[Code of Federal Regulations]
[Title 29, Volume 6]
[Revised as of July 1, 2001]
From the U.S. Government Printing Office via GPO Access
[CITE: 29CFR1910.1025]

[Page 104-135]
 
                             TITLE 29--LABOR
 
CHAPTER XVII--OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT 
                                OF LABOR
 
PART 1910--OCCUPATIONAL SAFETY AND HEALTH STANDARDS (Continued)--Table of Contents
 
                Subpart Z--Toxic and Hazardous Substances
 
Sec. 1910.1025  Lead.

    (a) Scope and application. (1) This section applies to all 
occupational exposure to lead, except as provided in paragraph (a)(2).
    (2) This section does not apply to the construction industry or to 
agricultural operations covered by 29 CFR Part 1928.
    (b) Definitions. Action level means employee exposure, without 
regard to the use of respirators, to an airborne concentration of lead 
of 30 micrograms per cubic meter of air (30 <greek-m>g/m<SUP>3</SUP>) 
averaged over an 8-hour period.
    Assistant Secretary means the Assistant Secretary of Labor for 
Occupational Safety and Health, U.S. Department of Labor, or designee.
    Director means the Director, National Institute for Occupational 
Safety and Health (NIOSH), U.S. Department of Health, Education, and 
Welfare, or designee.
    Lead means metallic lead, all inorganic lead compounds, and organic 
lead soaps. Excluded from this definition are all other organic lead 
compounds.
    (c) Permissible exposure limit (PEL). (1) The employer shall assure 
that no employee is exposed to lead at concentrations greater than fifty 
micrograms per cubic meter of air (50 <greek-m>g/m<SUP>3</SUP>) averaged 
over an 8-hour period.
    (2) If an employee is exposed to lead for more than 8 hours in any 
work day, the permissible exposure limit, as a time weighted average 
(TWA) for that day, shall be reduced according to the following formula:

Maximum permissible limit (in <greek-m>g/m<SUP>3</SUP>)=400<divide>hours 
                           worked in the day.

    (3) When respirators are used to supplement engineering and work 
practice controls to comply with the PEL and all the requirements of 
paragraph (f) have been met, employee exposure, for the purpose of 
determining whether the employer has complied with the PEL, may be 
considered to be at the level provided by the protection factor of the 
respirator for those periods the respirator is worn. Those periods may 
be averaged with exposure levels during periods when respirators are not 
worn to determine the employee's daily TWA exposure.

[[Page 105]]

    (d) Exposure monitoring--(1) General. (i) For the purposes of 
paragraph (d), employee exposure is that exposure which would occur if 
the employee were not using a respirator.
    (ii) With the exception of monitoring under paragraph (d)(3), the 
employer shall collect full shift (for at least 7 continuous hours) 
personal samples including at least one sample for each shift for each 
job classification in each work area.
    (iii) Full shift personal samples shall be representative of the 
monitored employee's regular, daily exposure to lead.
    (2) Initial determination. Each employer who has a workplace or work 
operation covered by this standard shall determine if any exployee may 
be exposed to lead at or above the action level.
    (3) Basis of initial determination. (i) The employer shall monitor 
employee exposures and shall base initial determinations on the employee 
exposure monitoring results and any of the following, relevant 
considerations:
    (A) Any information, observations, or calculations which would 
indicate employee exposure to lead;
    (B) Any previous measurements of airborne lead; and
    (C) Any employee complaints of symptoms which may be attributable to 
exposure to lead.
    (ii) Monitoring for the initial determination may be limited to a 
representative sample of the exposed employees who the employer 
reasonably believes are exposed to the greatest airborne concentrations 
of lead in the workplace.
    (iii) Measurements of airborne lead made in the preceding 12 months 
may be used to satisfy the requirement to monitor under paragraph 
(d)(3)(i) if the sampling and analytical methods used meet the accuracy 
and confidence levels of paragraph (d)(9) of this section.
    (4) Positive initial determination and initial monitoring. (i) Where 
a determination conducted under paragraphs (d) (2) and (3) of this 
section shows the possibility of any employee exposure at or above the 
action level, the employer shall conduct monitoring which is 
representative of the exposure for each employee in the workplace who is 
exposed to lead.
    (ii) Measurements of airborne lead made in the preceding 12 months 
may be used to satisfy this requirement if the sampling and analytical 
methods used meet the accuracy and confidence levels of paragraph (d)(9) 
of this section.
    (5) Negative initial determination. Where a determination, conducted 
under paragraphs (d) (2) and (3) of this section is made that no 
employee is exposed to airborne concentrations of lead at or above the 
action level, the employer shall make a written record of such 
determination. The record shall include at least the information 
specified in paragraph (d)(3) of this section and shall also include the 
date of determination, location within the worksite, and the name and 
social security number of each employee monitored.
    (6) Frequency. (i) If the initial monitoring reveals employee 
exposure to be below the action level the measurements need not be 
repeated except as otherwise provided in paragraph (d)(7) of this 
section.
    (ii) If the initial determination or subsequent monitoring reveals 
employee exposure to be at or above the action level but below the 
permissible exposure limit the employer shall repeat monitoring in 
accordance with this paragraph at least every 6 months. The employer 
shall continue monitoring at the required frequency until at least two 
consecutive measurements, taken at least 7 days apart, are below the 
action level at which time the employer may discontinue monitoring for 
that employee except as otherwise provided in paragraph (d)(7) of this 
section.
    (iii) If the initial monitoring reveals that employee exposure is 
above the permissible exposure limit the employer shall repeat 
monitoring quarterly. The employer shall continue monitoring at the 
required frequency until at least two consecutive measurements, taken at 
least 7 days apart, are below the PEL but at or above the action level 
at which time the employer shall repeat monitoring for that employee at 
the frequency specified in paragraph (d)(6)(ii), except as otherwise

[[Page 106]]

provided in paragraph (d)(7) of this section.
    (7) Additional monitoring. Whenever there has been a production, 
process, control or personnel change which may result in new or 
additional exposure to lead, or whenever the employer has any other 
reason to suspect a change which may result in new or additional 
exposures to lead, additional monitoring in accordance with this 
paragraph shall be conducted.
    (8) Employee notification. (i) Within 5 working days after the 
receipt of monitoring results, the employer shall notify each employee 
in writing of the results which represent that employee's exposure.
    (ii) Whenever the results indicate that the representative employee 
exposure, without regard to respirators, exceeds the permissible 
exposure limit, the employer shall incude in the written notice a 
statement that the permissible exposure limit was exceeded and a 
description of the corrective action taken or to be taken to reduce 
exposure to or below the permissible exposure limit.
    (9) Accuracy of measurement. The employer shall use a method of 
monitoring and analysis which has an accuracy (to a confidence level of 
95%) of not less than plus or minus 20 percent for airborne 
concentrations of lead equal to or greater than 30 <greek-m>g/
m<SUP>3</SUP>.
    (e) Methods of compliance--(1) Engineering and work practice 
controls. (i) Where any employee is exposed to lead above the 
permissible exposure limit for more than 30 days per year, the employer 
shall implement engineering and work practice controls (including 
administrative controls) to reduce and maintain employee exposure to 
lead in accordance with the implementation schedule in Table I below, 
except to the extent that the employer can demonstrate that such 
controls are not feasible. Wherever the engineering and work practice 
controls which can be instituted are not sufficient to reduce employee 
exposure to or below the permissible exposure limit, the employer shall 
nonetheless use them to reduce exposures to the lowest feasible level 
and shall supplement them by the use of respiratory protection which 
complies with the requirements of paragraph (f) of this section.
    (ii) Where any employee is exposed to lead above the permissible 
exposure limit, but for 30 days or less per year, the employer shall 
implement engineering controls to reduce exposures to 200 <greek-m>g/
m<SUP>3</SUP>, but thereafter may implement any combination of 
engineering, work practice (including administrative controls), and 
respiratory controls to reduce and maintain employee exposure to lead to 
or below 50 <greek-m>g/m<SUP>3</SUP>.

                                 Table I
------------------------------------------------------------------------
                                              Compliance dates: <SUP>1</SUP> (50
                 Industry                         <greek-m>g/m\3\)
------------------------------------------------------------------------
Lead chemicals, secondary copper smelting  July 19, 1996.
Nonferrous foundries.....................  July 19, 1996. \2\
Brass and bronze ingot manufacture.......  6 years.\3\
------------------------------------------------------------------------
\1\ Calculated by counting from the date the stay on implementation of
  paragraph (e)(1) was lifted by the U.S. Court of Appeals for the
  District of Columbia, the number of years specified in the 1978 lead
  standard and subsequent amendments for compliance with the PEL of 50
  <greek-m> g/m\3\ for exposure to airborne concentrations of lead
  levels for the particular industry.
\2\ Large nonferrous foundries (20 or more employees) are required to
  achieve the PEL of 50 <greek-m> g/m\3\ by means of engineering and
  work practice controls. Small nonferrous foundries (fewer than 20
  employees) are required to achieve an 8-hour TWA of 75 <greek-m> g/
  m\3\ by such controls.
\3\ Expressed as the number of years from the date on which the Court
  lifts the stay on the implementation of paragraph (e)(1) for this
  industry for employers to achieve a lead in air concentration of 75
  <greek-m> g/m\3\. Compliance with paragraph (e) in this industry is
  determined by a compliance directive that incorporates elements from
  the settlement agreement between OSHA and representatives of the
  industry.

    (2) Respiratory protection. Where engineering and work practice 
controls do not reduce employee exposure to or below the 50 <greek-m>g/
m<SUP>3</SUP>permissible exposure limit, the employer shall supplement 
these controls with respirators in accordance with paragraph (f). 
    (3) Compliance program. (i) Each employer shall establish and 
implement a written compliance program to reduce exposures to or below 
the permissible exposure limit, and interim levels if applicable, solely 
by means of engineering and work practice controls in accordance with 
the implementation schedule in paragraph (e)(1).
    (ii) Written plans for these compliance programs shall include at 
least the following:
    (A) A description of each operation in which lead is emitted; e.g. 
machinery used, material processed, controls in

[[Page 107]]

place, crew size, employee job responsibilities, operating procedures 
and maintenance practices;
    (B) 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 lead;
    (C) A report of the technology considered in meeting the permissible 
exposure limit;
    (D) Air monitoring data which documents the source of lead 
emissions;
    (E) A detailed schedule for implementation of the program, including 
documentation such as copies of purchase orders for equipment, 
construction contracts, etc.;
    (F) A work practice program which includes items required under 
paragraphs (g), (h) and (i) of this regulation;
    (G) An administrative control schedule required by paragraph (e)(6), 
if applicable;
    (H) Other relevant information.
    (iii) Written programs shall be submitted upon request to the 
Assistant Secretary and the Director, and shall be available at the 
worksite for examination and copying by the Assistant Secretary, 
Director, any affected employee or authorized employee representatives.
    (iv) Written programs shall be revised and updated at least every 6 
months to reflect the current status of the program.
    (4) Mechanical ventilation. (i) When ventilation is used to control 
exposure, measurements which demonstrate the effectiveness of the system 
in controlling exposure, such as capture velocity, duct velocity, or 
static pressure shall be made at least every 3 months. Measurements of 
the system's effectiveness in controlling exposure shall be made within 
5 days of any change in production, process, or control which might 
result in a change in employee exposure to lead.
    (ii) Recirculation of air. If air from exhaust ventilation is 
recirculated into the workplace, the employer shall assure that (A) the 
system has a high efficiency filter with reliable back-up filter; and 
(B) controls to monitor the concentration of lead in the return air and 
to bypass the recirculation system automatically if it fails are 
installed, operating, and maintained.
    (5) Administrative controls. If administrative controls are used as 
a means of reducing employees TWA exposure to lead, the employer shall 
establish and implement a job rotation schedule which includes:
    (i) Name or identification number of each affected employee;
    (ii) Duration and exposure levels at each job or work station where 
each affected employee is located; and
    (iii) Any other information which may be useful in assessing the 
reliability of administrative controls to reduce exposure to lead.
    (f) Respiratory protection--(1) General. For employees who use 
respirators required by this section, the employer must provide 
respirators that comply with the requirements of this paragraph. 
Respirators must be used during:
    (i) Periods necessary to install or implement engineering or work-
practice controls.
    (ii) Work operations for which engineering and work-practice 
controls are not sufficient to reduce employee exposures to or below the 
permissible exposure limit.
    (iii) Periods when an employee requests a respirator.
    (2) Respirator program. (i) The employer must implement a 
respiratory protection program in accordance with 29 CFR 1910.134 (b) 
through (d) (except (d)(1)(iii)), and (f) through (m).
    (ii) If an employee has breathing difficulty during fit testing or 
respirator use, the employer must provide the employee with a medical 
examination in accordance with paragraph (j)(3)(i)(C) of this section to 
determine whether or not the employee can use a respirator while 
performing the required duty.

           Table II--Respiratory Protection for Lead Aerosols
------------------------------------------------------------------------
  Airborne concentration of
   lead or condition of use               Required respirator
------------------------------------------------------------------------
Not in excess of 0.5 mg/m\3\   Half-mask, air-purifying respirator
 (10X PEL).                     equipped with high efficiency
                                filters.\2\ \3\

[[Page 108]]


Not in excess of 2.5 mg/m\3\   Full facepiece, air-purifying respirator
 (50X PEL).                     with high efficiency filters.\3\
Not in excess of 50 mg/m\3\    (1) Any powered, air-purifying respirator
 (1000X PEL).                   with high efficiency filters\3\; or (2)
                                Half-mask supplied-air respirator
                                operated in positive-pressure mode.\2\
Not in excess of 100 mg/m\3\   Supplied-air respirators with full
 (2000XPEL).                    facepiece, hood, helmet, or suit,
                                operated in positive pressure mode.
Greater than 100 mg/m\3\,      Full facepiece, self-contained breathing
 unknown concentration or       apparatus operated in positive-pressure
 fire fighting.                 mode.
------------------------------------------------------------------------
\1\ Respirators specified for high concentrations can be used at lower
  concentrations of lead.
\2\ Full facepiece is required if the lead aerosols cause eye or skin
  irritation at the use concentrations.
\3\ A high efficiency particulate filter means 99.97 percent efficient
  against 0.3 micron size particles.

    (3) Respirator selection. (i) The employer must select the 
appropriate respirator or combination of respirators from Table II of 
this section.
    (ii) The employer must provide a powered air-purifying respirator 
instead of the respirator specified in Table II of this section when an 
employee chooses to use this type of respirator and such a respirator 
provides adequate protection to the employee.
    (g) Protective work clothing and equipment--(1) Provision and use. 
If an employee is exposed to lead above the PEL, without regard to the 
use of respirators or where the possibility of skin or eye irritation 
exists, the employer shall provide at no cost to the employee and assure 
that the employee uses appropriate protective work clothing and 
equipment such as, but not limited to:
    (i) Coveralls or similar full-body work clothing;
    (ii) Gloves, hats, and shoes or disposable shoe coverlets; and
    (iii) Face shields, vented goggles, or other appropriate protective 
equipment which complies with Sec. 1910.133 of this Part.
    (2) Cleaning and replacement. (i) The employer shall provide the 
protective clothing required in paragraph (g)(1) of this section in a 
clean and dry condition at least weekly, and daily to employees whose 
exposure levels without regard to a respirator are over 200 <greek-m>g/
m<SUP>3</SUP>of lead as an 8-hour TWA.
    (ii) The employer shall provide for the cleaning, laundering, or 
disposal of protective clothing and equipment required by paragraph 
(g)(1) of this section.
    (iii) The employer shall repair or replace required protective 
clothing and equipment as needed to maintain their effectiveness.
    (iv) The employer shall assure that all protective clothing is 
removed at the completion of a work shift only in change rooms provided 
for that purpose as prescribed in paragraph (i)(2) of this section.
    (v) The employer shall assure that contaminated protective clothing 
which is to be cleaned, laundered, or disposed of, is placed in a closed 
container in the change-room which prevents dispersion of lead outside 
the container.
    (vi) The employer shall inform in writing any person who cleans or 
launders protective clothing or equipment of the potentially harmful 
effects of exposure to lead.
    (vii) The employer shall assure that the containers of contaminated 
protective clothing and equipment required by paragraph (g)(2)(v) are 
labelled as follows:

CAUTION: CLOTHING CONTAMINATED WITH LEAD. DO NOT REMOVE DUST BY BLOWING 
OR SHAKING. DISPOSE OF LEAD CONTAMINATED WASH WATER IN ACCORDANCE WITH 
APPLICABLE LOCAL, STATE, OR FEDERAL REGULATIONS.

