwb, then for currently exposed employees, the employer shall comply with the requirements of subsection (l)(3)(A)1., and for previously exposed employees, the employer shall comply with the requirements of subsection (l)(3)(A)2.;
2. If the results of the initial biological monitoring tests show the level of CdU to exceed 3 [mu]g/g Cr, the level of [BETA]<2>-M to exceed 300 [mu]g/g Cr, or the level of CdB to exceed 5 [mu]g/lwb, the employer shall comply with the requirements of subsections (l)(3)(B)1.-3.; and,
3. If the results of the initial biological monitoring tests show the level of CdU to be in excess of 7 [mu]g/g Cr, or the level of CdB to be in excess of 10 [mu]g/lwb, or the level of [BETA]<2>-M to be in excess of 750 [mu]g/g Cr, the employer shall: comply with the requirements of subsections (l)(3)(B)1.-2.; and, within 90 days after receipt of biolog-ical monitoring results, provide a full medical examination to the employee in accordance with the requirements of subsection (l)(4)(B). After completing the medical examination, the examining physician shall determine in a written medical opinion whether to medically remove the employee. However, if the initial biological monitoring results and the biological monitoring results obtained during the medical examination both show that: CdU exceeds 7 [mu]g/g Cr; or CdB exceeds 10 [mu]g/lwb; or [BETA]<2>-M exceeds 750 [mu]g/g Cr, and in addition CdU exceeds 3 [mu]g/g Cr or CdB exceeds 5 mg/liter of whole blood, then the physician shall medically remove the employee from exposure to cadmium at or above the action level. If the second set of biological monitoring results obtained during the medical examination does not show that a mandatory removal trigger level has been exceeded, then the employee is not re-quired to be removed by the mandatory provisions of this subsection. If the employee is not required to be removed by the mandatory provisions of this subsection or by the physician's determination, then until the employee's CdU level falls to or below 3 [mu]g/g Cr, [BETA]<2>-M level falls to or below 300 [mu]g/g Cr and CdB level falls to or below 5 [mu]g/lwb, the employer shall: periodically reassess the employee's occupational exposure to cadmium; provide biological monitoring in accordance with subsection (l)(2)(B)2. on a quarterly basis; and provide semiannual medical examinations in accordance with subsection (l)(4)(B).
(4) Periodic Medical Surveillance.
(A) For each employee who is covered under subsection (l)(1)(A)1., the employer shall provide at least the mini-mum level of periodic medical surveillance, which consists of periodic medical examinations and periodic biological monitoring. A periodic medical examination shall be provided within one year after the initial examination required by subsection (l)(2) and thereafter at least biennially. Biological sampling shall be provided at least annually, either as part of a periodic medical examination or separately as periodic biological monitoring.
(B) The periodic medical examination shall include:
1. A detailed medical and work history, or update thereof, with emphasis on: past, present and anticipated future exposure to cadmium; smoking history and current status; reproductive history; current use of medications with po-tential nephrotoxic side-effects; any history of renal, cardiovascular, respiratory, hematopoietic, and/or muscu-lo-skeletal system dysfunction; and as part of the medical and work history, for employees who wear respirators, questions 3-11 and 25-32 in Appendix D;
2. A complete physical examination with emphasis on: blood pressure, the respiratory system, and the urinary system;
3. A 14 inch by 17 inch, or a reasonably standard sized posterior-anterior chest X-ray (after the initial X-ray, the frequency of chest X-rays is to be determined by the examining physician);
4. Pulmonary function tests, including forced vital capacity (FVC) and forced expiratory volume at 1 second (FEV1);
5. Biological monitoring, as required in subsection (l)(2)(B)2.;
6. Blood analysis, in addition to the analysis required under subsection (l)(2)(B)2., including blood urea nitrogen, complete blood count, and serum creatinine;
7. Urinalysis, in addition to the analysis required under subsection (l)(2)(B)2., including the determination of al-bumin, glucose, and total and low molecular weight proteins;
8. For males over 40 years old, prostate palpation, or other at least as effective diagnostic test(s); and
9. Any additional tests deemed appropriate by the examining physician.
(C) Periodic biological monitoring shall be provided in accordance with subsection (l)(2)(B)2..
(D) If the results of periodic biological monitoring or the results of biological monitoring performed as part of the periodic medical examination show the level of the employee's CdU, [BETA]<2>-M, or CdB to be in excess of the levels specified in subsections (l)(3)(B)-(C); or, beginning on January 1, 1999, in excess of the levels specified in subsections (l)(3)(B) or (D), the employer shall take the appropriate actions specified in subsections (l)(3)(B)-(D).
(E) For previously exposed employees under subsection (l)(1)(A)2.:
1. If the employee's levels of CdU did not exceed 3 [mu]g/g Cr, CdB did not exceed 5 [mu]g/lwb, and [BETA]<2>-M did not exceed 300 [mu]g/g Cr in the initial biological monitoring tests, and if the results of the followup biological monitoring required by subsection (l)(3)(A)2. one year after the initial examination confirm the previous results, the employer may discontinue all periodic medical surveillance for that employee.
2. If the initial biological monitoring results for CdU, CdB, or [BETA]<2>-M were in excess of the levels specified in (l)(3)(A), but subsequent biological monitoring results required by (l)(3)(B)-(D) show that the employee's CdU levels no longer exceed 3 [mu]g/g Cr, CdB levels no longer exceed 5 [mu]g/lwb, and [BETA]<2>-M levels no longer exceed 300 [mu]g/g Cr, the employer shall provide biological monitoring for CdU, CdB, and [BETA]<2>-M one year after these most recent biological monitoring results. If the results of the followup biological monitoring, specified in this subsection, confirm the previous results, the employer may discontinue all periodic medical surveillance for that employee.
3. However, if the results of the follow-up tests specified in (l)(4)(E)1. or 2. indicate that the level of the employee's CdU, [BETA]<2>-M, or CdB exceeds these same levels, the employer is required to provide annual medical exami-nations in accordance with the provisions of subsection (l)(4)(B) until the results of biological monitoring are consist-ently below these levels or the examining physician determines in a written medical opinion that further medical sur-veillance is not required to protect the employee's health.
(F) A routine, biennial medical examination is not required to be provided in accordance with subsections (l)(3)(A) and (l)(4) if adequate medical records show that the employee has been examined in accordance with the require-ments of subsection (l)(4)(B) within the past 12 months. In that case, such records shall be maintained by the employer as part of the employee's medical record, and the next routine, periodic medical examination shall be made available to the employee within two years of the previous examination.
