[Code of Federal Regulations]
[Title 29, Volume 8]
[Revised as of July 1, 2001]
From the U.S. Government Printing Office via GPO Access
[CITE: 29CFR1926.62]

[Page 85-116]
 
                             TITLE 29--LABOR
 
CHAPTER XVII--OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT 
                                OF LABOR
 
PART 1926--SAFETY AND HEALTH REGULATIONS FOR CONSTRUCTION--Table of Contents
 
        Subpart D--Occupational Health and Environmental Controls
 
Sec. 1926.62  Lead.

    (a) Scope. This section applies to all construction work where an 
employee may be occupationally exposed to lead. All construction work 
excluded from coverage in the general industry standard for lead by 29 
CFR 1910.1025(a)(2) is covered by this standard. Construction work is 
defined as work for construction, alteration and/or repair, including 
painting and decorating. It includes but is not limited to the 
following:
    (1) Demolition or salvage of structures where lead or materials 
containing lead are present;
    (2) Removal or encapsulation of materials containing lead;
    (3) New construction, alteration, repair, or renovation of 
structures, substrates, or portions thereof, that contain lead, or 
materials containing lead;
    (4) Installation of products containing lead;
    (5) Lead contamination/emergency cleanup;
    (6) Transportation, disposal, storage, or containment of lead or 
materials containing lead on the site or location at which construction 
activities are performed, and
    (7) Maintenance operations associated with the construction 
activities described in this paragraph.
    (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>) calculated as an 8-hour 
time-weighted average (TWA).
    Assistant Secretary means the Assistant Secretary of Labor for 
Occupational Safety and Health, U.S. Department of Labor, or designee.
    Competent person means one who is capable of identifying existing 
and predictable lead hazards in the surroundings or working conditions 
and who has authorization to take prompt corrective measures to 
eliminate them.
    Director means the Director, National Institute for Occupational 
Safety and Health (NIOSH), U.S. Department of Health and Human Services, 
or designee.
    Lead means metallic lead, all inorganic lead compounds, and organic 
lead soaps. Excluded from this definition are all other organic lead 
compounds.
    This section means this standard.
    (c) Permissible exposure limit. (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.

[[Page 86]]

    (2) If an employee is exposed to lead for more than 8 hours in any 
work day the employees' allowable exposure, as a time weighted average 
(TWA) for that day, shall be reduced according to the following formula:

Allowable employee exposure (in <greek-m>g/m<SUP>3</SUP>) = 400 divided 
by hours worked in the day.