    (viii) The employer shall prohibit the removal of lead from 
protective clothing or equipment by blowing, shaking, or any other means 
which disperses lead into the air.
    (h) Housekeeping--(1) Surfaces. All surfaces shall be maintained as 
free as practicable of accumulations of lead.
    (2) Cleaning floors. (i) Floors and other surfaces where lead 
accumulates may not be cleaned by the use of compressed air.
    (ii) Shoveling, dry or wet sweeping, and brushing may be used only 
where

[[Page 109]]

vacuuming or other equally effective methods have been tried and found 
not to be effective.
    (3) Vacuuming. Where vacuuming methods are selected, the vacuums 
shall be used and emptied in a manner which minimizes the reentry of 
lead into the workplace.
    (i) Hygiene facilities and practices. (1) The employer shall assure 
that in areas where employees are exposed to lead above the PEL, without 
regard to the use of respirators, food or beverage is not present or 
consumed, tobacco products are not present or used, and cosmetics are 
not applied, except in change rooms, lunchrooms, and showers required 
under paragraphs (i)(2) through (i)(4) of this section.
    (2) Change rooms. (i) The employer shall provide clean change rooms 
for employees who work in areas where their airborne exposure to lead is 
above the PEL, without regard to the use of respirators.
    (ii) The employer shall assure that change rooms are equipped with 
separate storage facilities for protective work clothing and equipment 
and for street clothes which prevent cross-contamination.
    (3) Showers. (i) The employer shall assure that employees who work 
in areas where their airborne exposure to lead is above the PEL, without 
regard to the use of respirators, shower at the end of the work shift.
    (ii) The employer shall provide shower facilities in accordance with 
Sec. 1910.141 (d)(3) of this part.
    (iii) The employer shall assure that employees who are required to 
shower pursuant to paragraph (i)(3)(i) do not leave the workplace 
wearing any clothing or equipment worn during the work shift.
    (4) Lunchrooms. (i) The employer shall provide lunchroom facilities 
for employees who work in areas where their airborne exposure to lead is 
above the PEL, without regard to the use of respirators.
    (ii) The employer shall assure that lunchroom facilities have a 
temperature controlled, positive pressure, filtered air supply, and are 
readily accessible to employees.
    (iii) The employer shall assure that employees who work in areas 
where their airborne exposure to lead is above the PEL without regard to 
the use of a respirator wash their hands and face prior to eating, 
drinking, smoking or applying cosmetics.
    (iv) The employer shall assure that employees do not enter lunchroom 
facilities with protective work clothing or equipment unless surface 
lead dust has been removed by vacuuming, downdraft booth, or other 
cleaning method.
    (5) Lavatories. The employer shall provide an adequate number of 
lavatory facilities which comply with Sec. 1910.141(d) (1) and (2) of 
this part.
    (j) Medical surveillance--(1) General. (i) The employer shall 
institute a medical surveillance program for all employees who are or 
may be exposed above the action level for more than 30 days per year.
    (ii) The employer shall assure that all medical examinations and 
procedures are performed by or under the supervision of a licensed 
physician.
    (iii) The employer shall provide the required medical surveillance 
including multiple physician review under paragraph (j)(3)(iii) without 
cost to employees and at a reasonable time and place.
    (2) Biological monitoring--(i) Blood lead and ZPP level sampling and 
analysis. The employer shall make available biological monitoring in the 
form of blood sampling and analysis for lead and zinc protoporphyrin 
levels to each employee covered under paragraph (j)(1)(i) of this 
section on the following schedule:
    (A) At least every 6 months to each employee covered under paragraph 
(j)(1)(i) of this section;
    (B) At least every two months for each employee whose last blood 
sampling and analysis indicated a blood lead level at or above 40 
<greek-m> g/100 g of whole blood. This frequency shall continue until 
two consecutive blood samples and analyses indicate a blood lead level 
below 40 <greek-m> g/100 g of whole blood; and
    (C) At least monthly during the removal period of each employee 
removed from exposure to lead due to an elevated blood lead level.
    (ii) Follow-up blood sampling tests. Whenever the results of a blood 
lead level test indicate that an employee's blood lead level exceeds the 
numerical

[[Page 110]]

criterion for medical removal under paragraph (k)(1)(i)(A) of this 
section, the employer shall provide a second (follow-up) blood sampling 
test within two weeks after the employer receives the results of the 
first blood sampling test.
    (iii) Accuracy of blood lead level sampling and analysis. Blood lead 
level sampling and analysis provided pursuant to this section shall have 
an accuracy (to a confidence level of 95 percent) within plus or minus 
15 percent or 6 <greek-m> g/100ml, whichever is greater, and shall be 
conducted by a laboratory licensed by the Center for Disease Control, 
United States Department of Health, Education and Welfare (CDC) or which 
has received a satisfactory grade in blood lead proficiency testing from 
CDC in the prior twelve months.
    (iv) Employee notification. Within five working days after the 
receipt of biological monitoring results, the employer shall notify in 
writing each employee whose blood lead level exceeds 40 <greek-m> g/100 
g: (A) of that employee's blood lead level and (B) that the standard 
requires temporary medical removal with Medical Removal Protection 
benefits when an employee's blood lead level exceeds the numerical 
criterion for medical removal under paragraph (k)(1)(i) of this section.
    (3) Medical examinations and consultations--(i) Frequency. The 
employer shall make available medical examinations and consultations to 
each employee covered under paragraph (j)(1)(i) of this section on the 
following schedule:
    (A) At least annually for each employee for whom a blood sampling 
test conducted at any time during the preceding 12 months indicated a 
blood lead level at or above 40 <greek-m> g/100 g;
    (B) Prior to assignment for each employee being assigned for the 
first time to an area in which airborne concentrations of lead are at or 
above the action level;
    (C) As soon as possible, upon notification by an employee either 
that the employee has developed signs or symptoms commonly associated 
with lead intoxication, that the employee desires medical advice 
concerning the effects of current or past exposure to lead on the 
employee's ability to procreate a healthy child, or that the employee 
has demonstrated difficulty in breathing during a respirator fitting 
test or during use; and
    (D) As medically appropriate for each employee either removed from 
exposure to lead due to a risk of sustaining material impairment to 
health, or otherwise limited pursuant to a final medical determination.
    (ii) Content. Medical examinations made available pursuant to 
paragraph (j)(3)(i) (A) through (B) of this section shall include the 
following elements:
    (A) A detailed work history and a medical history, with particular 
attention to past lead exposure (occupational and non-occupational), 
personal habits (smoking, hygiene), and past gastrointestinal, 
hematologic, renal, cardiovascular, reproductive and neurological 
problems;
    (B) A thorough physical examination, with particular attention to 
teeth, gums, hematologic, gastrointestinal, renal, cardiovascular, and 
neurological systems. Pulmonary status should be evaluated if 
respiratory protection will be used;
    (C) A blood pressure measurement;
    (D) A blood sample and analysis which determines:
    (1) Blood lead level;
    (2) Hemoglobin and hematocrit determinations, red cell indices, and 
examination of peripheral smear morphology;
    (3) Zinc protoporphyrin;
    (4) Blood urea nitrogen; and,
    (5) Serum creatinine;
    (E) A routine urinalysis with microscopic examination; and
    (F) Any laboratory or other test which the examining physician deems 
necessary by sound medical practice.

The content of medical examinations made available pursuant to paragraph 
(j)(3)(i) (C) through (D) of this section shall be determined by an 
examining physician and, if requested by an employee, shall include 
pregnancy testing or laboratory evaluation of male fertility.
    (iii) Multiple physician review mechanism. (A) If the employer 
selects the initial physician who conducts any medical examination or 
consultation provided to an employee under this section, the employee 
may designate a second physician:

[[Page 111]]

    (1) To review any findings, determinations or recommendations of the 
initial physician; and
    (2) To conduct such examinations, consultations, and laboratory 
tests as the second physician deems necessary to facilitate this review.
    (B) The employer shall promptly notify an employee of the right to 
seek a second medical opinion after each occasion that an initial 
physician conducts a medical examination or consultation pursuant to 
this section. The employer may condition its participation in, and 
payment for, the multiple physician review mechanism upon the employee 
doing the following within fifteen (15) days after receipt of the 
foregoing notification, or receipt of the initial physician's written 
opinion, whichever is later:
    (1) The employee informing the employer that he or she intends to 
seek a second medical opinion, and
    (2) The employee 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 employee through their 
respective physicians shall designate a third physician:
    (1) To review any findings, determinations or recommendations of the 
prior physicians; and
    (2) To conduct such examinations, consultations, laboratory tests 
and discussions with the prior physicians as the third physician deems 
necessary to resolve the disagreement of the prior physicians.
    (E) The employer shall act consistent with the findings, 
determinations and recommendations of the third physician, unless the 
employer and the employee reach an agreement which is otherwise 
consistent with the recommendations of at least one of the three 
physicians.
    (iv) Information provided to examining and consulting physicians. 
(A) The employer shall provide an initial physician conducting a medical 
examination or consultation under this section with the following 
information:
    (1) A copy of this regulation for lead including all Appendices;
    (2) A description of the affected employee's duties as they relate 
to the employee's exposure;
    (3) The employee's exposure level or anticipated exposure level to 
lead and to any other toxic substance (if applicable);
    (4) A description of any personal protective equipment used or to be 
used;
    (5) Prior blood lead determinations; and
    (6) All prior written medical opinions concerning the employee in 
the employer's possession or control.
    (B) The employer shall provide the foregoing information to a second 
or third physician conducting a medical examination or consultation 
under this section upon request either by the second or third physician, 
or by the employee.
    (v) Written medical opinions. (A) The employer shall obtain and 
furnish the employee with a copy of a written medical opinion from each 
examining or consulting physician which contains the following 
information:
    (1) The physician's opinion as to whether the employee has any 
detected medical condition which would place the employee at increased 
risk of material impairment of the employee's health from exposure to 
lead;
    (2) Any recommended special protective measures to be provided to 
the employee, or limitations to be placed upon the employee's exposure 
to lead;
    (3) Any recommended limitation upon the employee's use of 
respirators, including a determination of whether the employee can wear 
a powered air purifying respirator if a physician determines that the 
employee cannot wear a negative pressure respirator; and
    (4) The results of the blood lead determinations.
    (B) The employer shall instruct each examining and consulting 
physician to:
    (1) Not reveal either in the written opinion, or in any other means 
of communication with the employer, findings, including laboratory 
results, or

[[Page 112]]

diagnoses unrelated to an employee's occupational exposure to lead; and
    (2) Advise the employee of any medical condition, occupational or 
nonoccupational, which dictates further medical examination or 
treatment.
    (vi) Alternate Physician Determination Mechanisms. The employer and 
an employee or authorized employee representative may agree upon the use 
of any expeditious alternate physician determination mechanism in lieu 
of the multiple physician review mechanism provided by this paragraph so 
long as the alternate mechanism otherwise satisfies the requirements 
contained in this paragraph.
    (4) Chelation. (i) The employer shall assure that any person whom he 
retains, employs, supervises or controls does not engage in prophylactic 
chelation of any employee at any time.
    (ii) If therapeutic or diagnostic chelation is to be performed by 
any person in paragraph (j)(4)(i), the employer shall assure that it be 
done under the supervision of a licensed physician in a clinical setting 
with thorough and appropriate medical monitoring and that the employee 
is notified in writing prior to its occurrence.
    (k) Medical Removal Protection--(1) Temporary medical removal and 
return of an employee--(i) Temporary removal due to elevated blood lead 
levels. (A) The employer shall remove an employee from work having an 
exposure to lead at or above the action level on each occasion that a 
periodic and a follow-up blood sampling test conducted pursuant to this 
section indicate that the employee's blood lead level is at or above 60 
<greek-m> g/100 g of whole blood; and
    (B) The employer shall remove an employee from work having an 
exposure to lead at or above the action level on each occasion that the 
average of the last three blood sampling tests conducted pursuant to 
this section (or the average of all blood sampling tests conducted over 
the previous six (6) months, whichever is longer) indicates that the 
employee's blood lead level is at or above 50 <greek-m> g/100 g of whole 
blood; provided, however, that an employee need not be removed if the 
last blood sampling test indicates a blood lead level at or below 40 
<greek-m> g/100 g of whole blood.
    (ii) Temporary removal due to a final medical determination. (A) The 
employer shall remove an employee from work having an exposure to lead 
at or above the action level on each occasion that a final medical 
determination results in a medical finding, determination, or opinion 
that the employee has a detected medical condition which places the 
employee at increased risk of material impairment to health from 
exposure to lead.
    (B) For the purposes of this section, the phrase ``final medical 
determination'' shall mean the outcome of the multiple physician review 
mechanism or alternate medical determination mechanism used pursuant to 
the medical surveillance provisions of this section.
    (C) Where a final medical determination results in any recommended 
special protective measures for an employee, or limitations on an 
employee's exposure to lead, the employer shall implement and act 
consistent with the recommendation.
    (iii) Return of the employee to former job status. (A) The employer 
shall return an employee to his or her former job status:
    (1) For an employee removed due to a blood lead level at or above 60 
<greek-m>g/100 g, or due to an average blood lead level at or above 50 
<greek-m>g/100 g, when two consecutive blood sampling tests indicate 
that the employee's blood lead level is at or below 40 <greek-m>g/100 g 
of whole blood;
    (2) For an employee removed due to a final medical determination, 
when a subsequent final medical determination results in a medical 
finding, determination, or opinion that the employee no longer has a 
detected medical condition which places the employee at increased risk 
of material impairment to health from exposure to lead.
    (B) For the purposes of this section, the requirement that an 
employer return an employee to his or her former job status is not 
intended to expand upon or restrict any rights an employee has or would 
have had, absent temporary medical removal, to a specific job 
classification or position under the terms of a collective bargaining 
agreement.
    (iv) Removal of other employee special protective measure or 
limitations. The