(5) Actions Triggered by Medical Examinations:
(A) If the results of a medical examination carried out in accordance with this section indicate any laboratory or clinical finding consistent with cadmium toxicity that does not require employer action under subsections (l)(2), (3) or (4), the employer, within 30 days, shall reassess the employee's occupational exposure to cadmium and take the fol-lowing corrective action until the physician determines they are no longer necessary:
1. Periodically reassess: the employee's work practices and personal hygiene; the employee's respirator use, if any; the employee's smoking history and status; the respiratory protection program; the hygiene facilities; and the maintenance and effectiveness of the relevant engineering controls;
2. Within 30 days after the reassessment, take all reasonable steps to correct the deficiencies found in the reas-sessment that may be responsible for the employee's excess exposure to cadmium;
3. Provide semiannual medical reexaminations to evaluate the abnormal clinical sign(s) of cadmium toxicity until the results are normal or the employee is medically removed; and
4. Where the results of tests for total proteins in urine are abnormal, provide a more detailed medical evaluation of the toxic effects of cadmium on the employee's renal system.
(6) Examination for Respirator Use:
(A) To determine an employee's fitness for respirator use, the employer shall provide a medical examination that includes the elements specified in (l)(6)1.-4.. This examination shall be provided prior to the employee's being assigned to a job that requires the use of a respirator or no later than 90 days after this section goes into effect, whichever date is later, to any employee without a medical examination within the preceding 12 months that satisfies the requirements of this subsection.
1. A detailed medical and work history, or update thereof, with emphasis on: past exposure to cadmium; smoking history and current status; any history of renal, cardiovascular, respiratory, hematopoietic, and/or musculo-skeletal system dysfunction; a description of the job for which the respirator is required; and questions 3-11 and 25-32 in Ap-pendix D;
2. A blood pressure test;
3. Biological monitoring of the employee's levels of CdU, CdB and [BETA]<2>-M in accordance with the require-ments of subsection (l)(2)(B)2., unless such results already have been obtained within the previous 12 months; and
4. Any other test or procedure that the examining physician deems appropriate.
(B) After reviewing all the information obtained from the medical examination required in subsection (l)(6)(A), the physician shall determine whether the employee is fit to wear a respirator.
(C) Whenever an employee has exhibited difficulty in breathing during a respirator fit test or during use of a res-pirator, the employer, as soon as possible, shall provide the employee with a periodic medical examination in accord-ance with subsection (l)(4)(B) to determine the employee's fitness to wear a respirator.
(D) Where the results of the examination required under subsection (l)(6)(A), (B) or (C) are abnormal, medical lim-itation or prohibition of respirator use shall be considered. If the employee is allowed to wear a respirator, the em-ployee's ability to continue to do so shall be periodically evaluated by a physician.
(7) Emergency Examinations:
(A) In addition to the medical surveillance required in subsections (l)(2)-(6), the employer shall provide a medical examination as soon as possible to any employee who may have been acutely exposed to cadmium because of an emergency.
(B) The examination shall include the requirements of subsection (l)(4)(B), with emphasis on the respiratory sys-tem, other organ systems considered appropriate by the examining physician, and symptoms of acute overexposure, as identified in Appendix A in subsections II2.(1)-(2) and IV.
(8) Termination of Employment Examination:
(A) At termination of employment, the employer shall provide a medical examination in accordance with subsec-tion (l)(4)(B), including a chest X-ray, to any employee to whom at any prior time the employer was required to provide medical surveillance under subsections (l)(1)(A) or (l)(7). However, if the last examination satisfied the requirements of subsection (l)(4)(B) and was less than six months prior to the date of termination, no further examination is required unless otherwise specified in subsections (l)(3) or (l)(5);
(B) However, for employees covered by subsection(l)(1)(A)2., if the employer has discontinued all periodic medical surveillance under (l)(4)(E), no termination of employment medical examination is required.
(9) Information Provided to the Physician:
The employer shall provide the following information to the examining physician:
(A) A copy of this standard and appendices;
(B) A description of the affected employee's former, current, and anticipated duties as they relate to the employ-ee's occupational exposure to cadmium;
(C) The employee's former, current, and anticipated future levels of occupational exposure to cadmium;
(D) A description of any personal protective equipment, including respirators, used or to be used by the employee, including when and for how long the employee has used that equipment; and
(E) relevant results of previous biological monitoring and medical examinations.
(10) Physician's Written Medical Opinion:
(A) The employer shall promptly obtain a written, signed medical opinion from the examining physician for each medical examination performed on each employee. This written opinion shall contain:
1. The physician's diagnosis for the employee;
2. The physician's opinion as to whether the employee has any detected medical condition(s) that would place the employee at increased risk of material impairment to health from further exposure to cadmium, including any indica-tions of potential cadmium toxicity;
3. The results of any biological or other testing or related evaluations that directly assess the employee's absorp-tion of cadmium;
4. Any recommended removal from, or limitation on the activities or duties of the employee or on the employee's use of personal protective equipment, such as respirators;
5. A statement that the physician has clearly and carefully explained to the employee the results of the medical examination, including all biological monitoring results and any medical conditions related to cadmium exposure that require further evaluation or treatment, and any limitation on the employee's diet or use of medications.
(B) The employer promptly shall obtain a copy of the results of any biological monitoring provided by an employer to an employee independently of a medical examination under subsections (l)(2) and (l)(4), and, in lieu of a written medical opinion, an explanation sheet explaining those results.
(C) The employer shall instruct the physician not to reveal orally or in the written medical opinion given to the employer specific findings or diagnoses unrelated to occupational exposure to cadmium.
(11) Medical Removal Protection (MRP):
(A) General.
1. The employer shall temporarily remove an employee from work where there is excess exposure to cadmium on each occasion that medical removal is required under subsections (l)(3), (l)(4), or (l)(6) and on each occasion that a physician determines in a written medical opinion that the employee should be removed from such exposure. The physician's determination may be based on biological monitoring results, inability to wear a respirator, evidence of illness, other signs or symptoms of cadmium-related dysfunction or disease, or any other reason deemed medically sufficient by the physician.
2. The employer shall medically remove an employee in accordance with subsection (l)(11) regardless of whether at the time of removal a job is available into which the removed employee may be transferred.
3. Whenever an employee is medically removed under subsection (l)(11), the employer shall transfer the removed employee to a job where the exposure to cadmium is within the permissible levels specified in that subsection as soon as one becomes available.
4. For any employee who is medically removed under the provisions of subsection (l)(11)(A), the employer shall provide follow-up biological monitoring in accordance with (l)(2)(B)2. at least every three months and follow-up med-ical examinations semi-annually at least every six months until in a written medical opinion the examining physician determines that either the employee may be returned to his/her former job status as specified under (l)(11)(D)-(E) or the employee must be permanently removed from excess cadmium exposure.
5. The employer may not return an employee who has been medically removed for any reason to his/her former job status until a physician determines in a written medical opinion that continued medical removal is no longer nec-essary to protect the employee's health.
(B) Where an employee is found unfit to wear a respirator under subsection (l)(6)(B), the employer shall remove the employee from work where exposure to cadmium is above the PEL.