    (3) When respirators are used to limit employee exposure as required 
under paragraph (c) of this section and all the requirements of 
paragraphs (e)(1) and (f) of this section have been met, employee 
exposure 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.
    (d) Exposure assessment--(1) General. (i) Each employer who has a 
workplace or operation covered by this standard shall initially 
determine if any employee may be exposed to lead at or above the action 
level.
    (ii) For the purposes of paragraph (d) of this section, employee 
exposure is that exposure which would occur if the employee were not 
using a respirator.
    (iii) With the exception of monitoring under paragraph (d)(3), where 
monitoring is required under this section, the employer shall collect 
personal samples representative of a full shift including at least one 
sample for each job classification in each work area either for each 
shift or for the shift with the highest exposure level.
    (iv) Full shift personal samples shall be representative of the 
monitored employee's regular, daily exposure to lead.
    (2) Protection of employees during assessment of exposure. (i) With 
respect to the lead related tasks listed in paragraph (d)(2)(i) of this 
section, where lead is present, until the employer performs an employee 
exposure assessment as required in paragraph (d) of this section and 
documents that the employee performing any of the listed tasks is not 
exposed above the PEL, the employer shall treat the employee as if the 
employee were exposed above the PEL, and not in excess of ten (10) times 
the PEL, and shall implement employee protective measures prescribed in 
paragraph (d)(2)(v) of this section. The tasks covered by this 
requirement are:
    (A) Where lead containing coatings or paint are present: Manual 
demolition of structures (e.g, dry wall), manual scraping, manual 
sanding, heat gun applications, and power tool cleaning with dust 
collection systems;
    (B) Spray painting with lead paint.
    (ii) In addition, with regard to tasks not listed in paragraph 
(d)(2)(i), where the employee has any reason to believe that an employee 
performing the task may be exposed to lead in excess of the PEL, until 
the employer performs an employee exposure assessment as required by 
paragraph (d) of this section and documents that the employee's lead 
exposure is not above the PEL the employer shall treat the employee as 
if the employee were exposed above the PEL and shall implememt employee 
protective measures as prescribed in paragraph (d)(2)(v) of this 
section.
    (iii) With respect to the tasks listed in paragraph (d)(2)(iii) of 
this section, where lead is present, until the employer performs an 
employee exposure assessment as required in paragraph (d) of this 
section, and documents that the employee performing any of the listed 
tasks is not exposed in excess of 500 <greek-m>g/m<SUP>3</SUP>, the 
employer shall treat the employee as if the employee were exposed to 
lead in excess of 500 <greek-m>g/m<SUP>3</SUP> and shall implement 
employee protective measures as prescribed in paragraph (d)(2)(v) of 
this section. Where the employer does establish that the employee is 
exposed to levels of lead below 500 <greek-m>g/m<SUP>3</SUP>, the 
employer may provide the exposed employee with the appropriate 
respirator prescribed for such use at such lower exposures, in 
accordance with Table 1 of this section. The tasks covered by this 
requirement are:
    (A) Using lead containing mortar; lead burning
    (B) Where lead containing coatings or paint are present: rivet 
busting; power tool cleaning without dust collection systems; cleanup 
activities where dry expendable abrasives are used; and abrasive 
blasting enclosure movement and removal.
    (iv) With respect to the tasks listed in paragraph (d)(2)(iv) of 
this section,

[[Page 87]]

where lead is present, until the employer performs an employee exposure 
assessment as required in paragraph (d) of this section and documents 
that the employee performing any of the listed tasks is not exposed to 
lead in excess of 2,500 <greek-m>g/m<SUP>3</SUP> (50 x PEL), the 
employer shall treat the employee as if the employee were exposed to 
lead in excess of 2,500 <greek-m>g/m<SUP>3</SUP> and shall implement 
employee protective measures as prescribed in paragraph (d)(2)(v) of 
this section. Where the employer does establish that the employee is 
exposed to levels of lead below 2,500 <greek-m>g/m3, the employer may 
provide the exposed employee with the appropriate respirator prescribed 
for use at such lower exposures, in accordance with Table I of this 
section. Interim protection as described in this paragaraph is required 
where lead containing coatings or paint are present on structures when 
performing:
    (A) Abrasive blasting,
    (B) Welding,
    (C) Cutting, and
    (D) Torch burning.
    (v) Until the employer performs an employee exposure assessment as 
required under paragraph (d) of this section and determines actual 
employee exposure, the employer shall provide to employees performing 
the tasks described in paragraphs (d)(2)(i), (d)(2)(ii), (d)(2)(iii), 
and (d)(2)(iv) of this section with interim protection as follows:
    (A) Appropriate respiratory protection in accordance with paragraph 
(f) of this section.
    (B) Appropriate personal protective clothing and equipment in 
accordance with paragraph (g) of this section.
    (C) Change areas in accordance with paragraph (i)(2) of this 
section.
    (D) Hand washing facilities in accordance with paragraph (i)(5) of 
this section.
    (E) Biological monitoring in accordance with paragraph (j)(1)(i) of 
this section, to consist of blood sampling and analysis for lead and 
zinc protoporphyrin levels, and
    (F) Training as required under paragraph (l)(1)(i) of this section 
regarding 29 CFR 1926.59, Hazard Communication; training as required 
under paragraph (l)(2)(ii)(C) of this section, regarding use of 
respirators; and training in accordance with 29 CFR 1926.21, Safety 
training and education.
    (3) Basis of initial determination. (i) Except as provided under 
paragraphs (d)(3)(iii) and (d)(3)(iv) of this section 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 where performed 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) Where the employer has previously monitored for lead 
exposures, and the data were obtained within the past 12 months during 
work operations conducted under workplace conditions closely resembling 
the processes, type of material, control methods, work practices, and 
environmental conditions used and prevailing in the employer's current 
operations, the employer may rely on such earlier monitoring results to 
satisfy the requirements of paragraphs (d)(3)(i) and (d)(6) of this 
section if the sampling and analytical methods meet the accuracy and 
confidence levels of paragraph (d)(10) of this section.
    (iv) Where the employer has objective data, demonstrating that a 
particular product or material containing lead or a specific process, 
operation or activity involving lead cannot result in employee exposure 
to lead at or above the action level during processing, use, or 
handling, the employer may rely upon such data instead of implementing 
initial monitoring.
    (A) The employer shall establish and maintain an accurate record 
documenting the nature and relevancy of objective data as specified in 
paragraph (n)(4) of this section, where used in assessing employee 
exposure in lieu of exposure monitoring.