[[Page 113]]

employer shall remove any limitations placed on an employee or end any 
special protective measures provided to an employee pursuant to a final 
medical determination when a subsequent final medical determination 
indicates that the limitations or special protective measures are no 
longer necessary.
    (v) Employer options pending a final medical determination. Where 
the multiple physician review mechanism, or alternate medical 
determination mechanism used pursuant to the medical surveillance 
provisions of this section, has not yet resulted in a final medical 
determination with respect to an employee, the employer shall act as 
follows:
    (A) Removal. The employer may remove the employee from exposure to 
lead, provide special protective measures to the employee, or place 
limitations upon the employee, consistent with the medical findings, 
determinations, or recommendations of any of the physicians who have 
reviewed the employee's health status.
    (B) Return. The employer may return the employee to his or her 
former job status, end any special protective measures provided to the 
employee, and remove any limitations placed upon the employee, 
consistent with the medical findings, determinations, or recommendations 
of any of the physicians who have reviewed the employee's health status, 
with two exceptions. If
    (1) the initial removal, special protection, or limitation of the 
employee resulted from a final medical determination which differed from 
the findings, determinations, or recommendations of the initial 
physician or
    (2) The employee has been on removal status for the preceding 
eighteen months due to an elevated blood lead level, then the employer 
shall await a final medical determination.
    (2) Medical removal protection benefits--(i) Provision of medical 
removal protection benefits. The employer shall provide to an employee 
up to eighteen (18) months of medical removal protection benefits on 
each occasion that an employee is removed from exposure to lead or 
otherwise limited pursuant to this section.
    (ii) Definition of medical removal protection benefits. For the 
purposes of this section, the requirement that an employer provide 
medical removal protection benefits means that the employer shall 
maintain the earnings, seniority and other employment rights and 
benefits of an employee as though the employee had not been removed from 
normal exposure to lead or otherwise limited.
    (iii) Follow-up medical surveillance during the period of employee 
removal or limitation. During the period of time that an employee is 
removed from normal exposure to lead or otherwise limited, the employer 
may condition the provision of medical removal protection benefits upon 
the employee's participation in follow-up medical surveillance made 
available pursuant to this section.
    (iv) Workers' compensation claims. If a removed employee files a 
claim for workers' compensation payments for a lead-related disability, 
then the employer shall continue to provide medical removal protection 
benefits pending disposition of the claim. To the extent that an award 
is made to the employee for earnings lost during the period of removal, 
the employer's medical removal protection obligation shall be reduced by 
such amount. The employer shall receive no credit for workers' 
compensation payments received by the employee for treatment related 
expenses.
    (v) Other credits. The employer's obligation to provide medical 
removal protection benefits to a removed employee shall be reduced to 
the extent that the employee receives compensation for earnings lost 
during the period of removal either from a publicly or employer-funded 
compensation program, or receives income from employment with another 
employer made possible by virtue of the employee's removal.
    (vi) Employees whose blood lead levels do not adequately decline 
within 18 months of removal. The employer shall take the following 
measures with respect to any employee removed from exposure to lead due 
to an elevated blood lead level whose blood lead level has not declined 
within the past eighteen (18) months of removal so that the

[[Page 114]]

employee has been returned to his or her former job status:
    (A) The employer shall make available to the employee a medical 
examination pursuant to this section to obtain a final medical 
determination with respect to the employee;
    (B) The employer shall assure that the final medical determination 
obtained indicates whether or not the employee may be returned to his or 
her former job status, and if not, what steps should be taken to protect 
the employee's health;
    (C) Where the final medical determination has not yet been obtained, 
or once obtained indicates that the employee may not yet be returned to 
his or her former job status, the employer shall continue to provide 
medical removal protection benefits to the employee until either the 
employee is returned to former job status, or a final medical 
determination is made that the employee is incapable of ever safely 
returning to his or her former job status.
    (D) Where the employer acts pursuant to a final medical 
determination which permits the return of the employee to his or her 
former job status despite what would otherwise be an unacceptable blood 
lead level, later questions concerning removing the employee again shall 
be decided by a final medical determination. The employer need not 
automatically remove such an employee pursuant to the blood lead level 
removal criteria provided by this section.
    (vii) Voluntary Removal or Restriction of An Employee. Where an 
employer, although not required by this section to do so, removes an 
employee from exposure to lead or otherwise places limitations on an 
employee due to the effects of lead exposure on the employee's medical 
condition, the employer shall provide medical removal protection 
benefits to the employee equal to that required by paragraph (k)(2)(i) 
of this section.
    (l) Employee information and training--(1) Training program. (i) 
Each employer who has a workplace in which there is a potential exposure 
to airborne lead at any level shall inform employees of the content of 
Appendices A and B of this regulation.
    (ii) The employer shall institute a training program for and assure 
the participation of all employees who are subject to exposure to lead 
at or above the action level or for whom the possibility of skin or eye 
irritation exists.
    (iii) The employer shall provide initial training by 180 days from 
the effective date for those employees covered by paragraph (l)(1) (ii) 
on the standard's effective date and prior to the time of initial job 
assignment for those employees subsequently covered by this paragraph.
    (iv) The training program shall be repeated at least annually for 
each employee.
    (v) The employer shall assure that each employee is informed of the 
following:
    (A) The content of this standard and its appendices;
    (B) The specific nature of the operations which could result in 
exposure to lead above the action level;
    (C) The purpose, proper selection, fitting, use, and limitations of 
respirators;
    (D) The purpose and a description of the medical surveillance 
program, and the medical removal protection program including 
information concerning the adverse health effects associated with 
excessive exposure to lead (with particular attention to the adverse 
reproductive effects on both males and females);
    (E) The engineering controls and work practices associated with the 
employee's job assignment;
    (F) The contents of any compliance plan in effect; and
    (G) Instructions to employees that chelating agents should not 
routinely be used to remove lead from their bodies and should not be 
used at all except under the direction of a licensed physician;
    (2) Access to information and training materials. (i) The employer 
shall make readily available to all affected employees a copy of this 
standard and its appendices.
    (ii) The employer shall provide, upon request, all materials 
relating to the employee information and training program to the 
Assistant Secretary and the Director.

[[Page 115]]

    (iii) In addition to the information required by paragraph 
(l)(1)(v), the employer shall include as part of the training program, 
and shall distribute to employees, any materials pertaining to the 
Occupational Safety and Health Act, the regulations issued pursuant to 
that Act, and this lead standard, which are made available to the 
employer by the Assistant Secretary.
    (m) Signs--(1) General. (i) The employer may use signs required by 
other statutes, regulations or ordinances in addition to, or in 
combination with, signs required by this paragraph.
    (ii) The employer shall assure that no statement appears on or near 
any sign required by this paragraph which contradicts or detracts from 
the meaning of the required sign.
    (2) Signs. (i) The employer shall post the following warning signs 
in each work area where the PEL is exceeded:

                                 WARNING

                             LEAD WORK AREA

                                 POISON

                          NO SMOKING OR EATING

    (ii) The employer shall assure that signs required by this paragraph 
are illuminated and cleaned as necessary so that the legend is readily 
visible.
    (n) Recordkeeping--(1) Exposure monitoring. (i) The employer shall 
establish and maintain an accurate record of all monitoring required in 
paragraph (d) of this section.
    (ii) This record shall include:
    (A) The date(s), number, duration, location and results of each of 
the samples taken, including a description of the sampling procedure 
used to determine representative employee exposure where applicable;
    (B) A description of the sampling and analytical methods used and 
evidence of their accuracy;
    (C) The type of respiratory protective devices worn, if any;
    (D) Name, social security number, and job classification of the 
employee monitored and of all other employees whose exposure the 
measurement is intended to represent; and
    (E) The environmental variables that could affect the measurement of 
employee exposure.
    (iii) The employer shall maintain these monitoring records for at 
least 40 years or for the duration of employment plus 20 years, 
whichever is longer.
    (2) Medical surveillance. (i) The employer shall establish and 
maintain an accurate record for each employee subject to medical 
surveillance as required by paragraph (j) of this section.
    (ii) This record shall include:
    (A) The name, social security number, and description of the duties 
of the employee;
    (B) A copy of the physician's written opinions;
    (C) Results of any airborne exposure monitoring done for that 
employee and the representative exposure levels supplied to the 
physician; and
    (D) Any employee medical complaints related to exposure to lead.
    (iii) The employer shall keep, or assure that the examining 
physician keeps, the following medical records:
    (A) A copy of the medical examination results including medical and 
work history required under paragraph (j) of this section;
    (B) A description of the laboratory procedures and a copy of any 
standards or guidelines used to interpret the test results or references 
to that information;
    (C) A copy of the results of biological monitoring.
    (iv) The employer shall maintain or assure that the physician 
maintains those medical records for at least 40 years, or for the 
duration of employment plus 20 years, whichever is longer.
    (3) Medical removals. (i) The employer shall establish and maintain 
an accurate record for each employee removed from current exposure to 
lead pursuant to paragraph (k) of this section.
    (ii) Each record shall include:
    (A) The name and social security number of the employee;
    (B) The date on each occasion that the employee was removed from 
current exposure to lead as well as the corresponding date on which the 
employee was returned to his or her former job status;
    (C) A brief explanation of how each removal was or is being 
accomplished; and
    (D) A statement with respect to each removal indicating whether or 
not the

[[Page 116]]

reason for the removal was an elevated blood lead level.
    (iii) The employer shall maintain each medical removal record for at 
least the duration of an employee's employment.
    (4) Availability. (i) The employer shall make available upon request 
all records required to be maintained by paragraph (n) of this section 
to the Assistant Secretary and the Director for examination and copying.
    (ii) Environmental monitoring, medical removal, and medical records 
required by this paragraph shall be provided upon request to employees, 
designated representatives, and the Assistant Secretary in accordance 
with 29 CFR 1910.20 (a)-(e) and (2)-(i). Medical removal records shall 
be provided in the same manner as environmental monitoring records.
    (5) Transfer of records. (i) Whenever the employer ceases to do 
business, the successor employer shall receive and retain all records 
required to be maintained by paragraph (n) of this section.
    (ii) Whenever the employer ceases to do business and there is no 
successor employer to receive and retain the records required to be 
maintained by this section for the prescribed period, these records 
shall be transmitted to the Director.
    (iii) At the expiration of the retention period for the records 
required to be maintained by this section, the employer shall notify the 
Director at least 3 months prior to the disposal of such records and 
shall transmit those records to the Director if requested within the 
period.
    (iv) The employer shall also comply with any additional requirements 
involving transfer of records set forth in 29 CFR 1910.20(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 lead conducted pursuant to paragraph (d) of this section.
    (2) Observation procedures. (i) Whenever observation of the 
monitoring of employee exposure to lead requires entry into an area 
where the use of respirators, protective clothing or equipment is 
required, the employer shall provide the observer with and assure the 
use of such respirators, clothing and such equipment, and shall require 
the observer to comply with all other applicable safety and health 
procedures.
    (ii) Without interfering with the monitoring, observers shall be 
entitled to:
    (A) Receive an explanation of the measurement procedures;
    (B) Observe all steps related to the monitoring of lead performed at 
the place of exposure; and
    (C) Record the results obtained or receive copies of the results 
when returned by the laboratory.
    (p) Effective date. This standard shall become effective March 1, 
1979.
    (q) Appendices. The information contained in the appendices to this 
section is not intended by itself, to create any additional obligations 
not otherwise imposed by this standard nor detract from any existing 
obligation.
    (r) Startup dates. All obligations of this standard commence on the 
effective date except as follows:
    (1) The initial determination under paragraph (d)(2) shall be made 
as soon as possible but no later than 30 days from the effective date.
    (2) Initial monitoring under paragraph (d)(4) shall be completed as 
soon as possible but no later than 90 days from the effective date.
    (3) Initial biological monitoring and medical examinations under 
paragraph (j) shall be completed as soon as possible but no later than 
180 days from the effective date. Priority for biological monitoring and 
medical examinations shall be given to employees whom the employer 
believes to be at greatest risk from continued exposure.
    (4) Initial training and education shall be completed as soon as 
possible but no later than 180 days from the effective date.
    (5) Hygiene and lunchroom facilities under paragraph (i) shall be in 
operation as soon as possible but no later than 1 year from the 
effective year.
    (6)(i) Respiratory protection required by paragraph (f) shall be 
provided as soon as possible but no later than the following schedule:

[[Page 117]]

    (A) Employees whose 8-hour TWA exposure exceeds 200 <greek-m>g/
m<SUP>3</SUP>--on the effective date.
    (B) Employees whose 8-hour TWA exposure exceeds the PEL but is less 
than 200 <greek-m>g/m<SUP>3</SUP>--150 days from the effective date.
    (C) Powered, air-purifying respirators provided under (f)(2)(ii)--
210 days from the effective date.
    (D) Quantitative fit testing required under (f)(3)(ii)--one year 
from effective date. Qualitative fit testing is required in the interim.
    (7)(i) Written compliance plans required by paragraph (e)(3) shall 
be completed and available for inspection and copying as soon as 
possible but no later than the following schedule:
    (A) Employers for whom compliance with the PEL or interim level is 
required within 1 year from the effective date--6 months from the 
effective date.
    (B) Employers in secondary lead smelting and refining and in lead 
storage battery manufacturing--1 year from the effective date.
    (C) Employers in primary smelting and refining industry--1 year from 
the effective date for the interim level; 5 years from the effective 
date for PEL.
    (D) Plans for construction of hygiene facilities, if required--6 
months from the effective date.
    (E) All other industries--1 year from the date on which the court 
lifts the stay on the implementation of paragraph (e)(1) for the 
particular industry.
    (8) The permissible exposure limit in paragraph (c) shall become 
effective 150 days from the effective date.

  Appendix A to Sec. 1910.1025--Substance Data Sheet for Occupational 
                            Exposure to Lead

                       i. Substance Identification

    A. Substance: Pure lead (Pb) is a heavy metal at room temperature 
and pressure and is a basic chemical element. It can combine with 
various other substances to form numerous lead compounds.
    B. Compounds Covered by the Standard: The word ``lead'' when used in 
this standard means elemental lead, all inorganic lead compounds and a 
class of organic lead compounds called lead soaps. This standard does 
not apply to other organic lead compounds.
    C. Uses: Exposure to lead occurs in at least 120 different 
occupations, including primary and secondary lead smelting, lead storage 
battery manufacturing, lead pigment manufacturing and use, solder 
manufacturing and use, shipbuilding and ship repairing, auto 
manufacturing, and printing.
    D. Permissible Exposure: The Permissible Exposure Limit (PEL) set by 
the standard is 50 micrograms of lead per cubic meter of air (50 
<greek-m>g/m<SUP>3</SUP>), averaged over an 8-hour workday.
    E. Action Level: The standard establishes an action level of 30 
micrograms per cubic meter of air (30 <greek-m>g/m<SUP>3</SUP>), time 
weighted average, based on an 8-hour work-day. The action level 
initiates several requirements of the standard, such as exposure 
monitoring, medical surveillance, and training and education.