(C) Where removal is based on any reason other than the employee's inability to wear a respirator, the employer shall remove the employee from work where exposure to cadmium is at or above the action level.
(D) Except as specified in subsection (l)(11)(E), no employee who was removed because his/her level of CdU, CdB and/or [BETA]<2>-M exceeded the medical removal trigger levels in subsections (l)(3) or (l)(4) may be returned to work with exposure to cadmium at or above the action level until the employee's levels of CdU fall to or below 3 [mu]g/g Cr, CdB falls to or below 5 [mu]g/lwb, and [BETA]<2>-M falls to or below 300 [mu]g/g Cr.
(E) However, when in the examining physician's opinion continued exposure to cadmium will not pose an in-creased risk to the employee's health and there are special circumstances that make continued medical removal an inappropriate remedy, the physician shall fully discuss these matters with the employee, and then in a written deter-mination may return a worker to his/her former job status despite what would otherwise be unacceptably high bio-logical monitoring results. Thereafter, the returned employee shall continue to be provided with medical surveillance as if he/she were still on medical removal until the employee's levels of CdU fall to or below 3 [mu]g/g Cr, CdB falls to or below 5 [mu]g/lwb, and [BETA]<2>-M falls to or below 300 [mu]g/g Cr.
(F) Where an employer, although not required by(l)(11)(A)-(C) to do so, removes an employee from exposure to cadmium or otherwise places limitations on an employee due to the effects of cadmium exposure on the employee's medical condition, the employer shall provide the same medical removal protection benefits to that employee under subsection (l)(12) as would have been provided had the removal been required under subsection (l)(11)(A)-(C).
(12) Medical Removal Protection Benefits (MRPB).
(A) The employer shall provide MRPB for up to a maximum of 18 months to an employee each time and while the employee is temporarily medically removed under subsection (l)(11).
(B) For purposes of this section, the requirement that the employer provide MRPB means that the employer shall maintain the total normal earnings, seniority, and all other employee rights and benefits of the removed employee, including the employee's right to his/her former job status, as if the employee had not been removed from the em-ployee's job or otherwise medically limited.
(C) Where, after 18 months on medical removal because of elevated biological monitoring results, the employee's monitoring results have not declined to a low enough level to permit the employee to be returned to his/her former job status:
1. the employer shall make available to the employee a medical examination pursuant to this section in order to obtain a final medical determination as to whether the employee may be returned to his/her former job status or must be permanently removed from excess cadmium exposure; and
2. the employer shall assure that the final medical determination indicates whether the employee may be returned to his/her former job status and what steps, if any, should be taken to protect the employee's health.
(D) The employer may condition the provision of MRPB upon the employee's participation in medical surveillance provided in accordance with this section.
(13) Multiple Physician Review.
(A) If the employer selects the initial physician to conduct any medical examination or consultation provided to an employee under this section, the employee may designate a second physician to:
1. Review any findings, determinations, or recommendations of the initial physician; and
2. Conduct such examinations, consultations, and laboratory tests as the second physician deems necessary to fa-cilitate this review.
(B) The employer shall promptly notify an employee of the right to seek a second medical opinion after each oc-casion that an initial physician provided by the employer conducts a medical examination or consultation pursuant to this section. The employer may condition its participation in, and payment for, multiple physician review upon the employee doing the following within fifteen (15) days after receipt of this notice, or receipt of the initial physician's written opinion, whichever is later:
1. Informing the employer that he or she intends to seek a medical opinion; and
2. Initiating steps to make an appointment with a second physician.
(C) If the findings, determinations, or recommendations of the second physician differ from those of the initial physician, then the employer and the employee shall assure that efforts are made for the two physicians to resolve any disagreement.
(D) If the two physicians have been unable to quickly resolve their disagreement, then the employer and the em-ployee, through their respective physicians, shall designate a third physician to:
1. Review any findings, determinations, or recommendations of the other two physicians; and
2. Conduct such examinations, consultations, laboratory tests, and discussions with the other two physicians as the third physician deems necessary to resolve the disagreement among them.
(E) The employer shall act consistently with the findings, determinations, and recommendations of the third phy-sician, unless the employer and the employee reach an agreement that is consistent with the recommendations of at least one of the other two physicians.
(14) Alternate Physician Determination.
The employer and an employee or designated employee representative may agree upon the use of any alternate form of physician determination in lieu of the multiple physician review provided by subsection (l)(13), so long as the alternative is expeditious and at least as protective of the employee.
(15) Information the Employer Must Provide the Employee.
(A) The employer shall provide a copy of the physician's written medical opinion to the examined employee within two weeks after receipt thereof.
(B) The employer shall provide the employee with a copy of the employee's biological monitoring results and an explanation sheet explaining the results within two weeks after receipt thereof.
(C) Within 30 days after a request by an employee, the employer shall provide the employee with the information the employer is required to provide the examining physician under subsection (l)(9).
(16) Reporting.
In addition to other medical events that are required to be reported on the Cal/OSHA Form No. 200, the employer shall report any abnormal condition or disorder caused by occupational exposure to cadmium associated with em-ployment as specified in Title 8, Section 14301.
(m) Communication of Cadmium Hazards to Employees.
(1) Hazard Communication--General.
(A) Chemical manufacturers, importers, distributors and employers shall comply with all requirements of the Haz-ard Communication Standard (HCS) (Section 5194) for cadmium.
(B) In classifying the hazards of cadmium at least the following hazards are to be addressed: Cancer; lung effects; kidney effects; and acute toxicity effects.
(C) Employers shall include cadmium in the hazard communication program established to comply with the HCS (Section 5194). Employers shall ensure that each employee has access to labels on containers of cadmium and to safety data sheets, and is trained in accordance with the requirements of HCS and subsection (m)(4) of this section.
(2) Warning Signs.
(A) Warning signs shall be provided and displayed in regulated areas. In addition, warning signs shall be posted at all approaches to regulated areas so that an employee may read the signs and take necessary protective steps before entering the area.
(B) Warning signs required by subsection (m)(2)(A) of this section shall bear the following legend:
DANGER
CADMIUM
MAY CAUSE CANCER
CAUSES DAMAGE TO LUNGS AND KIDNEYS
WEAR RESPIRATORY PROTECTION IN THIS AREA
AUTHORIZED PERSONNEL ONLY
(C) The employer shall ensure that signs required by this subsection (m)(2) are illuminated, cleaned, and main-tained as necessary so that the legend is readily visible.
(D) Prior to June 1, 2016, employers may use the following legend in lieu of that specified in subsection (m)(2)(B) of this section:
DANGER
CADMIUM
CANCER HAZARD
CAN CAUSE LUNG AND KIDNEY DISEASE
AUTHORIZED PERSONNEL ONLY
RESPIRATORS REQUIRED IN THIS AREA
(3) Warning Labels.