[[Page 88]]

    (B) Objective data, as described in paragraph (d)(3)(iv) of this 
section, is not permitted to be used for exposure assessment in 
connection with paragraph (d)(2) of this section.
    (4) Positive initial determination and initial monitoring. (i) Where 
a determination conducted under paragraphs (d) (1), (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) Where the employer has previously monitored for lead exposure, 
and the data were obtained within the past 12 months during work 
operations conducted under workplace conditions closely resembling the 
processes, type of material, control methods, work practices, and 
environmental conditions used and prevailing in the employer's current 
operations, the employer may rely on such earlier monitoring results to 
satisfy the requirements of paragraph (d)(4)(i) of this section if the 
sampling and analytical methods meet the accuracy and confidence levels 
of paragraph (d)(10) of this section.
    (5) Negative initial determination. Where a determination, conducted 
under paragraphs (d) (1), (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)(i) 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 determination reveals employee 
exposure to be below the action level further exposure determination 
need not be repeated except as otherwise provided in paragraph (d)(7) of 
this section.
    (ii) If the initial determination or subsequent determination 
reveals employee exposure to be at or above the action level but at or 
below the PEL the employer shall perform 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 determination reveals that employee exposure is 
above the PEL the employer shall perform monitoring quarterly. The 
employer shall continue monitoring at the required frequency until at 
least two consecutive measurements, taken at least 7 days apart, are at 
or 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) of this section, except as otherwise 
provided in paragraph (d)(7) of this section. 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.
    (7) Additional exposure assessments. Whenever there has been a 
change of equipment, process, control, personnel or a new task has been 
initiated that may result in additional employees being exposed to lead 
at or above the action level or may result in employees already exposed 
at or above the action level being exposed above the PEL, the employer 
shall conduct additional monitoring in accordance with this paragraph.
    (8) Employee notification. (i) Within 5 working days after 
completion of the exposure assessment 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, is at or above the PEL the 
employer shall include in the written notice a statement that the 
employees exposure was at or above that level and a description of the 
corrective action taken or to be

[[Page 89]]