                         ii. health hazard data

    A. Ways in which lead enters your body. When absorbed into your body 
in certain doses lead is a toxic substance. The object of the lead 
standard is to prevent absorption of harmful quantities of lead. The 
standard is intended to protect you not only from the immediate toxic 
effects of lead, but also from the serious toxic effects that may not 
become apparent until years of exposure have passed.
    Lead can be absorbed into your body by inhalation (breathing) and 
ingestion (eating). Lead (except for certain organic lead compounds not 
covered by the standard, such as tetraethyl lead) is not absorbed 
through your skin. When lead is scattered in the air as a dust, fume or 
mist it can be inhaled and absorbed through you lungs and upper 
respiratory tract. Inhalation of airborne lead is generally the most 
important source of occupational lead absorption. You can also absorb 
lead through your digestive system if lead gets into your mouth and is 
swallowed. If you handle food, cigarettes, chewing tobacco, or make-up 
which have lead on them or handle them with hands contaminated with 
lead, this will contribute to ingestion.
    A significant portion of the lead that you inhale or ingest gets 
into your blood stream. Once in your blood stream, lead is circulated 
throughout your body and stored in various organs and body tissues. Some 
of this lead is quickly filtered out of your body and excreted, but some 
remains in the blood and other tissues. As exposure to lead continues, 
the amount stored in your body will increase if you are absorbing more 
lead than your body is excreting. Even though you may not be aware of 
any immediate symptoms of disease, this lead stored in your tissues can 
be slowly causing irreversible damage, first to individual cells, then 
to your organs and whole body systems.
    B. Effects of overexposure to lead--(1) Short term (acute) 
overexposure. Lead is a potent, systemic poison that serves no known 
useful function once absorbed by your body. Taken in large enough doses, 
lead can kill you in a matter of days. A condition affecting the brain 
called acute encephalopathy may arise which develops quickly to 
seizures, coma,

[[Page 118]]

and death from cardiorespiratory arrest. A short term dose of lead can 
lead to acute encephalopathy. Short term occupational exposures of this 
magnitude are highly unusual, but not impossible. Similar forms of 
encephalopathy may, however, arise from extended, chronic exposure to 
lower doses of lead. There is no sharp dividing line between rapidly 
developing acute effects of lead, and chronic effects which take longer 
to acquire. Lead adversely affects numerous body systems, and causes 
forms of health impairment and disease which arise after periods of 
exposure as short as days or as long as several years.
    (2) Long-term (chronic) overexposure. Chronic overexposure to lead 
may result in severe damage to your blood-forming, nervous, urinary and 
reproductive systems. Some common symptoms of chronic overexposure 
include loss of appetite, metallic taste in the mouth, anxiety, 
constipation, nausea, pallor, excessive tiredness, weakness, insomnia, 
headache, nervous irritability, muscle and joint pain or soreness, fine 
tremors, numbness, dizziness, hyperactivity and colic. In lead colic 
there may be severe abdominal pain.
    Damage to the central nervous system in general and the brain 
(encephalopathy) in particular is one of the most severe forms of lead 
poisoning. The most severe, often fatal, form of encephalopathy may be 
preceded by vomiting, a feeling of dullness progressing to drowsiness 
and stupor, poor memory, restlessness, irritability, tremor, and 
convulsions. It may arise suddenly with the onset of seizures, followed 
by coma, and death. There is a tendency for muscular weakness to develop 
at the same time. This weakness may progress to paralysis often observed 
as a characteristic ``wrist drop'' or ``foot drop'' and is a 
manifestation of a disease to the nervous system called peripheral 
neuropathy.
    Chronic overexposure to lead also results in kidney disease with 
few, if any, symptoms appearing until extensive and most likely 
permanent kidney damage has occurred. Routine laboratory tests reveal 
the presence of this kidney disease only after about two-thirds of 
kidney function is lost. When overt symptoms of urinary dysfunction 
arise, it is often too late to correct or prevent worsening conditions, 
and progression to kidney dialysis or death is possible.
    Chronic overexposure to lead impairs the reproductive systems of 
both men and women. Overexposure to lead may result in decreased sex 
drive, impotence and sterility in men. Lead can alter the structure of 
sperm cells raising the risk of birth defects. There is evidence of 
miscarriage and stillbirth in women whose husbands were exposed to lead 
or who were exposed to lead themselves. Lead exposure also may result in 
decreased fertility, and abnormal menstrual cycles in women. The course 
of pregnancy may be adversely affected by exposure to lead since lead 
crosses the placental barrier and poses risks to developing fetuses. 
Children born of parents either one of whom were exposed to excess lead 
levels are more likely to have birth defects, mental retardation, 
behavioral disorders or die during the first year of childhood.
    Overexposure to lead also disrupts the blood-forming system 
resulting in decreased hemoglobin (the substance in the blood that 
carries oxygen to the cells) and ultimately anemia. Anemia is 
characterized by weakness, pallor and fatigability as a result of 
decreased oxygen carrying capacity in the blood.
    (3) Health protection goals of the standard. Prevention of adverse 
health effects for most workers from exposure to lead throughout a 
working lifetime requires that worker blood lead (PbB) levels be 
maintained at or below forty micrograms per one hundred grams of whole 
blood (40 <greek-m>g/100g). The blood lead levels of workers (both male 
and female workers) who intend to have children should be maintained 
below 30 <greek-m>g/100g to minimize adverse reproductive health effects 
to the parents and to the developing fetus.
    The measurement of your blood lead level is the most useful 
indicator of the amount of lead being absorbed by your body. Blood lead 
levels (PbB) are most often reported in units of milligrams (mg) or 
micrograms (<greek-m>g) of lead (1 mg=1000 <greek-m>g) per 100 grams 
(100g), 100 milliters (100 ml) or deciliter (dl) of blood. These three 
units are essentially the same. Sometime PbB's are expressed in the form 
of mg% or <greek-m>g%. This is a shorthand notation for 100g, 100 ml, or 
dl.
    PbB measurements show the amount of lead circulating in your blood 
stream, but do not give any information about the amount of lead stored 
in your various tissues. PbB measurements merely show current absorption 
of lead, not the effect that lead is having on your body or the effects 
that past lead exposure may have already caused. Past research into 
lead-related diseases, however, has focused heavily on associations 
between PbBs and various diseases. As a result, your PbB is an important 
indicator of the likelihood that you will gradually acquire a lead-
related health impairment or disease.
    Once your blood lead level climbs above 40 <greek-m>g/100g, your 
risk of disease increases. There is a wide variability of individual 
response to lead, thus it is difficult to say that a particular PbB in a 
given person will cause a particular effect. Studies have associated 
fatal encephalopathy with PbBs as low as 150 <greek-m>g/100g. Other 
studies have shown other forms of diseases in some workers with PbBs 
well below 80 <greek-m>g/100g. Your PbB is a crucial indicator of the 
risks to your health, but one other factor is also extremely important. 
This factor is the length of time you have

[[Page 119]]

had elevated PbBs. The longer you have an elevated PbB, the greater the 
risk that large quantities of lead are being gradually stored in your 
organs and tissues (body burden). The greater your overall body burden, 
the greater the chances of substantial permanent damage.
    The best way to prevent all forms of lead-related impairments and 
diseases--both short term and long term- is to maintain your PbB below 
40 <greek-m>g/100g. The provisions of the standard are designed with 
this end in mind. Your employer has prime responsibility to assure that 
the provisions of the standard are complied with both by the company and 
by individual workers. You as a worker, however, also have a 
responsibility to assist your employer in complying with the standard. 
You can play a key role in protecting your own health by learning about 
the lead hazards and their control, learning what the standard requires, 
following the standard where it governs your own actions, and seeing 
that your employer complies with provisions governing his actions.
    (4) Reporting signs and symptoms of health problems. You should 
immediately notify your employer if you develop signs or symptoms 
associated with lead poisoning or if you desire medical advice 
concerning the effects of current or past exposure to lead on your 
ability to have a healthy child. You should also notify your employer if 
you have difficulty breathing during a respirator fit test or while 
wearing a respirator. In each of these cases your employer must make 
available to you appropriate medical examinations or consultations. 
These must be provided at no cost to you and at a reasonable time and 
place.
    The standard contains a procedure whereby you can obtain a second 
opinion by a physician of your choice if the employer selected the 
initial physician.

         Appendix B to Sec. 1910.1025--Employee Standard Summary

    This appendix summarizes key provisions of the standard that you as 
a worker should become familiar with.

           i. Permissible Exposure Limit (pel)--Paragraph (c)

    The standards sets a permissible exposure limit (PEL) of fifty 
micrograms of lead per cubic meter of air (50 <greek-m>g/m<SUP>3</SUP>), 
averaged over an 8-hour work-day. This is the highest level of lead in 
air to which you may be permissibly exposed over an 8-hour workday. 
Since it is an 8-hour average it permits short exposures above the PEL 
so long as for each 8-hour work day your average exposure does not 
exceed the PEL.
    This standard recognizes that your daily exposure to lead can extend 
beyond a typical 8-hour workday as the result of overtime or other 
alterations in your work schedule. To deal with this, the standard 
contains a formula which reduces your permissible exposure when you are 
exposed more than 8 hours. For example, if you are exposed to lead for 
10 hours a day, the maximum permitted average exposure would be 40 
<greek-m>g/m<SUP>3</SUP>.

                 ii. exposure monitoring--paragraph (d)

    If lead is present in the workplace where you work in any quantity, 
your employer is required to make an initial determination of whether 
the action level is exceeded for any employee. This initial 
determination must include instrument monitoring of the air for the 
presence of lead and must cover the exposure of a representative number 
of employees who are reasonably believed to have the highest exposure 
levels. If your employer has conducted appropriate air sampling for lead 
in the past year he may use these results. If there have been any 
employee complaints of symptoms which may be attributable to exposure to 
lead or if there is any other information or observations which would 
indicate employee exposure to lead, this must also be considered as part 
of the initial determination. This initial determination must have been 
completed by March 31, 1979. If this initial determination shows that a 
reasonable possibility exists that any employee may be exposed, without 
regard to respirators, over the action level (30 <greek-m>g/
m<SUP>3</SUP>) your employer must set up an air monitoring program to 
determine the exposure level of every employee exposed to lead at your 
workplace.
    In carrying out this air monitoring program, your employer is not 
required to monitor the exposure of every employee, but he must monitor 
a representative number of employees and job types. Enough sampling must 
be done to enable each employee's exposure level to be reasonably least 
one full shift (at least 7 hours) air sample. In addition, these air 
samples must be taken under conditions which represent each employee's 
regular, daily exposure to lead. All initial exposure monitoring must 
have been completed by May 30, 1979.
    If you are exposed to lead and air sampling is performed, your 
employer is required to quickly notify you in writing of air monitoring 
results which represent your exposure. If the results indicate your 
exposure exceeds the PEL (without regard to your use of respirators), 
then your employer must also notify you of this in writing, and provide 
you with a description of the corrective action that will be taken to 
reduce your exposure.
    Your exposure must be rechecked by monitoring every six months if 
your exposure is over the action level but below the PEL. Air monitoring 
must be repeated every 3 months if you are exposed over the PEL. Your 
employer may discontinue monitoring for you if

[[Page 120]]

2 consecutive measurements, taken at least two weeks apart, are below 
the action level. However, whenever there is a production, process, 
control, or personnel change at your workplace which may result in new 
or additional exposure to lead, or whenever there is any other reason to 
suspect a change which may result in new or additional exposure to lead, 
your employer must perform additional monitoring.

                iii. methods of compliance--paragraph (e)

    Your employer is required to assure that no employee is exposed to 
lead in excess of the PEL. The standard establishes a priority of 
methods to be used to meet the PEL.

                iv. respiratory protection--paragraph (f)

    Your employer is required to provide and assure your use of 
respirators when your exposure to lead is not controlled below the PEL 
by other means. The employer must pay the cost of the respirator. 
Whenever you request one, your employer is also required to provide you 
a respirator even if your air exposure level does not exceed the PEL. 
You might desire a respirator when, for example, you have received 
medical advice that your lead absorption should be decreased. Or, you 
may intend to have children in the near future, and want to reduce the 
level of lead in your body to minimize adverse reproductive effects. 
While respirators are the least satisfactory means of controlling your 
exposure, they are capable of providing significant protection if 
properly chosen, fitted, worn, cleaned, maintained, and replaced when 
they stop providing adequate protection.
    Your employer is required to select respirators from the seven types 
listed in Table II of the Respiratory Protection section of the standard 
(Sec. 1910.1025(f)). Any respirator chosen must be approved by the 
National Institute for Occupational Safety and Health (NIOSH) under the 
provisions of 42 CFR part 84. This respirator selection table will 
enable your employer to choose a type of respirator that will give you a 
proper amount of protection based on your airborne lead exposure. Your 
employer may select a type of respirator that provides greater 
protection than that required by the standard; that is, one recommended 
for a higher concentration of lead than is present in your workplace. 
For example, a powered air-purifying respirator (PAPR) is much more 
protective than a typical negative pressure respirator, and may also be 
more comfortable to wear. A PAPR has a filter, cartridge, or canister to 
clean the air, and a power source that continuously blows filtered air 
into your breathing zone. Your employer might make a PAPR available to 
you to ease the burden of having to wear a respirator for long periods 
of time. The standard provides that you can obtain a PAPR upon request.
    Your employer must also start a Respiratory Protection Program. This 
program must include written procedures for the proper selection, use, 
cleaning, storage, and maintenance of respirators.
    Your employer must ensure that your respirator facepiece fits 
properly. Proper fit of a respirator facepiece is critical to your 
protection from airborne lead. Obtaining a proper fit on each employee 
may require your employer to make available several different types of 
respirator masks. To ensure that your respirator fits properly and that 
facepiece leakage is minimal, your employer must give you either a 
qualitative or quantitative fit test as specified in Appendix A of the 
Respiratory Protection standard located at 29 CFR 1910.134.
    You must also receive from your employer proper training in the use 
of respirators. Your employer is required to teach you how to wear a 
respirator, to know why it is needed, and to understand its limitations.
    The standard provides that if your respirator uses filter elements, 
you must be given an opportunity to change the filter elements whenever 
an increase in breathing resistance is detected. You also must be 
permitted to periodically leave your work area to wash your face and 
respirator facepiece whenever necessary to prevent skin irritation. If 
you ever have difficulty in breathing during a fit test or while using a 
respirator, your employer must make a medical examination available to 
you to determine whether you can safely wear a respirator. The result of 
this examination may be to give you a positive pressure respirator 
(which reduces breathing resistance) or to provide alternative means of 
protection.

        v. protective work clothing and equipment--paragraph (g)

    If you are exposed to lead above the PEL, or if you are exposed to 
lead compounds such as lead arsenate or lead azide which can cause skin 
and eye irritation, your employer must provide you with protective work 
clothing and equipment appropriate for the hazard. If work clothing is 
provided, it must be provided in a clean and dry condition at least 
weekly, and daily if your airborne exposure to lead is greater than 200 
<greek-m>g/m<SUP>3</SUP>. Appropriate protective work clothing and 
equipment can include coveralls or similar full-body work clothing, 
gloves, hats, shoes or disposable shoe coverlets, and face shields or 
vented goggles. Your employer is required to provide all such equipment 
at no cost to you. He is responsible for providing repairs and 
replacement as necessary, and also is responsible for the cleaning, 
laundering or disposal of protective clothing and equipment. 
Contaminated work clothing or equipment must be removed in change rooms 
and not worn home or you will extend your exposure and expose your 
family since lead from your

[[Page 121]]

clothing can accumulate in your house, car, etc. Contaminated clothing 
which is to be cleaned, laundered or disposed of must be placed in 
closed containers in the change room. At no time may lead be removed 
from protective clothing or equipment by any means which disperses lead 
into the workroom air.

                     vi. housekeeping--paragraph (h)

    Your employer must establish a housekeeping program sufficient to 
maintain all surfaces as free as practicable of accumulations of lead 
dust. Vacuuming is the preferred method of meeting this requirement, and 
the use of compressed air to clean floors and other surfaces is 
absolutely prohibited. Dry or wet sweeping, shoveling, or brushing may 
not be used except where vaccuming or other equally effective methods 
have been tried and do not work. Vacuums must be used and emptied in a 
manner which minimizes the reentry of lead into the workplace.

          vii. hygiene facilities and practices--paragraph (i)

    The standard requires that change rooms, showers, and filtered air 
lunchrooms be constructed and made available to workers exposed to lead 
above the PEL. When the PEL is exceeded the employer must assure that 
food and beverage is not present or consumed, tobacco products are not 
present or used, and cosmetics are not applied, except in these 
facilities. Change rooms, showers, and lunchrooms, must be used by 
workers exposed in excess of the PEL. After showering, no clothing or 
equipment worn during the shift may be worn home, and this includes 
shoes and underwear. Your own clothing worn during the shift should be 
carried home and cleaned carefully so that it does not contaminate your 
home. Lunchrooms may not be entered with protective clothing or 
equipment unless surface dust has been removed by vacuuming, downdraft 
booth, or other cleaning method. Finally, workers exposed above the PEL 
must wash both their hands and faces prior to eating, drinking, smoking 
or applying cosmetics.
    All of the facilities and hygiene practices just discussed are 
essential to minimize additional sources of lead absorption from 
inhalation or ingestion of lead that may accumulate on you, your 
clothes, or your possessions. Strict compliance with these provisions 
can virtually eliminate several sources of lead exposure which 
significantly contribute to excessive lead absorption.

                viii. medical surveillance--paragraph (j)