(A) Shipping and storage containers containing cadmium, cadmium compounds, or cadmium contaminated clothing, equipment, waste, scrap, or debris shall bear appropriate warning labels, as specified in subsection (m)(1) of this section.
(B) The warning labels for containers of contaminated protective clothing, equipment, waste, scrap, or debris shall include at least the following information:
DANGER
CONTAINS CADMIUM
MAY CAUSE CANCER
CAUSES DAMAGE TO LUNGS AND KIDNEYS
AVOID CREATING DUST
(C) Prior to June 1, 2015, employers may include the following information on shipping and storage containers containing cadmium, cadmium compounds, or cadmium contaminated clothing, equipment, waste, scrap, or debris in lieu of the labeling requirements specified in subsections (m)(1)(A) and (m)(3)(B) of this section:
DANGER
CONTAINS CADMIUM
CANCER HAZARD
AVOID CREATING DUST
CAN CAUSE LUNG AND KIDNEY DISEASE
(D) Where feasible, installed cadmium products shall have a visible label or other indication that cadmium is pre-sent.
(4) Employee Information and Training.
(A) The employer shall institute a training program for all employees who are potentially exposed to cadmium, assure employee participation in the program, and maintain a record of the contents of such program.
(B) Training shall be provided prior to or at the time of initial assignment to a job involving potential exposure to cadmium and at least annually thereafter.
(C) The employer shall make the training program understandable to the employee and shall assure that each employee is informed of the following:
1. The health hazards associated with cadmium exposure, with special attention to the information incorporated in Appendix A;
2. The quantity, location, manner of use, release, and storage of cadmium in the workplace and the specific nature of operations that could result in exposure to cadmium, especially exposures above the PEL;
3. The engineering controls and work practices associated with the employee's job assignment;
4. The measures employees can take to protect themselves from exposure to cadmium, including modification of such habits as smoking and personal hygiene, and specific procedures the employer has implemented to protect em-ployees from exposure to cadmium such as appropriate work practices, emergency procedures, and the provision of personal protective equipment;
5. The purpose, proper selection, fitting, proper use, and limitations of respirators and protective clothing;
6. The purpose and a description of the medical surveillance program required by subsection (l);
7. The contents of this section and its appendices, and,
8. The employee's rights of access to records under section 3204(e) and (g).
(D) Additional access to information and training program and materials.
1. The employer shall make a copy of this section and its appendices readily available without cost to all affected employees and shall provide a copy if requested.
2. The employer shall provide to the Chief or NIOSH, upon request, all materials relating to the employee infor-mation and the training program.
(n) Recordkeeping.
(1) Exposure Monitoring.
(A) The employer shall establish and keep an accurate record of all air monitoring for cadmium in the workplace.
(B) This record shall include at least the following information:
1. The monitoring date, duration, and results in terms of an 8-hour TWA of each sample taken;
2. The name, social security number, and job classification of the employees monitored and of all other employees whose exposures the monitoring is intended to represent;
3. A description of the sampling and analytical methods used and evidence of their accuracy;
4. The type of respiratory protective device, if any, worn by the monitored employee;
5. A notation of any other conditions that might have affected the monitoring results.
(C) The employer shall maintain this record for at least thirty (30) years, in accordance with section 3204.
(2) Objective Data for Exemption from Requirement for Initial Monitoring.
(A) For purposes of this section, objective data are information demonstrating that a particular product or material containing cadmium or a specific process, operation, or activity involving cadmium cannot release dust or fumes in concentrations at or above the action level even under the worst-case release conditions. Objective data can be ob-tained from an industry-wide study or from laboratory product test results from manufacturers of cadmium-containing products or materials. The data the employer uses from an industry-wide survey must be obtained under workplace conditions closely resembling the processes, types of material, control methods, work practices and environmental conditions in the employer's current operations.
(B) The employer shall establish and maintain a record of the objective data for at least 30 years.
(3) Medical Surveillance.
(A) The employer shall establish and maintain an accurate record for each employee covered by medical surveil-lance under subsection (l)(1)(A).
(B) The record shall include at least the following information about the employee:
1. Name, social security number, and description of the duties;
2. A copy of the physician's written opinions and an explanation sheet for biological monitoring results;
3. A copy of the medical history, and the results of any physical examination and all test results that are required to be provided by this section, including biological tests, X-rays, pulmonary function tests, etc., or that have been obtained to further evaluate any condition that might be related to cadmium exposure;
4. The employee's medical symptoms that might be related to exposure to cadmium; and
5. A copy of the information provided to the physician as required by subsection (l)(9)(B)-(E).
(C) The employer shall assure that this record is maintained for the duration of employment plus thirty (30) years, in accordance with section 3204.
(4) Training.
The employer shall certify that employees have been trained by preparing a certification record which includes the identity of the person trained, the signature of the employer or the person who conducted the training, and the date the training was completed. The certification records shall be prepared at the completion of training and shall be maintained on file for one (1) year beyond the date of training of that employee.
(5) Availability.
(A) Except as otherwise provided for in this section, access to all records required to be maintained by subsections (n)(1)-(4) shall be in accordance with the provisions of section 3204.
(B) Within 15 days after a request, the employer shall make an employee's medical records required to be kept by subsection (n)(3) available for examination and copying to the subject employee, to designated representatives, to anyone having the specific written consent of the subject employee, and after the employee's death or incapacitation, to the employee's family members.
(6) Transfer of Records.
Whenever an employer ceases to do business and there is no successor employer to receive and retain records for the prescribed period or the employer intends to dispose of any records required to be preserved for at least 30 years, the employer shall comply with the requirements concerning transfer of records set forth in section 3204 (h).
(o) Observation of Monitoring.
(1) Employee Observation.
The employer shall provide affected employees or their designated representatives an opportunity to observe any monitoring of employee exposure to cadmium.
(2) Observation Procedures.
When observation of monitoring requires entry into an area where the use of protective clothing or equipment is required, the employer shall provide the observer with that clothing and equipment and shall assure that the observer uses such clothing and equipment and complies with all other applicable safety and health procedures.
(p) Reporting requirements. See section 5203.
(q) Dates.
(1) Effective Date.
This section shall become effective June 14, 1993.
(2) Start-up dates.
All obligations of this section commence on the effective date except as follows:
(A) Exposure monitoring. Except for small businesses [nineteen (19) or fewer employees], initial monitoring re-quired by subsection (d)(2) shall be completed as soon as possible and in any event no later than 60 days after the effective date of this standard. For small businesses, initial monitoring required by subsection (d)(2) shall be completed as soon as possible and in any event no later than 120 days after the effective date of this standard.
(B) Regulated areas. Except for small business, defined under subsection (q)(2)(A) above, regulated areas required to be established by subsection (e) shall be set up as soon as possible after the results of exposure monitoring are known and in any event no later than 90 days after the effective date of this section. For small businesses, regulated areas required to be established by subsection (e) shall be set up as soon as possible after the results of exposure monitoring are known and in any event no later than 150 days after the effective date of this section.