taken to reduce exposure to below that level.
    (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 25 percent for airborne 
concentrations of lead equal to or greater than 30<greek-m>g/m\3\.
    (e) Methods of compliance. (1) Engineering and work practice 
controls. The employer shall implement engineering and work practice 
controls, including administrative controls, to reduce and maintain 
employee exposure to lead to or below the permissible exposure limit to 
the extent that such controls are feasible. Wherever all feasible 
engineering and work practices controls that can be instituted are not 
sufficient to reduce employee exposure to or below the permissible 
exposure limit prescribed in paragraph (c) of this section, the employer 
shall nonetheless use them to reduce employee exposure to the lowest 
feasible level and shall supplement them by the use of respiratory 
protection that complies with the requirements of paragraph (f) of this 
section.
    (2) Compliance program. (i) Prior to commencement of the job each 
employer shall establish and implement a written compliance program to 
achieve compliance with paragraph (c) of this section.
    (ii) Written plans for these compliance programs shall include at 
least the following:
    (A) A description of each activity in which lead is emitted; e.g. 
equipment used, material involved, controls in 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 and, where engineering controls are required 
engineering plans and studies used to determine methods selected for 
controlling exposure to lead;
    (C) A report of the technology considered in meeting the PEL;
    (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 section and incorporates other 
relevant work practices such as those specified in paragraph (e)(5) of 
this section;
    (G) An administrative control schedule required by paragraph (e)(4) 
of this section, if applicable;
    (H) A description of arrangements made among contractors on multi-
contractor sites with respect to informing affected employees of 
potential exposure to lead and with respect to responsibility for 
compliance with this section as set-forth in Sec. 1926.16.
    (I) Other relevant information.
    (iii) The compliance program shall provide for frequent and regular 
inspections of job sites, materials, and equipment to be made by a 
competent person.
    (iv) Written programs shall be submitted upon request to any 
affected employee or authorized employee representatives, to the 
Assistant Secretary and the Director, and shall be available at the 
worksite for examination and copying by the Assistant Secretary and the 
Director.
    (v) Written programs shall be revised and updated at least every 6 
months to reflect the current status of the program.
    (3) Mechanical ventilation. When ventilation is used to control lead 
exposure, the employer shall evaluate the mechanical performance of the 
system in controlling exposure as necessary to maintain its 
effectiveness.
    (4) 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.
    (5) The employer shall ensure that, to the extent relevant, 
employees follow

[[Page 90]]

good work practices such as described in Appendix B of this section.
    (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 when an employee's exposure to lead exceeds the PEL.
    (ii) Work operations for which engineering and work-practice 
controls are not sufficient to reduce employee exposures to or below the 
PEL.
    (iii) Periods when an employee requests a respirator.
    (iv) Periods when respirators are required to provide interim 
protection of employees while they perform the operations specified in 
paragraph (d)(2) of this section.
    (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)(B) of this section to 
determine whether or not the employee can use a respirator while 
performing the required duty.
    (3) Respirator selection. (i) The employer must select the 
appropriate respirator or combination of respirators from Table I of 
this section.
    (ii) The employer must provide a powered air-purifying respirator 
when an employee chooses to use such a respirator and it will provide 
adequate protection to the employee.

            Table 1--Respiratory Protection for Lead Aerosols
------------------------------------------------------------------------
  Airborne concentration of
   lead or condition of use              Required respirator <SUP>1</SUP>
------------------------------------------------------------------------
Not in excess of 500 ug/m<SUP>3</SUP>...  \1/2\ mask air purifying respirator with
                                high efficiency filters.<SUP>2</SUP> <SUP>3</SUP>
                               \1/2\ mask supplied air respirator
                                operated in demand (negative pressure)
                                mode.
Not in excess of 1,250 ug/m<SUP>3</SUP>.  Loose fitting hood or helmet powered air
                                purifying respirator with high
                                efficiency filters.<SUP>3</SUP>
                               Hood or helmet supplied air respirator
                                operated in a continuous-flow mode--
                                e.g., type CE abrasive blasting
                                respirators operated in a continuous-
                                flow mode.
Not in excess of 2,500 ug/m<SUP>3</SUP>.  Full facepiece air purifying respirator
                                with high efficiency filters.<SUP>3</SUP>
                               Tight fitting powered air purifying
                                respirator with high efficiency
                                filters.<SUP>3</SUP>
                               Full facepiece supplied air respirator
                                operated in demand mode.
                               \1/2\ mask or full facepiece supplied air
                                respirator operated in a continuous-flow
                                mode.
                               Full facepiece self-contained breathing
                                apparatus (SCBA) operated in demand
                                mode.
Not in excess of 50,000 ug/m<SUP>3</SUP>  \1/2\ mask supplied air respirator
                                operated in pressure demand or other
                                positive-pressure mode.
Not in excess of 100,000 ug/   Full facepiece supplied air respirator
 m<SUP>3</SUP>.                            operated in pressure demand or other
                                positive-pressure mode--e.g., type CE
                                abrasive blasting respirators operated
                                in a positive-pressure mode.
Greater than 100,000 ug/m<SUP>3</SUP>     Full facepiece SCBA operated in pressure
 unknown concentration, or      demand or other positive-pressure mode.
 fire fighting.
------------------------------------------------------------------------
\1\ Respirators specified for higher 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 (HEPA) means a filter that is a
  99.97 percent efficient against particles of 0.3 micron size or
  larger.