    The medical surveillance program is part of the standard's 
comprehensive approach to the prevention of lead-related disease. Its 
purpose is to supplement the main thrust of the standard which is aimed 
at minimizing airborne concentrations of lead and sources of ingestion. 
Only medical surveillance can determine if the other provisions of the 
standard have affectively protected you as an individual. Compliance 
with the standard's provision will protect most workers from the adverse 
effects of lead exposure, but may not be satisfactory to protect 
individual workers (1) who have high body burdens of lead acquired over 
past years, (2) who have additional uncontrolled sources of non-
occupational lead exposure, (3) who exhibit unusual variations in lead 
absorption rates, or (4) who have specific non-work related medical 
conditions which could be aggravated by lead exposure (e.g., renal 
disease, anemia). In addition, control systems may fail, or hygiene and 
respirator programs may be inadequate. Periodic medical surveillance of 
individual workers will help detect those failures. Medical surveillance 
will also be important to protect your reproductive ability--regardless 
of whether you are a man or woman.
    All medical surveillance required by the standard must be performed 
by or under the supervision of a licensed physician. The employer must 
provide required medical surveillance without cost to employees and at a 
reasonable time and place. The standard's medical surveillance program 
has two parts-periodic biological monitoring and medical examinations.
    Your employer's obligation to offer you medical surveillance is 
triggered by the results of the air monitoring program. Medical 
surveillance must be made available to all employees who are exposed in 
excess of the action level for more than 30 days a year. The initial 
phase of the medical surveillance program, which includes blood lead 
level tests and medical examinations, must be completed for all covered 
employees no later than August 28, 1979. Priority within this first 
round of medical surveillance must be given to employees whom the 
employer believes to be at greatest risk from continued exposure (for 
example, those with the longest prior exposure to lead, or those with 
the highest current exposure). Thereafter, the employer must 
periodically make medical surveillance--both biological monitoring and 
medical examinations--available to all covered employees.
    Biological monitoring under the standard consists of blood lead 
level (PbB) and zinc protoporphyrin tests at least every 6 months after 
the initial PbB test. A zinc protoporphyrin (ZPP) test is a very useful 
blood test which measures an effect of lead on your body. Thus 
biological monitoring under the standard is currently limited to PbB 
testing. If a worker's PbB exceeds 40 <greek-m>g/100g the monitoring 
frequency must be increased from every 6 months to at least every 2 
months and not reduced until two consecutive PbBs indicate a blood lead 
level

[[Page 122]]

below 40 <greek-m>g/100g. Each time your PbB is determined to be over 40 
<greek-m>g/100g, your employer must notify you of this in writing within 
five working days of his receipt of the test results. The employer must 
also inform you that the standard requires temporary medical removal 
with economic protection when your PbB exceeds certain criteria. (See 
Discussion of Medical Removal Protection--Paragraph (k).) During the 
first year of the standard, this removal criterion is 80 <greek-m>g/
100g. Anytime your PbB exceeds 80 <greek-m>g/100g your employer must 
make available to you a prompt follow-up PbB test to ascertain your PbB. 
If the two tests both exceed 80 <greek-m>g/100g and you are temporarily 
removed, then your employer must make successive PbB tests available to 
you on a monthly basis during the period of your removal.
    Medical examinations beyond the initial one must be made available 
on an annual basis if your blood lead level exceeds 40 <greek-m>g/100g 
at any time during the preceding year. The initial examination will 
provide information to establish a baseline to which subsequent data can 
be compared. An initial medical examination must also be made available 
(prior to assignment) for each employee being assigned for the first 
time to an area where the airborne concentration of lead equals or 
exceeds the action level. In addition, a medical examination or 
consultation must be made available as soon as possible if you notify 
your employer that you are experiencing signs or symptoms commonly 
associated with lead poisoning or that you have difficulty breathing 
while wearing a respirator or during a respirator fit test. You must 
also be provided a medical examination or consultation if you notify 
your employer that you desire medical advice concerning the effects of 
current or past exposure to lead on your ability to procreate a healthy 
child.
    Finally, appropriate follow-up medical examinations or consultations 
may also be provided for employees who have been temporarily removed 
from exposure under the medical removal protection provisions of the 
standard. (See Part IX, below.)
    The standard specifies the minimum content of pre-assignment and 
annual medical examinations. The content of other types of medical 
examinations and consultations is left up to the sound discretion of the 
examining physician. Pre-assignment and annual medical examinations must 
include (1) a detailed work history and medical history, (2) a thorough 
physical examination, and (3) a series of laboratory tests designed to 
check your blood chemistry and your kidney function. In addition, at any 
time upon your request, a laboratory evaluation of male fertility will 
be made (microscopic examination of a sperm sample), or a pregnancy test 
will be given.
    The standard does not require that you participate in any of the 
medical procedures, tests, etc. which your employer is required to make 
available to you. Medical surveillance can, however, play a very 
important role in protecting your health. You are strongly encouraged, 
therefore, to participate in a meaningful fashion. The standard contains 
a multiple physician review mechanism which would give you a chance to 
have a physician of your choice directly participate in the medical 
surveillance program. If you were dissatisfied with an examination by a 
physician chosen by your employer, you could select a second physician 
to conduct an independent analysis. The two doctors would attempt to 
resolve any differences of opinion, and select a third physician to 
resolve any firm dispute. Generally your employer will choose the 
physician who conducts medical surveillance under the lead standard--
unless you and your employer can agree on the choice of a physician or 
physicians. Some companies and unions have agreed in advance, for 
example, to use certain independent medical laboratories or panels of 
physicians. Any of these arrangements are acceptable so long as required 
medical surveillance is made available to workers.
    The standard requires your employer to provide certain information 
to a physician to aid in his or her examination of you. This information 
includes (1) the standard and its appendices, (2) a description of your 
duties as they relate to lead exposure, (3) your exposure level, (4) a 
description of personal protective equipment you wear, (5) prior blood 
lead level results, and (6) prior written medical opinions concerning 
you that the employer has. After a medical examination or consultation 
the physician must prepare a written report which must contain (1) the 
physician's opinion as to whether you have any medical condition which 
places you at increased risk of material impairment to health from 
exposure to lead, (2) any recommended special protective measures to be 
provided to you, (3) any blood lead level determinations, and (4) any 
recommended limitation on your use of respirators. This last element 
must include a determination of whether you can wear a powered air 
purifying respirator (PAPR) if you are found unable to wear a negative 
pressure respirator.
    The medical surveillance program of the lead standard may at some 
point in time serve to notify certain workers that they have acquired a 
disease or other adverse medical condition as a result of occupational 
lead exposure. If this is true, these workers might have legal rights to 
compensation from public agencies, their employers, firms that supply 
hazardous products to their employers, or other persons. Some states 
have laws, including worker compensation laws, that disallow a worker 
who learns of a job-

[[Page 123]]

related health impairment to sue, unless the worker sues within a short 
period of time after learning of the impairment. (This period of time 
may be a matter of months or years.) An attorney can be consulted about 
these possibilities. It should be stressed that OSHA is in no way trying 
to either encourage or discourage claims or lawsuits. However, since 
results of the standard's medical surveillance program can significantly 
affect the legal remedies of a worker who has acquired a job-related 
disease or impairment, it is proper for OSHA to make you aware of this.
    The medical surveillance section of the standard also contains 
provisions dealing with chelation. Chelation is the use of certain drugs 
(administered in pill form or injected into the body) to reduce the 
amount of lead absorbed in body tissues. Experience accumulated by the 
medical and scientific communities has largely confirmed the 
effectiveness of this type of therapy for the treatment of very severe 
lead poisoning. On the other hand, it has also been established that 
there can be a long list of extremely harmful side effects associated 
with the use of chelating agents. The medical community has balanced the 
advantages and disadvantages resulting from the use of chelating agents 
in various circumstances and has established when the use of these 
agents is acceptable. The standard includes these accepted limitations 
due to a history of abuse of chelation therapy by some lead companies. 
The most widely used chelating agents are calcium disodium EDTA, (Ca 
Na<INF>2</INF> EDTA), Calcium Disodium Versenate (Versenate), and d-
penicillamine (pencillamine or Cupramine).
    The standard prohibits ``prophylactic chelation'' of any employee by 
any person the employer retains, supervises or controls. ``Prophylactic 
chelation'' is the routine use of chelating or similarly acting drugs to 
prevent elevated blood levels in workers who are occupationally exposed 
to lead, or the use of these drugs to routinely lower blood lead levels 
to predesignated concentrations believed to be `safe'. It should be 
emphasized that where an employer takes a worker who has no symptoms of 
lead poisoning and has chelation carried out by a physician (either 
inside or outside of a hospital) solely to reduce the worker's blood 
lead level, that will generally be considered prophylactic chelation. 
The use of a hospital and a physician does not mean that prophylactic 
chelation is not being performed. Routine chelation to prevent increased 
or reduce current blood lead levels is unacceptable whatever the 
setting.
    The standard allows the use of ``therapeutic'' or ``diagnostic'' 
chelation if administered under the supervision of a licensed physician 
in a clinical setting with thorough and appropriate medical monitoring. 
Therapeutic chelation responds to severe lead poisoning where there are 
marked symptoms. Diagnostic chelation involved giving a patient a dose 
of the drug then collecting all urine excreted for some period of time 
as an aid to the diagnosis of lead poisoning.
    In cases where the examining physician determines that chelation is 
appropriate, you must be notified in writing of this fact before such 
treatment. This will inform you of a potentially harmful treatment, and 
allow you to obtain a second opinion.

              ix. medical removal protection--paragraph (k)

    Excessive lead absorption subjects you to increased risk of disease. 
Medical removal protection (MRP) is a means of protecting you when, for 
whatever reasons, other methods, such as engineering controls, work 
practices, and respirators, have failed to provide the protection you 
need. MRP involves the temproary removal of a worker from his or her 
regular job to a place of significantly lower exposure without any loss 
of earnings, seniority, or other employment rights or benefits. The 
purpose of this program is to cease further lead absorption and allow 
your body to naturally excrete lead which has previously been absorbed. 
Temporary medical removal can result from an elevated blood lead level, 
or a medical opinion. Up to 18 months of protection is provided as a 
result of either form of removal. The vast majority of removed workers, 
however, will return to their former jobs long before this eighteen 
month period expires. The standard contains special provisions to deal 
with the extraordinary but possible case where a longterm worker's blood 
lead level does not adequately decline during eighteen months of 
removal.
    During the first year of the standard, if your blood lead level is 
80 <greek-m>g/100g or above you must be removed from any exposure where 
your air lead level without a respirator would be 100 <greek-m>g/
m<SUP>3</SUP>or above. If you are removed from your normal job you may 
not be returned until your blood lead level declines to at least 60 
<greek-m>g/100g. These criteria for removal and return will change 
according to the following schedule:

----------------------------------------------------------------------------------------------------------------
                                          Removal blood lead     Air lead (<greek-m>g/      Return blood lead
                                          (<greek-m>g/100 g)             m\3\)              (<greek-m>g/100 g)
----------------------------------------------------------------------------------------------------------------
After Mar. 1, 1980...................  70 and above...........  50 and above...........  At or below 50.
After Mar. 1, 1981...................  60 and above...........  30 and above...........  At or below 40.

[[Page 124]]


After Mar. 1, 1983...................  50 and above averaged    30 and above...........      Do.
                                        over six months.
----------------------------------------------------------------------------------------------------------------

    You may also be removed from exposure even if your blood lead levels 
are below these criteria if a final medical determination indicates that 
you temporarily need reduced lead exposure for medical reasons. If the 
physician who is implementing your employers medical program makes a 
final written opinion recommending your removal or other special 
protective measures, your employer must implement the physician's 
recommendation. If you are removed in this manner, you may only be 
returned when the doctor indicates that it is safe for you to do so.
    The standard does not give specific instructions dealing with what 
an employer must do with a removed worker. Your job assignment upon 
removal is a matter for you, your employer and your union (if any) to 
work out consistent with existing procedures for job assignments. Each 
removal must be accomplished in a manner consistent with existing 
collective bargaining relationships. Your employer is given broad 
discretion to implement temporary removals so long as no attempt is made 
to override existing agreements. Similarly, a removed worker is provided 
no right to veto an employer's choice which satisfies the standard.
    In most cases, employers will likely transfer removed employees to 
other jobs with sufficiently low lead exposure. Alternatively, a 
worker's hours may be reduced so that the time weighted average exposure 
is reduced, or he or she may be temporarily laid off if no other 
alternative is feasible.
    In all of these situation, MRP benefits must be provided during the 
period of removal--i.e., you continue to receive the same earnings, 
seniority, and other rights and benefits you would have had if you had 
not been removed. Earnings includes more than just your base wage; it 
includes overtime, shift differentials, incentives, and other 
compensation you would have earned if you had not been removed. During 
the period of removal you must also be provided with appropriate follow-
up medical surveillance. If you were removed because your blood lead 
level was too high, you must be provided with a monthly blood test. If a 
medical opinion caused your removal, you must be provided medical tests 
or examinations that the doctor believes to be appropriate. If you do 
not participate in this follow up medical surveillance, you may lose 
your eligibility for MRP benefits.
    When you are medically eligible to return to your former job, your 
employer must return you to your ``former job status.'' This means that 
you are entitled to the position, wages, benefits, etc., you would have 
had if you had not been removed. If you would still be in your old job 
if no removal had occurred that is where you go back. If not, you are 
returned consistent with whatever job assignment discretion your 
employer would have had if no removal had occurred. MRP only seeks to 
maintain your rights, not expand them or diminish them.
    If you are removed under MRP and you are also eligible for worker 
compensation or other compensation for lost wages, your employer's MRP 
benefits obligation is reduced by the amount that you actually receive 
from these other sources. This is also true if you obtain other 
employment during the time you are laid off with MRP benefits.
    The standard also covers situations where an employer voluntarily 
removes a worker from exposure to lead due to the effects of lead on the 
employee's medical condition, even though the standard does not require 
removal. In these situations MRP benefits must still be provided as 
though the standard required removal. Finally, it is important to note 
that in all cases where removal is required, respirators cannot be used 
as a substitute. Respirators may be used before removal becomes 
necessary, but not as an alternative to a transfer to a low exposure 
job, or to a lay-off with MRP benefits.

           x. employee information and training--paragraph (l)

    Your employer is required to provide an information and training 
program for all employees exposed to lead above the action level or who 
may suffer skin or eye irritation from lead. This program must inform 
these employees of the specific hazards associated with their work 
environment, protective measures which can be taken, the danger of lead 
to their bodies (including their reproductive systems), and their rights 
under the standard. In addition your employer must make readily 
available to all employees, including those exposed below the action 
level, a copy of the standard and its appendices and must distribute to 
all employees any materials provided to the employer by the Occupational 
Safety and Health Administration (OSHA).
    Your employer is required to complete this training program for all 
employees by August 28, 1979. After this date, all new employees must be 
trained prior to initial assignment to areas where there is a 
possibility of exposure over the action level.

[[Page 125]]

    This training program must also be provided at least annually 
thereafter.

