Worker Exposure Symptoms and Medical Surveillance
A 45-year-old abatement worker has been employed for 12 years, with intermittent exposure to asbestos during abatement projects. He reports shortness of breath, a persistent dry cough, and chest tightness that have worsened over the past 6 months. He is a smoker (1 pack/day for 20 years). His most recent training was 8 months ago. He has not had a medical examination in 3 years. The employer's respiratory protection program requires annual fit testing and medical clearance. The worker's last fit test was 14 months ago. The employer is a small contractor with 8 employees and no on-site physician. The worker is reluctant to report symptoms because he fears losing his job.
1. What are the employer's obligations regarding medical surveillance and fit testing for this worker?
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Under OSHA 29 CFR 1926.1101(m), the employer must provide medical examinations to employees exposed to asbestos at or above the permissible exposure limit (PEL) or excursion limit, or who wear negative pressure respirators. The worker's symptoms and history warrant a medical examination. The employer must ensure the worker is examined by or under the supervision of a licensed physician, at no cost to the employee, with information provided to the physician about the worker's exposure and respiratory protection use. The fit test is overdue (annual requirement); the employer must not allow the worker to use a respirator until fit testing and medical clearance are current. The employer must also provide training (annual requirement) and ensure the worker is not penalized for reporting symptoms. Retaliation is prohibited.
2. What exposure control measures should be considered given the worker's symptoms and smoking history?
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The worker's symptoms could be related to asbestos exposure, smoking, or both. The employer should remove the worker from further asbestos exposure pending medical evaluation, if possible, without penalty. The employer should review exposure monitoring records to ensure controls are adequate. If the worker returns to work, the employer must ensure engineering controls (e.g., negative pressure, HEPA vacuums) and work practices are effective, and provide respiratory protection appropriate for the exposure level. The employer should also offer smoking cessation resources. Under OSHA, the employer must provide a respirator if requested, even if exposure is below the PEL, and must ensure medical clearance. The worker's smoking history increases risk of asbestos-related disease, so a comprehensive medical evaluation including chest X-ray and pulmonary function tests is recommended.