    (g) Protective work clothing and equipment--(1) Provision and use. 
Where an employee is exposed to lead above the PEL without regard to the 
use of respirators, where employees are exposed to lead compounds which 
may cause skin or eye irritation (e.g. lead arsenate, lead azide), and 
as interim protection for employees performing tasks as specified in 
paragraph (d)(2) of this section, the employer shall provide at no cost 
to the employee and assure that the employee uses appropriate protective 
work clothing and equipment that prevents contamination of the employee 
and the employee's garments such as, but not limited to:
    (i) Coveralls or similar full-body work clothing;
    (ii) Gloves, hats, and shoes or disposable shoe coverlets; and

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    (iii) Face shields, vented goggles, or other appropriate protective 
equipment which complies with Sec. 1910.133 of this chapter.
    (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, and 
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 areas 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 area 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) of 
this section are labeled 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) All surfaces shall be maintained as free as 
practicable of accumulations of lead.
    (2) Clean-up of floors and other surfaces where lead accumulates 
shall wherever possible, be cleaned by vacuuming or other methods that 
minimize the likelihood of lead becoming airborne.
    (3) Shoveling, dry or wet sweeping, and brushing may be used only 
where vacuuming or other equally effective methods have been tried and 
found not to be effective.
    (4) Where vacuuming methods are selected, the vacuums shall be 
equipped with HEPA filters and used and emptied in a manner which 
minimizes the reentry of lead into the workplace.
    (5) Compressed air shall not be used to remove lead from any surface 
unless the compressed air is used in conjunction with a ventilation 
system designed to capture the airborne dust created by the compressed 
air.
    (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.
    (2) Change areas. (i) The employer shall provide clean change areas 
for employees whose airborne exposure to lead is above the PEL, and as 
interim protection for employees performing tasks as specified in 
paragraph (d)(2) of this section, without regard to the use of 
respirators.
    (ii) The employer shall assure that change areas are equipped with 
separate storage facilities for protective work clothing and equipment 
and for street clothes which prevent cross-contamination.
    (iii) The employer shall assure that employees do not leave the 
workplace wearing any protective clothing or equipment that is required 
to be worn during the work shift.
    (3) Showers. (i) The employer shall provide shower facilities, where 
feasible, for use by employees whose airborne exposure to lead is above 
the PEL.
    (ii) The employer shall assure, where shower facilities are 
available, that employees shower at the end of the work shift and shall 
provide an adequate supply of cleansing agents and towels for use by 
affected employees.

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    (4) Eating facilities. (i) The employer shall provide lunchroom 
facilities or eating areas for employees whose airborne exposure to lead 
is above the PEL, without regard to the use of respirators.
    (ii) The employer shall assure that lunchroom facilities or eating 
areas are as free as practicable from lead contamination and are readily 
accessible to employees.
    (iii) The employer shall assure that employees whose 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 or eating areas with protective work clothing or equipment 
unless surface lead dust has been removed by vacuuming, downdraft booth, 
or other cleaning method that limits dispersion of lead dust.
    (5) Hand washing facilities. (i) The employer shall provide adequate 
handwashing facilities for use by employees exposed to lead in 
accordance with 29 CFR 1926.51(f).
    (ii) Where showers are not provided the employer shall assure that 
employees wash their hands and face at the end of the work-shift.
    (j) Medical surveillance--(1) General. (i) The employer shall make 
available initial medical surveillance to employees occupationally 
exposed on any day to lead at or above the action level. Initial medical 
surveillance consists of biological monitoring in the form of blood 
sampling and analysis for lead and zinc protoporphyrin levels.
    (ii) The employer shall institute a medical surveillance program in 
accordance with paragraphs (j)(2) and (j)(3) of this section for all 
employees who are or may be exposed by the employer at or above the 
action level for more than 30 days in any consecutive 12 months;
    (iii) The employer shall assure that all medical examinations and 
procedures are performed by or under the supervision of a licensed 
physician.
    (iv) The employer shall make available 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 paragraphs (j)(1)(i) and (ii) of 
this section on the following schedule:
    (A) For each employee covered under paragraph (j)(1)(ii) of this 
section, at least every 2 months for the first 6 months and every 6 
months thereafter;
    (B) For each employee covered under paragraphs (j)(1) (i) or (ii) of 
this section whose last blood sampling and analysis indicated a blood 
lead level at or above 40 <greek-m>g/dl, at least every two months. This 
frequency shall continue until two consecutive blood samples and 
analyses indicate a blood lead level below 40 <greek-m>g/dl; and
    (C) For each employee who is removed from exposure to lead due to an 
elevated blood lead level at least monthly during the removal period.
    (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 criterion for medical removal under paragraph (k)(1)(i) 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/dl, whichever is greater, and shall be 
conducted by a laboratory approved by OSHA.
    (iv) Employee notification. (A) Within five working days after the 
receipt of biological monitoring results, the employer shall notify each 
employee in writing of his or her blood lead level; and
    (B) The employer shall notify each employee whose blood lead level 
exceeds 40 <greek-m>g/dl that the standard requires temporary medical 
removal with Medical Removal Protection benefits when an employee's 
blood lead