                        xi. signs--paragraph (m)

    The standard requires that the following warning sign be posted in 
work areas where the exposure to lead exceeds the PEL:

                                 WARNING

                             LEAD WORK AREA

                          NO SMOKING OR EATING

                    xii. recordkeeping--paragraph (n)

    Your employer is required to keep all records of exposure monitoring 
for airborne lead. These records must include the name and job 
classification of employees measured, details of the sampling and 
analytic techniques, the results of this sampling, and the type of 
respiratory protection being worn by the person sampled. Your employer 
is also required to keep all records of biological monitoring and 
medical examination results. These must include the names of the 
employees, the physician's written opinion, and a copy of the results of 
the examination. All of the above kinds of records must be kept for 40 
years, or for at least 20 years after your termination of employment, 
whichever is longer.
    Recordkeeping is also required if you are temporarily removed from 
your job under the medical removal protection program. This record must 
include your name and social security number, the date of your removal 
and return, how the removal was or is being accomplished, and whether or 
not the reason for the removal was an elevated blood lead level. Your 
employer is required to keep each medical removal record only for as 
long as the duration of an employee's employment.
    The standard requires that if you request to see or copy 
environmental monitoring, blood lead level monitoring, or medical 
removal records, they must be made available to you or to a 
representative that you authorize. Your union also has access to these 
records. Medical records other than PbB's must also be provided upon 
request to you, to your physician or to any other person whom you may 
specifically designate. Your union does not have access to your personal 
medical records unless you authorize their access.

             xiii. observations of monitoring--paragraph (o)

    When air monitoring for lead is performed at your workplace as 
required by this standard, your employer must allow you or someone you 
designate to act as an observer of the monitoring. Observers are 
entitled to an explanation of the measurement procedure, and to record 
the results obtained. Since results will not normally be available at 
the time of the monitoring, observers are entitled to record or receive 
the results of the monitoring when returned by the laboratory. Your 
employer is required to provide the observer with any personal 
protective devices required to be worn by employees working in the area 
that is being monitored. The employer must require the observer to wear 
all such equipment and to comply with all other applicable safety and 
health procedures.

                   xiv. effective date--paragraph (p)

    The standard's effective data is March 1, 1979, and employer 
obligations under the standard begin to come into effect as of that 
date.

                     xv. for additional information

    A. Copies of the Standard and explanatory material may be obtained 
by writing or calling the OSHA Docket Office, U.S. Department of Labor, 
room N2634, 200 Constitution Avenue, N.W., Washington, DC 20210. 
Telephone: (202) 219-7894.
    1. The standard and summary of the statement of reasons (preamble), 
Federal Register, Volume 43, pp. 52952-53014, November 14, 1978.
    2. The full statement of reasons (preamble) Federal Register, vol. 
43, pp. 54354-54509, November 21, 1978.
    3. Partial Administrative Stay and Corrections to the standard, (44 
FR 5446-5448) January 26, 1979.
    4. Notice of the Partial Judicial Stay (44 FR 14554-14555) March 13, 
1979.
    5. Corrections to the preamble, Federal Register, vol. 44, pp. 
20680-20681, April 6, 1979.
    6. Additional correction to the preamble concerning the construction 
industry, Federal Register, vol. 44, p. 50338, August 28, 1979.
    7. Appendices to the standard (Appendices A, B, C), Federal 
Register, Vol. 44, pp. 60980-60995, October 23, 1979.
    8. Corrections to appendices, Federal Register, Vol. 44, 68828, 
November 30, 1979.
    9. Revision to the standard and an additional appendix (Appendix D), 
Federal Register, Vol. 47, pp. 51117-51119, November 12, 1982.
    10. Notice of reopening of lead rulemaking for nine remand industry 
sectors, Federal Register, vol. 53, pp. 11511-11513, April 7, 1988.
    11. Statement of reasons, Federal Register, vol. 54, pp. 29142-
29275, July 11, 1989.
    12. Statement of reasons, Federal Register, vol. 55, pp. 3146-3167, 
January 30, 1990.
    13. Correction to appendix B, Federal Register, vol. 55, pp. 4998-
4999, February 13, 1991.
    14. Correction to appendices, Federal Register, vol. 56, p. 24686, 
May 31, 1991.
    B. Additional information about the standard, its enforcement, and 
your employer's

[[Page 126]]

compliance can be obtained from the nearest OSHA Area Office listed in 
your telephone directory under United States Government/Department of 
Labor.

      Appendix C to Sec. 1910.1025--Medical Surveillance Guidelines

                              introduction

    The primary purpose of the Occupational Safety and Health Act of 
1970 is to assure, so far as possible, safe and healthful working 
conditions for every working man and woman. The occupational health 
standard for inorganic lead<SUP>1</SUP> was promulgated to protect 
workers exposed to inorganic lead including metallic lead, all inorganic 
lead compounds and organic lead soaps.
---------------------------------------------------------------------------

    <SUP>1</SUP> The term inorganic lead used throughout the medical 
surveillance appendices is meant to be synonymous with the definition of 
lead set forth in the standard.
---------------------------------------------------------------------------

    Under this final standard in effect as of March 1, 1979, 
occupational exposure to inorganic lead is to be limited to 50 
<greek-m>g/m<SUP>3</SUP> (micrograms per cubic meter) based on an 8 hour 
time-weighted average (TWA). This level of exposure eventually must be 
achieved through a combination of engineering, work practice and other 
administrative controls. Periods of time ranging from 1 to 10 years are 
provided for different industries to implement these controls. The 
schedule which is based on individual industry considerations is given 
in Table 1. Until these controls are in place, respirators must be used 
to meet the 50 <greek-m>g/m<SUP>3</SUP> exposure limit.
    The standard also provides for a program of biological monitoring 
and medical surveillance for all employees exposed to levels of 
inorganic lead above the action level of 30 <greek-m>g/m<SUP>3</SUP> 
(TWA) for more than 30 days per year.
    The purpose of this document is to outline the medical surveillance 
provisions of the standard for inorganic lead, and to provide further 
information to the physician regarding the examination and evaluation of 
workers exposed to inorganic lead.
    Section 1 provides a detailed description of the monitoring 
procedure including the required frequency of blood testing for exposed 
workers, provisions for medical removal protection (MRP), the 
recommended right of the employee to a second medical opinion, and 
notification and recordkeeping requirements of the employer. A 
discussion of the requirements for respirator use and respirator 
monitoring and OSHA's position on prophylactic chelation therapy are 
also included in this section.
    Section 2 discusses the toxic effects and clinical manifestations of 
lead poisoning and effects of lead intoxication on enzymatic pathways in 
heme synthesis. The adverse effects on both male and female reproductive 
capacity and on the fetus are also discussed.
    Section 3 outlines the recommended medical evaluation of the worker 
exposed to inorganic lead including details of the medical history, 
physical examination, and recommended laboratory tests, which are based 
on the toxic effects of lead as discussed in Section 2.
    Section 4 provides detailed information concerning the laboratory 
tests available for the monitoring of exposed workers. Included also is 
a discussion of the relative value of each test and the limitations and 
precautions which are necessary in the interpretation of the laboratory 
results.

                                                     Table 1
----------------------------------------------------------------------------------------------------------------
                                                                            Effective date
                                                     -----------------------------------------------------------
Permissible airborne lead levels by industry (<greek-                                                    Mar. 1,
                    m>g/m\3\) \1\                      Mar. 1,   Mar. 1,   Mar. 1,   Mar. 1,   Mar. 1,    1989
                                                        1979      1980      1981      1982      1984     (final)
----------------------------------------------------------------------------------------------------------------
1. Primary lead production..........................       200       200       200       100       100        50
2. Secondary lead production........................       200       200       200       100        50        50
3. Lead-acid battery manufacturing..................       200       200       100       100        50        50
4. Nonferrous foundries.............................       200       100       100       100        50        50
5. Lead pigment manufacturing.......................       200       200       200       100        50        50
6. All other industries.............................       200        50        50        50        50        50
----------------------------------------------------------------------------------------------------------------
\1\ Airborne levels to be achieved without reliance or respirator protection through a combination of
  engineering, work practice and other administrative controls. While these controls are being implemented
  respirators must be used to meet the 50 <greek-m>g/m<SUP>3</SUP> exposure limit.

i. medical surveillance and monitoring requirements for workers exposed 
                            to inorganic lead

    Under the occupational health standard for inorganic lead, a program 
of biological monitoring and medical surveillance is to be made 
available to all employees exposed to lead above the action level of 30 
<greek-m>g/m<SUP>3</SUP> TWA for more than 30 days each year. This 
program consists of periodic blood sampling and medical evaluation to be 
performed on a schedule which is defined by previous laboratory results, 
worker complaints or concerns,

[[Page 127]]

and the clinical assessment of the examining physician.
    Under this program, the blood lead level of all employees who are 
exposed to lead above the action level of 30 <greek-m>g/m<SUP>3</SUP> is 
to be determined at least every six months. The frequency is increased 
to every two months for employees whose last blood lead level was 
between 40 <greek-m> g/100 g whole blood and the level requiring 
employee medical removal to be discussed below. For employees who are 
removed from exposure to lead due to an elevated blood lead, a new blood 
lead level must be measured monthly. A zinc protoporphyrin (ZPP) is 
required on each occasion that a blood lead level measurement is made.
    An annual medical examination and consultation performed under the 
guidelines discussed in Section 3 is to be made available to each 
employee for whom a blood test conducted at any time during the 
preceding 12 months indicated a blood lead level at or above 40 
<greek-m> g/100 g. Also, an examination is to be given to all employees 
prior to their assignment to an area in which airborne lead 
concentrations reach or exceed the action level. In addition, a medical 
examination must be provided as soon as possible after notification by 
an employee that the employee has developed signs or symptoms commonly 
associated with lead intoxication, that the employee desires medical 
advice regarding lead exposure and the ability to procreate a healthy 
child, or that the employee has demonstrated difficulty in breathing 
during a respirator fitting test or during respirator use. An 
examination is also to be made available to each employee removed from 
exposure to lead due to a risk of sustaining material impairment to 
health, or otherwise limited or specially protected pursuant to medical 
recommendations.
    Results of biological monitoring or the recommendations of an 
examining physician may necessitate removal of an employee from further 
lead exposure pursuant to the standard's medical removal protection 
(MRP) program. The object of the MRP program is to provide temporary 
medical removal to workers either with substantially elevated blood lead 
levels or otherwise at risk of sustaining material health impairment 
from continued substantial exposure to lead. The following guidelines 
which are summarized in Table 2 were created under the standard for the 
temporary removal of an exposed employee and his or her subsequent 
return to work in an exposure area.

                                                     Table 2
----------------------------------------------------------------------------------------------------------------
                                                                  Effective date
                                --------------------------------------------------------------------------------
                                                                                                  Mar. 1, 1983
                                  Mar. 1, 1979    Mar. 1, 1980    Mar. 1, 1981   Mar. 1, 1982       (final)
----------------------------------------------------------------------------------------------------------------
A. Blood lead level requiring    <gr-thn-eq>80   <gr-thn-eq>70<  <gr-thn-eq>60  <gr-thn-eq>60  <gr-thn-eq>60<gre
 employee medical removal.        <greek-m>g/     gg/100 g        <greek-m>g/    <greek-m>g/    eg/100 g or
 (Level must be confirmed with    100 g                           100 g          100 g          average of last
 second follow-up blood lead                                                                    three blood
 level within two weeks of                                                                      samples or all
 first report.).                                                                                blood samples
                                                                                                over previous 6
                                                                                                months
                                                                                                (whichever is
                                                                                                over a longer
                                                                                                time period) is
                                                                                                50 <greek-m>g/
                                                                                                100 g or greater
                                                                                                unless last
                                                                                                blood sample is
                                                                                                40 <greek-m>g/
                                                                                                100 g or less.
B. Frequency which employees
 exposed to action level of
 lead (30 <greek-m>g/m<SUP>3</SUP> TWA)
 must have blood lead level
 checked (ZPP is also required
 in each occasion that a blood
 lead is obtained.):
  1. Last blood lead level less  Every 6 months  Every 6 months  Every 6        Every 6        Every 6 months.
   than 40 <greek-m>g/100 g.                                      months         months
  2. Last blood lead level       Every 2 months  Every 2 months  Every 2        Every 2        Every 2 months.
   between 40 <greek-m>g/100 g                                    months         months
   and level requiring medical
   removal (see A above).
  3. Employees removed from      Every 1 month   Every 1 month   Every 1 month  Every 1 month  Every 1 month.
   exposure to lead because of
   an elevated blood lead level.
C. Permissible airborne          100 <greek-m>g/ 50 <greek-m>g/  30 <greek-m>g/ 30 <greek-m>g/ 30 <greek-m>g/m<SUP>3</SUP>
 exposure limit for workers       m<SUP>3</SUP> 8 hr TWA     m<SUP>3</SUP> 8 hr TWA     m<SUP>3</SUP> 8 hr TWA    m<SUP>3</SUP> 8 hr TWA    8 hr TWA.
 removed from work due to an
 elevated blood lead level
 (without regard to respirator
 protection).

[[Page 128]]


D. Blood lead level confirmed    <t-bullet>60    <t-bullet>50    <t-bullet>40   <t-bullet>40   <t-bullet>40
 with a second blood analysis,    <greek-m>g/     <greek-m>g/     <greek-m>g/    <greek-m>g/    <greek-m>g/100
 at which employee may return     100 g           100 g           100 g          100 g          g.
 to work. Permissible exposure
 without regard to respirator
 protection is listed by
 industry in Table I.
----------------------------------------------------------------------------------------------------------------
Note: When medical opinion indicates that an employee is at risk of material impairment from exposure to lead,
  the physician can remove an employee from exposures exceeding the action level (or less) or recommend special
  protective measures as deemed appropriate and necessary. Medical monitoring during the medical removal period
  can be more stringent than noted in the table above if the physician so specifies. Return to work or removal
  of limitations and special protections is permitted when the physician indicates that the worker is no longer
  at risk of material impairment.

    Under the standard's ultimate worker removal criteria, a worker is 
to be removed from any work having any eight hour TWA exposure to lead 
of 30 <greek-m>g/m<SUP>3</SUP> or more whenever either of the following 
circumstances apply: (1) a blood lead level of 60 <greek-m> g/100 g or 
greater is obtained and confirmed by a second follow-up blood lead level 
performed within two weeks after the employer receives the results of 
the first blood sampling test, or (2) the average of the previous three 
blood lead determinations or the average of all blood lead 
determinations conducted during the previous six months, whichever 
encompasses the longest time period, equals or exceeds 50 <greek-m> g/
100 g, unless the last blood sample indicates a blood lead level at or 
below 40 <greek-m> g/100 g in which case the employee need not be 
removed. Medical removal is to continue until two consecutive blood lead 
levels are 40 <greek-m> g/100 g or less.
    During the first two years that the ultimate removal criteria are 
being phased in, the return criteria have been set to assure that a 
worker's blood lead level has substantially declined during the period 
of removal. From March 1, 1979 to March 1, 1980, the blood lead level 
requiring employee medical removal is 80 <greek-m> g/100 g. Workers 
found to have a confirmed blood lead at this level or greater need only 
be removed from work having a daily 8 hour TWA exposure to lead at or 
above 100 <greek-m>g/m<SUP>3</SUP>. Workers so removed are to be 
returned to work when their blood lead levels are at or below 60 
<greek-m> g/100 g of whole blood. From March 1, 1980 to March 1, 1981, 
the blood lead level requiring medical removal is 70 <greek-m> g/100 g. 
During this period workers need only be removed from jobs having a daily 
8 hour TWA exposure to lead at or above 50 <greek-m>g/m<SUP>3</SUP> and 
are to be returned to work when a level of 50 <greek-m> g/100 g is 
achieved. Beginning March 1, 1981, return depends on a worker's blood 
lead level declining to 40 <greek-m> g/100 g of whole blood.
    As part of the standard, the employer is required to notify in 
writing each employee whose blood lead level exceeds 40 <greek-m> g/100 
g. In addition each such employee is to be informed that the standard 
requires medical removal with MRP benefits, discussed below, when an 
employee's blood lead level exceeds the above defined limits.
    In addition to the above blood lead level criteria, temporary worker 
removal may also take place as a result of medical determinations and 
recommendations. Written medical opinions must be prepared after each 
examination pursuant to the standard. If the examining physician 
includes a medical finding, determination or opinion that the employee 
has a medical condition which places the employee at increased risk of 
material health impairment from exposure to lead, then the employee must 
be removed from exposure to lead at or above the action level. 
Alternatively, if the examining physician recommends special protective 
measures for an employee (e.g., use of a powered air purifying 
respirator) or recommends limitations on an employee's exposure to lead, 
then the employer must implement these recommendations. Recommendations 
may be more stringent than the specific provisions of the standard. The 
examining physician, therefore, is given broad flexibility to tailor 
special protective procedures to the needs of individual employees. This 
flexibility extends to the evaluation and management of pregnant workers 
and male and female workers who are planning to raise children. Based on 
the history, physical examination, and laboratory studies, the physician 
might recommend special protective measures or medical removal for an 
employee who is pregnant or who is planning to conceive a child when, in 
the physician's judgment, continued exposure to lead at the current job 
would pose a significant risk. The return of the employee to his or her 
former job status, or the removal of special protections or limitations, 
depends upon the examining physician determining that the employee is no 
longer at increased risk of material impairment or that special measures 
are no longer needed.
    During the period of any form of special protection or removal, the 
employer must maintain the worker's earnings, seniority,