(C) Respiratory protection. Except for small businesses, defined under subsection (q)(2)(A) above, respiratory protection required by subsection (g) shall be provided as soon as possible and in any event no later than 90 days after the effective date of this section. For small businesses, respiratory protection required by subsection (g) shall be pro-vided as soon as possible and in any event no later than 150 days after the effective date of this section.
(D) Compliance program. Written compliance programs required by subsection (f)(2) shall be completed and available for inspection and copying as soon as possible and in any event no later than 1 year after the effective date of this section.
(E) Methods of compliance. The engineering controls required by subsection (f)(1) shall be implemented as soon as possible and in any event no later than two (2) years after the effective date of this section. Work practice controls shall be implemented as soon as possible. Work practice controls that are directly related to engineering controls to be implemented in accordance with the compliance plan shall be implemented as soon as possible after such engineering controls are implemented.
(F) Hygiene and lunchroom facilities.
1. Handwashing facilities, permanent or temporary, shall be provided in accordance with Article 9 as soon as pos-sible and in any event no later than 60 days after the effective date of this section.
2. Change rooms, showers, and lunchroom facilities shall be completed as soon as possible and in any event no later than 1 year after the effective date of this section.
(G) Employee information and training. Except for small businesses, defined under subsection (q)(2)(A) above, employee information and training required by subsection (m)(4) shall be provided as soon as possible and in any event no later than 90 days after the effective date of this standard. For small businesses, employee information and training required by subsection (m)(4) shall be provided as soon as possible and in any event no later than 180 days after the effective date of this standard.
(H) Medical surveillance. Except for small businesses, defined under subsection (q)(2)(A) above, initial medical examinations required by subsection (l) shall be provided as soon as possible and in any event no later than 90 days after the effective date of this standard. For small businesses, initial medical examinations required by subsection (l) shall be provided as soon as possible and in any event no later than 180 days after the effective date of this standard.
(r) Appendices.
(1) Appendix C to this section is incorporated as part of this section, and compliance with its contents is mandatory.
(2) Except where portions of appendices A, B, D, E, and F to this section are expressly incorporated in require-ments of this section, these appendices are purely informational and are not intended to create any additional obliga-tions not otherwise imposed or to detract from any existing obligations.
Appendix A
Substance Safety Data Sheet
Cadmium
I. Substance Identification
A. Substance: Cadmium.
B. 8-Hour, Time-weighted-average, Permissible Exposure Limit (TWA PEL):
1. TWA PEL: Five micrograms of cadmium per cubic meter of air 5 [mu]g/m<3>, time-weighted average (TWA) for an 8-hour workday.
C. Appearance: Cadmium metal - soft, blue-white, malleable, lustrous metal or grayish-white powder. Some cad-mium compounds may also appear as a brown, yellow, or red powdery substance.
II. Health Hazard Data
A. Routes of Exposure.
Cadmium can cause local skin or eye irritation. Cadmium can affect your health if you inhale it or if you swallow it.
B. Effects of overexposure.
1. Short-term (acute) exposure: Cadmium is much more dangerous by inhalation than by ingestion. High exposures to cadmium that may be immediately dangerous to life or health occur in jobs where workers handle large quantities of cadmium dust or fume; heat cadmium-containing compounds or cadmium-coated surfaces; weld with cadmium solders or cut cadmium-containing materials such as bolts.
2. Severe exposure may occur before symptoms appear. Early symptoms may include mild irritation of the upper respiratory tract, a sensation of constriction of the throat, a metallic taste and/or a cough. A period of 1 - 10 hours may precede the onset of rapidly progressing shortness of breath, chest pain, and flu-like symptoms with weakness, fever, headache, chills, sweating and muscular pain. Acute pulmonary edema usually develops within 24 hours and reaches a maximum by three days. If death from asphyxia does not occur, symptoms may resolve within a week.
3. Long-term (chronic) exposure. Repeated or long-term exposure to cadmium, even at relatively low concentra-tions, may result in kidney damage and an increased risk of cancer of the lung and of the prostate.
C. Emergency First Aid Procedures
1. Eye exposure: Direct contact may cause redness or pain. Wash eyes immediately with large amounts of water, lifting the upper and lower eyelids. Get medical attention immediately.
2. Skin exposure: Direct contact may result in irritation. Remove contaminated clothing and shoes immediately. Wash affected area with soap or mild detergent and large amounts of water. Get medical attention immediately.
3. Ingestion: Ingestion may result in vomiting, abdominal pain, nausea, diarrhea, headache and sore throat. Treatment for symptoms must be administered by medical personnel. Under no circumstances should the employer allow any person whom he retains, employs, supervises or controls to engage in therapeutic chelation. Such treatment is likely to translocate cadmium from pulmonary or other tissue to renal tissue. Get medical attention immediately.
4. Inhalation: If large amounts of cadmium are inhaled, the exposed person must be moved to fresh air at once. If breathing has stopped, perform cardiopulmonary resuscitation. Administer oxygen if available. Keep the affected person warm and at rest. Get medical attention immediately.
5. Rescue: Move the affected person from the hazardous exposure. If the exposed person has been overcome, attempt rescue only after notifying at least one other person of the emergency and putting into effect established emergency procedures. Do not become a casualty yourself. Understand your emergency rescue procedures and know the location of the emergency equipment before the need arises.
III. Employee Information
A. Protective Clothing and Equipment
1. Respirators: You may be required to wear a respirator for non-routine activities; in emergencies; while your employer is in the process of reducing cadmium exposures through engineering controls; and where engineering con-trols are not feasible. If respirators are worn in the future, they must have a joint Mine Safety and Health Administration (MSHA) and National Institute for Occupational Safety and Health (NIOSH) label of approval. Cadmium does not have a detectable odor except at levels well above the permissible exposure limits. If you can smell cadmium while wearing a respirator, proceed immediately to fresh air. If you experience difficulty breathing while wearing a respirator, tell your employer.
2. Protective Clothing: You may be required to wear impermeable clothing, gloves, foot gear, a face shield, or other appropriate protective clothing to prevent skin contact with cadmium. Where protective clothing is required, your employer must provide clean garments to you as necessary to assure that the clothing protects you adequately. The employer must replace or repair protective clothing that has become torn or otherwise damaged.
3. Eye Protection: You may be required to wear splash-proof or dust resistant goggles to prevent eye contact with cadmium.
B. Employer Requirements
1. Medical: If you are exposed to cadmium at or above the action level, your employer is required to provide a medical examination, laboratory tests and a medical history according to the medical surveillance provisions under paragraph (l) of this standard. (See summary chart and tables in this Appendix A.) These tests shall be provided without cost to you. In addition, if you are accidentally exposed to cadmium under conditions known or suspected to constitute toxic exposure to cadmium, your employer is required to make special tests available to you.
