Worker Reports Shortness of Breath and a New Cough Mid-Project
A 52-year-old abatement worker with 14 years in the trade mentions to the supervisor that over the past three weeks he has had a persistent dry cough and gets short of breath climbing the scaffold, which he never noticed before. He is a smoker and says it is probably "just a cold." He has had no medical surveillance since he was hired years ago, and the employer has no written respiratory protection program on file. He asks the supervisor not to make a big deal of it because he needs the hours. The current job involves dry removal of friable material, and his fit test was never repeated after he grew a beard last year.
1. What are the supervisor's obligations regarding the worker's symptoms and the missing medical surveillance?
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The supervisor should not dismiss the symptoms or let the worker waive them. Obligations include:
- Refer the worker for medical evaluation through the employer's medical surveillance/respiratory protection program; new or worsening respiratory symptoms are a trigger for evaluation, not a reason to wait.
- Recognize that the absence of medical surveillance and a written respiratory protection program is a program deficiency that must be corrected for the whole crew, not just this worker.
- Document the report and the referral.
- Keep the worker's medical information confidential; the supervisor manages the process, not the diagnosis.
The judgment: symptoms in a asbestos-exposed worker are a medical-surveillance trigger, and the employer's missing program is itself a compliance problem that must be fixed.
2. The worker has a beard and has not been fit-tested since growing it. How does that affect his current assignment and the respirator program?
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Facial hair that crosses the sealing surface of a tight-fitting respirator prevents a reliable seal, so the worker cannot be safely assigned a tight-fitting respirator until he is clean-shaven at the seal and passes a fit test. Until then:
- He should not perform the dry friable removal in a tight-fitting respirator.
- Options include reassignment to a task not requiring tight-fitting respiratory protection, or use of a loose-fitting powered air-purifying respirator (if the program and hazard assessment support it), with the appropriate fit/performance checks.
- The employer must reinstate fit testing on a schedule and whenever facial conditions change.
The judgment: a beard is a disqualifying condition for a tight-fitting seal; the fix is reassignment or a different respirator type, not a verbal assurance.