[[Page 129]]

and other employment rights and benefits (as though the worker had not 
been removed) for a period of up to 18 months. This economic protection 
will maximize meaningful worker participation in the medical 
surveillance program, and is appropriate as part of the employer's 
overall obligation to provide a safe and healthful workplace. The 
provisions of MRP benefits during the employee's removal period may, 
however, be conditioned upon participation in medical surveillance.
    On rare occasions, an employee's blood lead level may not acceptably 
decline within 18 months of removal. This situation will arise only in 
unusual circumstances, thus the standard relies on an individual medical 
examination to determine how to protect such an employee. This medical 
determination is to be based on both laboratory values, including lead 
levels, zinc protoporphyrin levels, blood counts, and other tests felt 
to be warranted, as well as the physician's judgment that any symptoms 
or findings on physical examination are a result of lead toxicity. The 
medical determination may be that the employee is incapable of ever 
safely returning to his or her former job status. The medical 
determination may provide additional removal time past 18 months for 
some employees or specify special protective measures to be implemented.
    The lead standard provides for a multiple physician review in cases 
where the employee wishes a second opinion concerning potential lead 
poisoning or toxicity. If an employee wishes a second opinion, he or she 
can make an appointment with a physician of his or her choice. This 
second physician will review the findings, recommendations or 
determinations of the first physician and conduct any examinations, 
consultations or tests deemed necessary in an attempt to make a final 
medical determination. If the first and second physicians do not agree 
in their assessment they must try to resolve their differences. If they 
cannot reach an agreement then they must designate a third physician to 
resolve the dispute.
    The employer must provide examining and consulting physicians with 
the following specific information: a copy of the lead regulations and 
all appendices, a description of the employee's duties as related to 
exposure, the exposure level to lead and any other toxic substances (if 
applicable), a description of personal protective equipment used, blood 
lead levels, and all prior written medical opinions regarding the 
employee in the employer's possession or control. The employer must also 
obtain from the physician and provide the employee with a written 
medical opinion containing blood lead levels, the physicians's opinion 
as to whether the employee is at risk of material impairment to health, 
any recommended protective measures for the employee if further exposure 
is permitted, as well as any recommended limitations upon an employee's 
use of respirators.
    Employers must instruct each physician not to reveal to the employer 
in writing or in any other way his or her findings, laboratory results, 
or diagnoses which are felt to be unrelated to occupational lead 
exposure. They must also instruct each physician to advise the employee 
of any occupationally or non-occupationally related medical condition 
requiring further treatment or evaluation.
    The standard provides for the use of respirators where engineering 
and other primary controls have not been fully implemented. However, the 
use of respirator protection shall not be used in lieu of temporary 
medical removal due to elevated blood lead levels or findings that an 
employee is at risk of material health impairment. This is based on the 
numerous inadequacies of respirators including skin rash where the 
facepiece makes contact with the skin, unacceptable stress to breathing 
in some workers with underlying cardiopulmonary impairment, difficulty 
in providing adequate fit, the tendency for respirators to create 
additional hazards by interfering with vision, hearing, and mobility, 
and the difficulties of assuring the maximum effectiveness of a 
complicated work practice program involving respirators. Respirators do, 
however, serve a useful function where engineering and work practice 
controls are inadequate by providing supplementary, interim, or short-
term protection, provided they are properly selected for the environment 
in which the employee will be working, properly fitted to the employee, 
maintained and cleaned periodically, and worn by the employee when 
required.
    In its final standard on occupational exposure to inorganic lead, 
OSHA has prohibited prophylactic chelation. Diagnostic and therapeutic 
chelation are permitted only under the supervision of a licensed 
physician with appropriate medical monitoring in an acceptable clinical 
setting. The decision to initiate chelation therapy must be made on an 
individual basis and take into account the severity of symptoms felt to 
be a result of lead toxicity along with blood lead levels, ZPP levels, 
and other laboratory tests as appropriate. EDTA and penicillamine which 
are the primary chelating agents used in the therapy of occupational 
lead poisoning have significant potential side effects and their use 
must be justified on the basis of expected benefits to the worker. 
Unless frank and severe symptoms are present, therapeutic chelation is 
not recommended given the opportunity to remove a worker from exposure 
and allow the body to naturally excrete accumulated lead. As a 
diagnostic aid, the chelation mobilization test using CA-EDTA has 
limited applicability. According to some investigators, the test can 
differentiate between lead-induced and other nephropathies.

[[Page 130]]

The test may also provide an estimation of the mobile fraction of the 
total body lead burden.
    Employers are required to assure that accurate records are 
maintained on exposure monitoring, medical surveillance, and medical 
removal for each employee. Exposure monitoring and medical surveillance 
records must be kept for 40 years or the duration of employment plus 20 
years, whichever is longer, while medical removal records must be 
maintained for the duration of employment. All records required under 
the standard must be made available upon request to the Assistant 
Secretary of Labor for Occupational Safety and Health and the Director 
of the National Institute for Occupational Safety and Health. Employers 
must also make environmental and biological monitoring and medical 
removal records available to affected employees and to former employees 
or their authorized employee representatives. Employees or their 
specifically designated representatives have access to their entire 
medical surveillance records.
    In addition, the standard requires that the employer inform all 
workers exposed to lead at or above the action level of the provisions 
of the standard and all its appendices, the purpose and description of 
medical surveillance and provisions for medical removal protection if 
temporary removal is required. An understanding of the potential health 
effects of lead exposure by all exposed employees along with full 
understanding of their rights under the lead standard is essential for 
an effective monitoring program.

              ii. adverse health effects of inorganic lead

    Although the toxicity of lead has been known for 2,000 years, the 
knowledge of the complex relationship between lead exposure and human 
response is still being refined. Significant research into the toxic 
properties of lead continues throughout the world, and it should be 
anticipated that our understanding of thresholds of effects and margins 
of safety will be improved in future years. The provisions of the lead 
standard are founded on two prime medical judgments: first, the 
prevention of adverse health effects from exposure to lead throughout a 
working lifetime requires that worker blood lead levels be maintained at 
or below 40 <greek-m> g/100 g and second, the blood lead levels of 
workers, male or female, who intend to parent in the near future should 
be maintained below 30 <greek-m> g/100 g to minimize adverse 
reproductive health effects to the parents and developing fetus. The 
adverse effects of lead on reproduction are being actively researched 
and OSHA encourages the physician to remain abreast of recent 
developments in the area to best advise pregnant workers or workers 
planning to conceive children.
    The spectrum of health effects caused by lead exposure can be 
subdivided into five developmental stages: normal, physiological changes 
of uncertain significance, pathophysiological changes, overt symptoms 
(morbidity), and mortality. Within this process there are no sharp 
distinctions, but rather a continuum of effects. Boundaries between 
categories overlap due to the wide variation of individual responses and 
exposures in the working population. OSHA's development of the lead 
standard focused on pathophysiological changes as well as later stages 
of disease.
    1. Heme Synthesis Inhibition. The earliest demonstrated effect of 
lead involves its ability to inhibit at least two enzymes of the heme 
synthesis pathway at very low blood levels. Inhibition of delta 
aminolevulinic acid dehydrase (ALA-D) which catalyzes the conversion of 
delta-aminolevulinic acid (ALA) to protoporphyrin is observed at a blood 
lead level below 20 <greek-m> g/100 g whole blood. At a blood lead level 
of 40 ug/100 g, more than 20% of the population would have 70% 
inhibition of ALA-D. There is an exponential increase in ALA excretion 
at blood lead levels greater than 40 <greek-m> g/100 g.
    Another enzyme, ferrochelatase, is also inhibited at low blood lead 
levels. Inhibition of ferrochelatase leads to increased free erythrocyte 
protoporphyrin (FEP) in the blood which can then bind to zinc to yield 
zinc protoporphyrin. At a blood lead level of 50 <greek-m> g/100 g or 
greater, nearly 100% of the population will have an increase in FEP. 
There is also an exponential relationship between blood lead levels 
greater than 40 <greek-m> g/100 g and the associated ZPP level, which 
has led to the development of the ZPP screening test for lead exposure.
    While the significance of these effects is subject to debate, it is 
OSHA's position that these enzyme disturbances are early stages of a 
disease process which may eventually result in the clinical symptoms of 
lead poisoning. Whether or not the effects do progress to the later 
stages of clinical disease, disruption of these enzyme processes over a 
working lifetime is considered to be a material impairment of health.
    One of the eventual results of lead-induced inhibition of enzymes in 
the heme synthesis pathway is anemia which can be asymptomatic if mild 
but associated with a wide array of symptoms including dizziness, 
fatigue, and tachycardia when more severe. Studies have indicated that 
lead levels as low as 50 <greek-m> g/100 g can be associated with a 
definite decreased hemoglobin, although most cases of lead-induced 
anemia, as well as shortened red-cell survival times, occur at lead 
levels exceeding 80 <greek-m> g/100 g. Inhibited hemoglobin synthesis is 
more common in chronic cases whereas shortened erythrocyte life span is 
more common in acute cases.

[[Page 131]]

    In lead-induced anemias, there is usually a reticulocytosis along 
with the presence of basophilic stippling, and ringed sideroblasts, 
although none of the above are pathognomonic for lead-induced anemia.
    2. Neurological Effects. Inorganic lead has been found to have toxic 
effects on both the central and peripheral nervous systems. The earliest 
stages of lead-induced central nervous system effects first manifest 
themselves in the form of behavioral disturbances and central nervous 
system symptoms including irritability, restlessness, insomnia and other 
sleep disturbances, fatigue, vertigo, headache, poor memory, tremor, 
depression, and apathy. With more severe exposure, symptoms can progress 
to drowsiness, stupor, hallucinations, delerium, convulsions and coma.
    The most severe and acute form of lead poisoning which usually 
follows ingestion or inhalation of large amounts of lead is acute 
encephalopathy which may arise precipitously with the onset of 
intractable seizures, coma, cardiorespiratory arrest, and death within 
48 hours.
    While there is disagreement about what exposure levels are needed to 
produce the earliest symptoms, most experts agree that symptoms 
definitely can occur at blood lead levels of 60 <greek-m> g/100 g whole 
blood and therefore recommend a 40 <greek-m> g/100 g maximum. The 
central nervous system effects frequently are not reversible following 
discontinued exposure or chelation therapy and when improvement does 
occur, it is almost always only partial.
    The peripheral neuropathy resulting from lead exposure 
characteristically involves only motor function with minimal sensory 
damage and has a marked predilection for the extensor muscles of the 
most active extremity. The peripheral neuropathy can occur with varying 
degrees of severity. The earliest and mildest form which can be detected 
in workers with blood lead levels as low as 50 <greek-m> g/100 g is 
manifested by slowing of motor nerve conduction velocity often without 
clinical symptoms. With progression of the neuropathy there is 
development of painless extensor muscle weakness usually involving the 
extensor muscles of the fingers and hand in the most active upper 
extremity, followed in severe cases by wrist drop or, much less 
commonly, foot drop.
    In addition to slowing of nerve conduction, electromyographical 
studies in patients with blood lead levels greater than 50 <greek-m> g/
100 g have demonstrated a decrease in the number of acting motor unit 
potentials, an increase in the duration of motor unit potentials, and 
spontaneous pathological activity including fibrillations and 
fasciculations. Whether these effects occur at levels of 40 <greek-m> g/
100 g is undetermined.
    While the peripheral neuropathies can occasionally be reversed with 
therapy, again such recovery is not assured particularly in the more 
severe neuropathies and often improvement is only partial. The lack of 
reversibility is felt to be due in part to segmental demyelination.
    3. Gastrointestinal. Lead may also affect the gastrointestinal 
system producing abdominal colic or diffuse abdominal pain, 
constipation, obstipation, diarrhea, anorexia, nausea and vomiting. Lead 
colic rarely develops at blood lead levels below 80 <greek-m> g/100 g.
    4. Renal. Renal toxicity represents one of the most serious health 
effects of lead poisoning. In the early stages of disease nuclear 
inclusion bodies can frequently be identified in proximal renal tubular 
cells. Renal function remains normal and the changes in this stage are 
probably reversible. With more advanced disease there is progressive 
interstitial fibrosis and impaired renal function. Eventually extensive 
interstitial fibrosis ensues with sclerotic glomeruli and dilated and 
atrophied proximal tubules; all represent end stage kidney disease. 
Azotemia can be progressive, eventually resulting in frank uremia 
necessitating dialysis. There is occasionally associated hypertension 
and hyperuricemia with or without gout.
    Early kidney disease is difficult to detect. The urinalysis is 
normal in early lead nephropathy and the blood urea nitrogen and serum 
creatinine increase only when two-thirds of kidney function is lost. 
Measurement of creatinine clearance can often detect earlier disease as 
can other methods of measurement of glomerular filtration rate. An 
abnormal Ca-EDTA mobilization test has been used to differentiate 
between lead-induced and other nephropathies, but this procedure is not 
widely accepted. A form of Fanconi syndrome with aminoaciduria, 
glycosuria, and hyperphosphaturia indicating severe injury to the 
proximal renal tubules is occasionally seen in children.
    5. Reproductive effects. Exposure to lead can have serious effects 
on reproductive function in both males and females. In male workers 
exposed to lead there can be a decrease in sexual drive, impotence, 
decreased ability to produce healthy sperm, and sterility. Malformed 
sperm (teratospermia), decreased number of sperm (hypospermia), and 
sperm with decreased motility (asthenospermia) can all occur. 
Teratospermia has been noted at mean blood lead levels of 53 <greek-m> 
g/100 g and hypospermia and asthenospermia at 41 <greek-m> g/100 g. 
Furthermore, there appears to be a dose-response relationship for 
teratospermia in lead exposed workers.
    Women exposed to lead may experience menstrual disturbances 
including dysmenorrhea, menorrhagia and amenorrhea. Following exposure 
to lead, women have a higher frequency of sterility, premature births, 
spontaneous miscarriages, and stillbirths.
    Germ cells can be affected by lead and cause genetic damage in the 
egg or sperm

[[Page 132]]

cells before conception and result in failure to implant, miscarriage, 
stillbirth, or birth defects.
    Infants of mothers with lead poisoning have a higher mortality 
during the first year and suffer from lowered birth weights, slower 
growth, and nervous system disorders.
    Lead can pass through the placental barrier and lead levels in the 
mother's blood are comparable to concentrations of lead in the umbilical 
cord at birth. Transplacental passage becomes detectable at 12-14 weeks 
of gestation and increases until birth.
    There is little direct data on damage to the fetus from exposure to 
lead but it is generally assumed that the fetus and newborn would be at 
least as susceptible to neurological damage as young children. Blood 
lead levels of 50-60 <greek-m> g/100 g in children can cause significant 
neurobehavioral impairments and there is evidence of hyperactivity at 
blood levels as low as 25 <greek-m> g/100 g. Given the overall body of 
literature concerning the adverse health effects of lead in children, 
OSHA feels that the blood lead level in children should be maintained 
below 30 <greek-m> g/100 g with a population mean of 15 <greek-m> g/100 
g. Blood lead levels in the fetus and newborn likewise should not exceed 
30 <greek-m> g/100 g.
    Because of lead's ability to pass through the placental barrier and 
also because of the demonstrated adverse effects of lead on reproductive 
function in both the male and female as well as the risk of genetic 
damage of lead on both the ovum and sperm, OSHA recommends a 30 
<greek-m> g/100 g maximum permissible blood lead level in both males and 
females who wish to bear children.
    6. Other toxic effects. Debate and research continue on the effects 
of lead on the human body. Hypertension has frequently been noted in 
occupationally exposed individuals although it is difficult to assess 
whether this is due to lead's adverse effects on the kidney or if some 
other mechanism is involved. Vascular and electrocardiogarphic changes 
have been detected but have not been well characterized. Lead is thought 
to impair thyroid function and interfere with the pituitary-adrenal 
axis, but again these effects have not been well defined.