2. Access to Records: All medical records are kept strictly confidential. You or your representative are entitled to see the records of measurements of your exposure to cadmium. Your medical examination records can be furnished to your personal physician or designated representative upon request by you to your employer.
3. Observation of Monitoring: Your employer is required to perform measurements that are representative of your exposure to cadmium and you or your designated representative are entitled to observe the monitoring proce-dure. You are entitled to observe the steps taken in the measurement procedure, and to record the results obtained. When the monitoring procedure is taking place in an area where respirators or personal protective clothing and equipment are required to be worn, you or your representative must also be provided with, and must wear the pro-tective clothing and equipment.
C. Employee Requirements
You will not be able to smoke, eat, drink, chew gum or tobacco, or apply cosmetics while working with cadmium in regulated areas. You will also not be able to carry or store tobacco products, gum, food, drinks or cosmetics in reg-ulated areas because these products easily become contaminated with cadmium from the workplace and can therefore create another source unnecessary of cadmium exposure.
Some workers will have to change out of work clothes and shower at the end of the day, as part of their workday, in order to wash cadmium from skin and hair. Handwashing and cadmium-free eating facilities shall be provided by the employer and proper hygiene should always be performed before eating. It is also recommended that you do not smoke or use tobacco products, because among other things, they naturally contain cadmium. For further information, read the labeling on such products.
IV. Physician Information
A. Introduction
The medical surveillance provisions of paragraph (l) generally are aimed at accomplishing three main interrelated purposes: first, identifying employees at higher risk of adverse health effects from excess, chronic exposure to cad-mium; second, preventing cadmium-induced disease; and third, detecting and minimizing existing cadmium-induced disease. The core of medical surveillance in this standard is the early and periodic monitoring of the employee's bio-logical indicators of: a) recent exposure to cadmium; b) cadmium body burden; and c) potential and actual kidney damage associated with exposure to cadmium.
The main adverse health effects associated with cadmium overexposure are lung cancer and kidney dysfunction. It is not yet known how to adequately biologically monitor human beings to specifically prevent cadmium-induced lung cancer. By contrast, the kidney can be monitored to provide prevention and early detection of cadmium-induced kidney damage. Since, for non-carcinogenic effects, the kidney is considered the primary target organ of chronic ex-posure to cadmium, the medical surveillance provisions of this standard effectively focus on cadmium-induced kidney disease. Within that focus, the aim, where possible, is to prevent the onset of such disease and, where necessary, to minimize such disease as may already exist. The by-products of successful prevention of kidney disease are anticipated to be the reduction and prevention of other cadmium-induced diseases.
B. Health Effects
The major health effects associated with cadmium overexposure are described below.
1. Kidney
The most prevalent non-malignant disease observed among workers chronically exposed to cadmium is kidney dysfunction. Initially, such dysfunction is manifested as proteinuria. The proteinuria associated with cadmium exposure is most commonly characterized by excretion of low-molecular weight proteins (15,000 to 40,000 MW) accompanied by loss of electrolytes, uric acid, calcium, amino acids, and phosphate. The compounds commonly excreted include: beta-2- microglobulin ([beta][2]-M), retinol binding protein (RBP), immunoglobulin light chains, and lysozyme. Excretion of low molecular weight proteins are characteristic of damage to the proximal tubules of the kidney (Iwao et al., 1980).
It has also been observed that exposure to cadmium may lead to urinary excretion of high-molecular weight pro-teins such as albumin, immunoglobulin G, and glycoproteins (Ex. 29). Excretion of high-molecular weight proteins is typically indicative of damage to the glomeruli of the kidney. Bernard et al., (1979) suggest that damage to the glomeruli and damage to the proximal tubules of the kidney may both be linked to cadmium exposure but they may occur independently of each other.
Several studies indicate that the onset of low-molecular weight proteinuria is a sign of irreversible kidney damage (Friberg et al., 1974; Roels et al., 1982; Piscator 1984; Elinder et al., 1985; Smith et al., 1986). Above specific levels of [beta][2]-M associated with cadmium exposure it is unlikely that [beta][2]-M levels return to normal even when cad-mium exposure is eliminated by removal of the individual from the cadmium work environment (Friberg, Ex. 29, 1990).
Some studies indicate that such proteinuria may be progressive; levels of [beta][2]-M observed in the urine in-crease with time even after cadmium exposure has ceased. See, for example, Elinder et al., 1985. Such observations, however, are not universal, and it has been suggested that studies in which proteinuria has not been observed to pro-gress may not have tracked patients for a sufficiently long time interval (Jarup, Ex. 8-661).
When cadmium exposure continues after the onset of proteinuria, chronic nephrotoxicity may occur (Friberg, Ex. 29). Uremia results from the inability of the glomerulus to adequately filter blood. This leads to severe disturbance of electrolyte concentrations and may lead to various clinical complications including kidney stones (L-140-50).
After prolonged exposure to cadmium, glomerular proteinuria, glucosuria, aminoaciduria, phosphaturia, and hy-percalciuria may develop (Exs. 8-86, 4-28, 14-18). Phosphate, calcium, glucose, and amino acids are essential to life, and under normal conditions, their excretion should be regulated by the kidney. Once low molecular weight pro-teinuria has developed, these elements dissipate from the human body. Loss of glomerular function may also occur, manifested by decreased glomerular filtration rate and increased serum creatinine. Severe cadmium- induced renal damage may eventually develop into chronic renal failure and uremia (Ex. 55).
Studies in which animals are chronically exposed to cadmium confirm the renal effects observed in humans (Friberg et al., 1986). Animal studies also confirm problems with calcium metabolism and related skeletal effects which have been observed among humans exposed to cadmium in addition to the renal effects. Other effects commonly reported in chronic animal studies include anemia, changes in liver morphology, immunosuppression and hy-pertension. Some of these effects may be associated with co- factors. Hypertension, for example, appears to be asso-ciated with diet as well as cadmium exposure. Animals injected with cadmium have also shown testicular necrosis (Ex. 8-86B).
2. Biological Markers
It is universally recognized that the best measures of cadmium exposures and its effects are measurements of cadmium in biological fluids, especially urine and blood. Of the two, CdU is conventionally used to determine body burden of cadmium in workers without kidney disease. CdB is conventionally used to monitor for recent exposure to cadmium. In addition, levels of CdU and CdB historically have been used to predict the percent of the population likely to develop kidney disease (Thun et al., Ex. L-140-50; WHO, Ex. 8-674; ACGIH, Exs. 8-667, 140-50).
The third biological parameter upon which OSHA relies for medical surveillance is Beta-2-microglobulin in urine ([beta][2]-M), a low molecular weight protein. Excess [beta][2]-M has been widely accepted by physicians and scientists as a reliable indicator of functional damage to the proximal tubule of the kidney (Exs. 8- 447, 144-3-C, 4-47, L-140-45, 19-43-A).