                         iii. medical evaluation

    The most important principle in evaluating a worker for any 
occupational disease including lead poisoning is a high index of 
suspicion on the part of the examining physician. As discussed in 
Section 2, lead can affect numerous organ systems and produce a wide 
array of signs and symptoms, most of which are non-specific and subtle 
in nature at least in the early stages of disease. Unless serious 
concern for lead toxicity is present, many of the early clues to 
diagnosis may easily be overlooked.
    The crucial initial step in the medical evaluation is recognizing 
that a worker's employment can result in exposure to lead. The worker 
will frequently be able to define exposures to lead and lead containing 
materials but often will not volunteer this information unless 
specifically asked. In other situations the worker may not know of any 
exposures to lead but the suspicion might be raised on the part of the 
physician because of the industry or occupation of the worker. Potential 
occupational exposure to lead and its compounds occur in at least 120 
occupations, including lead smelting, the manufacture of lead storage 
batteries, the manufacture of lead pigments and products containing 
pigments, solder manufacture, shipbuilding and ship repair, auto 
manufacturing, construction, and painting.
    Once the possibility for lead exposure is raised, the focus can then 
be directed toward eliciting information from the medical history, 
physical exam, and finally from laboratory data to evaluate the worker 
for potential lead toxicity.
    A complete and detailed work history is important in the initial 
evaluation. A listing of all previous employment with information on 
work processes, exposure to fumes or dust, known exposures to lead or 
other toxic substances, respiratory protection used, and previous 
medical surveillance should all be included in the worker's record. 
Where exposure to lead is suspected, information concerning on-the-job 
personal hygiene, smoking or eating habits in work areas, laundry 
procedures, and use of any protective clothing or respiratory protection 
equipment should be noted. A complete work history is essential in the 
medical evaluation of a worker with suspected lead toxicity, especially 
when long term effects such as neurotoxicity and nephrotoxicity are 
considered.
    The medical history is also of fundamental importance and should 
include a listing of all past and current medical conditions, current 
medications including proprietary drug intake, previous surgeries and 
hospitalizations, allergies, smoking history, alcohol consumption, and 
also non-occupational lead exposures such as hobbies (hunting, riflery). 
Also known childhood exposures should be elicited. Any previous history 
of hematological, neurological, gastrointestinal, renal, psychological, 
gynecological, genetic, or reproductive problems should be specifically 
noted.
    A careful and complete review must be performed to assess both 
recognized complaints and subtle or slowly acquired symptoms which the 
worker might not appreciate as being significant. The review of symptoms 
should include the following:
    General--weight loss, fatigue, decreased appetite.
    Head, Eyes, Ears, Nose, Throat (HEENT)--headaches, visual 
disturbances or decreased visual acuity, hearing deficits or tinnitus,

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pigmentation of the oral mucosa, or metallic taste in mouth.
    Cardio-pulmonary--shortness of breath, cough, chest pains, 
palpitations, or orthopnea.
    Gastrointestinal--nausea, vomiting, heartburn, abdominal pain, 
constipation or diarrhea.
    Neurologic--irritability, insomnia, weakness (fatigue), dizziness, 
loss of memory, confusion, hallucinations, incoordination, ataxia, 
decreased strength in hands or feet, disturbances in gait, difficulty in 
climbing stairs, or seizures.
    Hematologic--pallor, easy fatigability, abnormal blood loss, melena.
    Reproductive (male and female and spouse where relevant)--history of 
infertility, impotence, loss of libido, abnormal menstrual periods, 
history of miscarriages, stillbirths, or children with birth defects.
    Musculo-skeletal--muscle and joint pains.
    The physical examination should emphasize the neurological, 
gastrointestinal, and cardiovascular systems. The worker's weight and 
blood pressure should be recorded and the oral mucosa checked for 
pigmentation characteristic of a possible Burtonian or lead line on the 
gingiva. It should be noted, however, that the lead line may not be 
present even in severe lead poisoning if good oral hygiene is practiced.
    The presence of pallor on skin examination may indicate an anemia, 
which if severe might also be associated with a tachycardia. If an 
anemia is suspected, an active search for blood loss should be 
undertaken including potential blood loss through the gastrointestinal 
tract.
    A complete neurological examination should include an adequate 
mental status evaluation including a search for behavioral and 
psychological disturbances, memory testing, evaluation for irritability, 
insomnia, hallucinations, and mental clouding. Gait and coordination 
should be examined along with close observation for tremor. A detailed 
evaluation of peripheral nerve function including careful sensory and 
motor function testing is warranted. Strength testing particularly of 
extensor muscle groups of all extremities is of fundamental importance.
    Cranial nerve evaluation should also be included in the routine 
examination.
    The abdominal examination should include auscultation for bowel 
sounds and abdominal bruits and palpation for organomegaly, masses, and 
diffuse abdominal tenderness.
    Cardiovascular examination should evaluate possible early signs of 
congestive heart failure. Pulmonary status should be addressed 
particularly if respirator protection is contemplated.
    As part of the medical evaluation, the lead standard requires the 
following laboratory studies:
    1. Blood lead level
    2. Hemoglobin and hematocrit determinations, red cell indices, and 
examination of the peripheral blood smear to evaluate red blood cell 
morphology
    3. Blood urea nitrogen
    4. Serum creatinine
    5. Routine urinalysis with microscopic examination.
    6. A zinc protoporphyrin level
    In addition to the above, the physician is authorized to order any 
further laboratory or other tests which he or she deems necessary in 
accordance with sound medical practice. The evaluation must also include 
pregnancy testing or laboratory evaluation of male fertility if 
requested by the employee.
    Additional tests which are probably not warranted on a routine basis 
but may be appropriate when blood lead and ZPP levels are equivocal 
include delta aminolevulinic acid and coproporphyrin concentrations in 
the urine, and dark-field illumination for detection of basophilic 
stippling in red blood cells.
    If an anemia is detected further studies including a careful 
examination of the peripheral smear, reticulocyte count, stool for 
occult blood, serum iron, total iron binding capacity, bilirubin, and, 
if appropriate, vitamin B12 and folate may be of value in attempting to 
identify the cause of the anemia.
    If a peripheral neuropathy is suspected, nerve conduction studies 
are warranted both for diagnosis and as a basis to monitor any therapy.
    If renal disease is questioned, a 24 hour urine collection for 
creatinine clearance, protein, and electrolytes may be indicated. 
Elevated uric acid levels may result from lead-induced renal disease and 
a serum uric acid level might be performed.
    An electrocardiogram and chest x-ray may be obtained as deemed 
appropriate.
    Sophisticated and highly specialized testing should not be done 
routinely and where indicated should be under the direction of a 
specialist.

                        iv. laboratory evaluation

    The blood lead level at present remains the single most important 
test to monitor lead exposure and is the test used in the medical 
surveillance program under the lead standard to guide employee medical 
removal. The ZPP has several advantages over the blood lead level. 
Because of its relatively recent development and the lack of extensive 
data concerning its interpretation, the ZPP currently remains an 
ancillary test.
    This section will discuss the blood lead level and ZPP in detail and 
will outline their relative advantages and disadvantages. Other blood 
tests currently available to evaluate lead exposure will also be 
reviewed.
    The blood lead level is a good index of current or recent lead 
absorption when there is

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no anemia present and when the worker has not taken any chelating 
agents. However, blood lead levels along with urinary lead levels do not 
necessarily indicate the total body burden of lead and are not adequate 
measures of past exposure. One reason for this is that lead has a high 
affinity for bone and up to 90% of the body's total lead is deposited 
there. A very important component of the total lead body burden is lead 
in soft tissue (liver, kidney, and brain). This fraction of the lead 
body burden, the biologically active lead, is not entirely reflected by 
blood lead levels since it is a function of the dynamics of lead 
absorption, distribution, deposition in bone and excretion. Following 
discontinuation of exposure to lead, the excess body burden is only 
slowly mobilized from bone and other relatively stable body stores and 
excreted. Consequently, a high blood lead level may only represent 
recent heavy exposure to lead without a significant total body excess 
and likewise a low blood lead level does not exclude an elevated total 
body burden of lead.
    Also due to its correlation with recent exposures, the blood lead 
level may vary considerably over short time intervals.
    To minimize laboratory error and erroneous results due to 
contamination, blood specimens must be carefully collected after 
thorough cleaning of the skin with appropriate methods using lead-free 
blood containers and analyzed by a reliable laboratory. Under the 
standard, samples must be analyzed in laboratories which are approved by 
the Center for Disease Control (CDC) or which have received satisfactory 
grades in proficiency testing by the CDC in the previous year. Analysis 
is to be made using atomic absorption spectrophotometry, anodic 
stripping voltammetry or any method which meets the accuracy 
requirements set forth by the standard.
    The determination of lead in urine is generally considered a less 
reliable monitoring technique than analysis of whole blood primarily due 
to individual variability in urinary excretion capacity as well as the 
technical difficulty of obtaining accurate 24 hour urine collections. In 
addition, workers with renal insufficiency, whether due to lead or some 
other cause, may have decreased lead clearance and consequently urine 
lead levels may underestimate the true lead burden. Therefore, urine 
lead levels should not be used as a routine test.
    The zinc protoporphyrin test, unlike the blood lead determination, 
measures an adverse metabolic effect of lead and as such is a better 
indicator of lead toxicity than the level of blood lead itself. The 
level of ZPP reflects lead absorption over the preceding 3 to 4 months, 
and therefore is a better indicator of lead body burden. The ZPP 
requires more time than the blood lead to read significantly elevated 
levels; the return to normal after discontinuing lead exposure is also 
slower. Furthermore, the ZPP test is simpler, faster, and less expensive 
to perform and no contamination is possible. Many investigators believe 
it is the most reliable means of monitoring chronic lead absorption.
    Zinc protoporphyrin results from the inhibition of the enzyme 
ferrochelatase which catalyzes the insertion of an iron molecule into 
the protoporphyrin molecule, which then becomes heme. If iron is not 
inserted into the molecule then zinc, having a greater affinity for 
protoporphyrin, takes the place of the iron, forming ZPP.
    An elevation in the level of circulating ZPP may occur at blood lead 
levels as low as 20-30 <greek-m> g/100 g in some workers. Once the blood 
lead level has reached 40 <greek-m> g/100 g there is more marked rise in 
the ZPP value from its normal range of less than 100 <greek-m> g/100 ml. 
Increases in blood lead levels beyond 40 <greek-m> g/100 g are 
associated with exponential increases in ZPP.
    Whereas blood lead levels fluctuate over short time spans, ZPP 
levels remain relatively stable. ZPP is measured directly in red blood 
cells and is present for the cell's entire 120 day life-span. Therefore, 
the ZPP level in blood reflects the average ZPP production over the 
previous 3-4 months and consequently the average lead exposure during 
that time interval.
    It is recommended that a hematocrit be determined whenever a 
confirmed ZPP of 50 <greek-m> g/100 ml whole blood is obtained to rule 
out a significant underlying anemia. If the ZPP is in excess of 100 
<greek-m> g/100 ml and not associated with abnormal elevations in blood 
lead levels, the laboratory should be checked to be sure that blood 
leads were determined using atomic absorption spectrophotometry anodic 
stripping voltammetry, or any method which meets the accuracy 
requirements set forth by the standard by a CDC approved laboratory 
which is experienced in lead level determinations. Repeat periodic blood 
lead studies should be obtained in all individuals with elevated ZPP 
levels to be certain that an associated elevated blood lead level has 
not been missed due to transient fluctuations in blood leads.
    ZPP has a characteristic fluorescence spectrum with a peak at 594 nm 
which is detectable with a hematofluorimeter. The hematofluorimeter is 
accurate and portable and can provide on-site, instantaneous results for 
workers who can be frequently tested via a finger prick.
    However, careful attention must be given to calibration and quality 
control procedures. Limited data on blood lead--ZPP correlations and the 
ZPP levels which are associated with the adverse health effects 
discussed in Section 2 are the major limitations of the test. Also it is 
difficult to correlate ZPP levels with environmental exposure and

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there is some variation of response with age and sex. Nevertheless, the 
ZPP promises to be an important diagnostic test for the early detection 
of lead toxicity and its value will increase as more data is collected 
regarding its relationship to other manifestations of lead poisoning.
    Levels of delta-aminolevulinic acid (ALA) in the urine are also used 
as a measure of lead exposure. Increasing concentrations of ALA are 
believed to result from the inhibition of the enzyme delta-
aminolevulinic acid dehydrase (ALA-D). Although the test is relatively 
easy to perform, inexpensive, and rapid, the disadvantages include 
variability in results, the necessity to collect a complete 24 hour 
urine sample which has a specific gravity greater than 1.010, and also 
the fact that ALA decomposes in the presence of light.
    The pattern of porphyrin excretion in the urine can also be helpful 
in identifying lead intoxication. With lead poisoning, the urine 
concentrations of coproporphyrins I and II, porphobilinogen and 
uroporphyrin I rise. The most important increase, however, is that of 
coproporphyrin III; levels may exceed 5,000 <greek-m> g/1 in the urine 
in lead poisoned individuals, but its correlation with blood lead levels 
and ZPP are not as good as those of ALA. Increases in urinary porphyrins 
are not diagnostic of lead toxicity and may be seen in porphyria, some 
liver diseases, and in patients with high reticulocyte counts.
    Summary. The Occupational Safety and Health Administration's 
standard for inorganic lead places significant emphasis on the medical 
surveillance of all workers exposed to levels of inorganic lead above 
the action level of 30 <greek-m>g/m<SUP>3</SUP> TWA. The physician has a 
fundamental role in this surveillance program, and in the operation of 
the medical removal protection program.
    Even with adequate worker education on the adverse health effects of 
lead and appropriate training in work practices, personal hygiene and 
other control measures, the physician has a primary responsibility for 
evaluating potential lead toxicity in the worker. It is only through a 
careful and detailed medical and work history, a complete physical 
examination and appropriate laboratory testing that an accurate 
assessment can be made. Many of the adverse health effects of lead 
toxicity are either irreversible or only partially reversible and 
therefore early detection of disease is very important.
    This document outlines the medical monitoring program as defined by 
the occupational safety and health standard for inorganic lead. It 
reviews the adverse health effects of lead poisoning and describes the 
important elements of the history and physical examinations as they 
relate to these adverse effects. Finally, the appropriate laboratory 
testing for evaluating lead exposure and toxicity is presented.
    It is hoped that this review and discussion will give the physician 
a better understanding of the OSHA standard with the ultimate goal of 
protecting the health and well-being of the worker exposed to lead under 
his or her care.

[43 FR 53007, Nov. 14, 1978]

    Editorial Note: For Federal Register citations affecting 
Sec. 1910.1025 see the List of CFR Sections Afffected, which appears in 
the Finding Aids section of the printed volume and on GPO Access.