Excess [beta][2]-M is found when the proximal tubules can no longer reabsorb this protein in a normal manner. This failure of the proximal tubules is an early stage of a kind of kidney disease that commonly occurs among workers with excessive cadmium exposure. Used in conjunction with biological test results indicating abnormal levels of CdU and CdB, the finding of excess [beta][2]-M can establish for an examining physician that any existing kidney disease is probably cadmium-related (Trs. 6/6/90, pp. 82- 86, 122, 134). The upper limits of normal levels for cadmium in urine and cadmium in blood are 3 [mu]g Cd/gram creatinine in urine and 5 [mu]g Cd/liter whole blood, respectively. These levels were derived from broad-based population studies.
Three issues confront the physicians in the use of [beta][2]-M as a marker of kidney dysfunction and material im-pairment. First, there are a few other causes of elevated levels of [beta][2[-M not related to cadmium exposures, some of which may be rather common diseases and some of which are serious diseases (e.g., myeloma or transient flu, Exs. 29 and 8-086). These can be medically evaluated as alternative causes (Friberg, Ex. 29). Also, there are other factors that can cause [beta][2]-M to degrade so that low levels would result in workers with tubular dysfunction. For example, regarding the degradation of [beta][2]-M, workers with acidic urine (pH < 6) might have [beta][2]-M levels that are within the "normal" range when in fact kidney dysfunction has occurred (Ex. L-140-1) and the low molecular weight proteins are degraded in acid urine. Thus, it is very important that the pH of urine be measured, that urine samples be buffered as necessary (See Appendix F.), and that urine samples be handled correctly, i.e., measure the pH of freshly voided urine samples, then if necessary, buffer to pH > 6 (or above for shipping purposes), measure pH again and then, perhaps, freeze the sample for storage and shipping. (See also Appendix F.) Second, there is debate over the pathological significance of proteinuria, however, most world experts believe that [beta][2]-M levels greater than 300 [mu]g/g Cr are abnormal (Elinder, Ex. 55, Friberg, Ex. 29). Such levels signify kidney dysfunction that constitutes material impairment of health. Finally, detection of [beta][2]-M at low levels has often been considered difficult, however, many laboratories have the capability of detecting excess [beta][2]-M using simple kits, such as the Phadebas Delphia test, that are accurate to levels of 100 [mu]g [beta][2]-M/g Cr U (Ex. L-140-1).
Specific recommendations for ways to measure [beta][2]-M and proper handling of urine samples to prevent degradation of [beta][2]-M have been addressed by OSHA in Appendix F, in the section on laboratory standardization. All biological samples must be analyzed in a laboratory that is proficient in the analysis of that particular analyte, under paragraph (l)(1)(iv). [See Appendix F]. Specifically, under paragraph (l)(1)(iv), the employer is to assure that the collecting and handling of biological samples of cadmium in urine (CdU), cadmium in blood (CdB), and beta-2 micro-globulin in urine ([beta][2]-M) taken from employees is collected in a manner that assures reliability. The employer must also assure that analysis of biological samples of cadmium in urine (CdU), cadmium in blood (CdB), and beta-2 microglobulin in urine ([beta][2]-M) taken from employees is performed in laboratories with demonstrated proficiency for that particular analyte. (See Appendix F.)
3. Lung and Prostate Cancer
The primary sites for cadmium-associated cancer appear to be the lung and the prostate (L-140-50). Evidence for an association between cancer and cadmium exposure derives from both epidemiological studies and animal experi-ments. Mortality from prostate cancer associated with cadmium is slightly elevated in several industrial cohorts, but the number of cases is small and there is not clear dose-response relationship. More substantive evidence exists for lung cancer.
The major epidemiological study of lung cancer was conducted by Thun et al., (Ex. 4-68). Adequate data on cad-mium exposures were available to allow evaluation of dose-response relationships between cadmium exposure and lung cancer. A statistically significant excess of lung cancer attributed to cadmium exposure was observed in this study even when confounding variables such as co-exposure to arsenic and smoking habits were taken into consideration (Ex. L-140-50).
The primary evidence for quantifying a link between lung cancer and cadmium exposure from animal studies de-rives from two rat bioassay studies; one by Takenaka et al., (1983), which is a study of cadmium chloride and a second study by Oldiges and Glaser (1990) of four cadmium compounds.
Based on the above cited studies, the U.S. Environmental Protection Agency (EPA) classified cadmium as "B1", a probable human carcinogen, in 1985 (Ex. 4- 4). The International Agency for Research on Cancer (IARC) in 1987 also recommended that cadmium be listed as "2A", a probable human carcinogen (Ex. 4- 15). The American Conference of Governmental Industrial Hygienists (ACGIH) has recently recommended that cadmium be labeled as a carcinogen. Since 1984, NIOSH has concluded that cadmium is possibly a human carcinogen and has recommended that exposures be controlled to the lowest level feasible.
4. Non-carcinogenic Effects
Acute pneumonitis occurs 10 to 24 hours after initial acute inhalation of high levels of cadmium fumes with symptoms such as fever and chest pain (Exs. 30, 8- 86B). In extreme exposure cases pulmonary edema may develop and cause death several days after exposure. Little actual exposure measurement data is available on the level of air-borne cadmium exposure that causes such immediate adverse lung effects, nonetheless, it is reasonable to believe a cadmium concentration of approximately 1 mg/m<3> over an eight hour period is "immediately dangerous" (55 FR 4052, ANSI; Ex. 8-86B).
In addition to acute lung effects and chronic renal effects, long term exposure to cadmium may cause other severe effects on the respiratory system. Reduced pulmonary function and chronic lung disease indicative of emphysema have been observed in workers who have had prolonged exposure to cadmium dust or fumes (Exs. 4-29, 4-22, 4-42, 4-50, 4-63). In a study of workers conducted by Kazantzis et al., a statistically significant excess of worker deaths due to chronic bronchitis was found, which in his opinion was directly related to high cadmium exposures of 1 mg/m<3> or more (Tr. 6/8/90, pp. 156-157).
Cadmium need not be respirable to constitute a hazard. Inspirable cadmium particles that are too large to be res-pirable but small enough to enter the tracheobronchial region of the lung can lead to bronchoconstriction, chronic pulmonary disease, and cancer of that portion of the lung. All of these diseases have been associated with occupational exposure to cadmium (Ex. 8- 86B). Particles that are constrained by their size to the extra-thoracic regions of the respiratory system such as the nose and maxillary sinuses can be swallowed through mucocillary clearance and be absorbed into the body (ACGIH, Ex. 8-692). The impaction of these particles in the upper airways can lead to anosmia, or loss of sense of smell, which is an early indication of overexposure among workers exposed to heavy metals. This condition is commonly reported among cadmium-exposed workers (Ex. 8-86-B).
C. Medical Surveillance
In general, the main provisions of the medical surveillance section of the standard, under paragraphs (l)(1)-(17) of the regulatory text, are as follows:
1. Workers exposed above the action level are covered;
2. Workers with intermittent exposures are not covered;
3. Past workers who are covered receive biological monitoring for at least one year;
4. Initial examinations include a medical questionnaire and biological monitoring of cadmium in blood (CdB), cad-mium in urine (CdU), and Beta-2- microglobulin in urine ([beta][2]-M);
5. Biological monitoring of these three analytes is performed at least annually; full medical examinations are per-formed biennially;
6. Until five years from the effective date of the standard, medical removal is required when CdU is greater than 15 [mu]g/gram creatinine (g Cr), or CdB is greater than 15 [mu]g/liter whole blood (lwb), or [beta][2]-M is greater than 1500 [mu]g/g Cr, and CdB is greater than 5 [mu]g/lwb or CdU is greater than 3 [mu]g/g Cr;
7. Beginning five years after the standard is in effect, medical removal triggers will be reduced;
8. Medical removal protection benefits are to be provided for up to 18 months;
9. Limited initial medical examinations are required for respirator usage;
10. Major provisions are fully described under section (l) of the regulatory text; they are outlined here as follows:
A. Eligibility
B. Biological monitoring
C. Actions triggered by levels of CdU, CdB, and [beta][2]-M (See Summary Charts and Tables in Attachment-1.)
D. Periodic medical surveillance
E. Actions triggered by periodic medical surveillance (See Appendix A Summary Chart and Tables in Attachment-1.)
F. Respirator usage
G. Emergency medical examinations
H. Termination examination
I. Information to physician
J. Physician's medical opinion
K. Medical removal protection
L. Medical removal protection benefits
M. Multiple physician review
N. Alternate physician review
O. Information employer gives to employee
P. Recordkeeping
Q. Reporting on OSHA form 200
11. The above mentioned summary of the medical surveillance provisions, the summary chart, and tables for the actions triggered at different levels of CdU, CdB and [beta][2]-M (in Appendix A Attachment-1) are included only for the purpose of facilitating understanding of the provisions of paragraphs (l)(3) of the final cadmium standard. The summary of the provisions, the summary chart, and the tables do not add to or reduce the requirements in paragraph (l)(3).
D. Recommendations to Physicians
1. It is strongly recommended that patients with tubular proteinuria are counseled on: the hazards of smoking; avoidance of nephrotoxins and certain prescriptions and over-the-counter medications that may exacerbate kidney symptoms; how to control diabetes and/or blood pressure; proper hydration, diet, and exercise (Ex. 19-2). A list of prominent or common nephrotoxins is attached. (See Appendix A Attachment-2.)
2. DO NOT CHELATE; KNOW WHICH DRUGS ARE NEPHROTOXINS OR ARE ASSOCIATED WITH NEPHRITIS.
3. The gravity of cadmium-induced renal damage is compounded by the fact there is no medical treatment to prevent or reduce the accumulation of cadmium in the kidney (Ex. 8-619). Dr. Friberg, a leading world expert on cad-mium toxicity, indicated in 1992, that there is no form of chelating agent that could be used without substantial risk. He stated that tubular proteinuria has to be treated in the same way as other kidney disorders (Ex. 29).
4. After the results of a workers' biological monitoring or medical examination are received the employer is re-quired to provide an information sheet to the patient, briefly explaining the significance of the results. (See Attachment 3 of this Appendix A.)
5. For additional information the physician is referred to the following additional resources:
a. The physician can always obtain a copy of the preamble, with its full discussion of the health effects, from OSHA's Computerized Information System (OCIS).
b. The Docket Officer maintains a record of the rulemaking. The Cadmium Docket (H-057A), is located at 200 Con-stitution Ave. N.W., Room N-2625, Washington, D.C. 20210; telephone: 202-523- 7894.
c. The following articles and exhibits in particular from that docket (H-057A):
Exhibit number Author and paper title
8-447 Lauwerys et. al., Guide for physicians, Health
Maintenance of Workers Exposed to Cadmium published by
the Cadmium Council
4-67 Takenaka, S., H. Oldiges, H. Konig, D. Hochrainer, G.
Oberdorster. "Carcinogenicity of Cadmium Chloride
Aerosols in Wistar Rats". JNCI 70:367-373, 1983. (32)
Exhibit number Author and paper title
4-68 Thun, M.J., T.M. Schnoor, A.B. Smith, W.E. Halperin,
R.A. Lemen. "Mortality Among a Cohort of U.S. Cadmium
Production Workers - An Update." JNCI 74(2):325-33,
1985. (8)
4-25 Elinder, C.G., Kjellstrom, T., Hogstedt, C., et al.,
"Cancer Mortality of Cadmium Workers. Brit. J. Ind. Med.
42:651-655, 1985. (14) Exhibit number Author and paper
title
4-26 Ellis, K.J. et al., "Critical Concentrations of Cadmium
in Human Renal Cortex: Dose Effect Studies to Cadmium
Smelter Workers." J. Toxicol. Environ. Health 7:691-703,
1981. (76)
4-27 Ellis, K.J., S.H. Cohn and T.J. Smith. "Cadmium
Inhalation Exposure Estimates: Their Significance with
Respect to Kidney and Liver Cadmium Burden." J. Toxicol.
Environ. Health 15:173-187, 1985.
4-28 Falck, F.Y., Jr., Fine, L.J., Smith, R.G.,
McClatchey, K.D., Annesley, T., England, B., and Schork,
A.M. "Occupational Cadmium Exposure and Renal Status."
Am J.Ind.Med. 4:541, 1983. (64)
8-86A Friberg, L., C.G. Elinder, et al., Cadmium and Health a
Toxicological and Epidemiological Appraisal Volume I
Exposure, Dose, and Metabolism. CRC Press, Inc., Boca
Raton, FL, 1986. (Available from the OSHA Technical Data
Center)
8-86B Friberg, L., C.G. Elinder, et al. Cadmium and Health: A
Toxicological and Epidemiological Appraisal Volume II
Effects and Response. CRC Press, Inc., Boca Raton, FL,
1986. (Available from the OSHA Technical Data Center)
L-140-45 Elinder, C.G., "Cancer Morality of Cadmium Workers",
Brit. J. Ind. Med., 42, 651-655, 1985.
L-140-50 Thun, M., Elinder, C.G., Friberg, L, "Scientific Basis
for an Occupational Standard for Cadmium, Am. J. Ind.
Med., 20; 629-642, 1991.
V. Information Sheet
The information sheet (Appendix A Attachment-3.) or an equally explanatory one should be provided to you after any biological monitoring results are reviewed by the physician, or where applicable, after any medical examination.
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