[[Page 93]]

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)(ii) 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/dl;
    (B) 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, that the employee is 
pregnant, or that the employee has demonstrated difficulty in breathing 
during a respirator fitting test or during use; and
    (C) 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. The content of medical examinations made available 
pursuant to paragraph (j)(3)(i)(B)-(C) 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. Medical examinations made available pursuant to paragraph 
(j)(3)(i)(A) 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 relevant to lead exposure which the 
examining physician deems necessary by sound medical practice.
    (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:
    (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.

[[Page 94]]

    (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 only 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 orally, or in any 
other means of communication with the employer, findings, including 
laboratory results, or 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 alternate physician determination mechanism in lieu of the 
multiple physician review mechanism provided by paragraph (j)(3)(iii) of 
this section so long as the alternate mechanism is as expeditious and 
protective as 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) of this section, 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

[[Page 95]]

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 
level. 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 50 
<greek-m>g/dl; and,
    (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 means the written medical opinion on the employees' health 
status by the examining physician or, where relevant, 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 50 
<greek-m>g/dl when two consecutive blood sampling tests indicate that 
the employee's blood lead level is at or below 40 <greek-m>g/dl;
    (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 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.
    (1) If 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;

[[Page 96]]

    (2) If 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 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, as long as the job the 
employee was removed from continues, the employer shall maintain the 
total normal earnings, seniority and other employment rights and 
benefits of an employee, including the employee's right to his or her 
former job status as though the employee had not been medically removed 
from the employee's job or otherwise medically limited.
    (iii) Follow-up medical surveillance during the period of employee 
removal or limitation. During the period of time that an employee is 
medically removed from his or her job or otherwise medically 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) 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) 
and (ii) of this section.
    (l) Employee information and training--(1) General. (i) The employer 
shall communicate information concerning lead hazards according to the 
requirements of OSHA's Hazard Communication Standard for the 
construction industry, 29 CFR 1926.59, including but not limited to the 
requirements concerning warning signs and labels, material safety data 
sheets (MSDS), and employee information and training. In addition, 
employers shall comply with the following requirements:
    (ii) For all employees who are subject to exposure to lead at or 
above the action level on any day or who are subject to exposure to lead 
compounds which may cause skin or eye irritation (e.g. lead arsenate, 
lead azide), the employer shall provide a training program in accordance 
with paragraph (l)(2) of this section and assure employee participation.
    (iii) The employer shall provide the training program as initial 
training prior to the time of job assignment or prior to the start up 
date for this requirement, whichever comes last.
    (iv) The employer shall also provide the training program at least 
annually for each employee who is subject to lead exposure at or above 
the action level on any day.
    (2) Training program. The employer shall assure that each employee 
is trained in the following:
    (i) The content of this standard and its appendices;

[[Page 97]]

    (ii) The specific nature of the operations which could result in 
exposure to lead above the action level;
    (iii) The purpose, proper selection, fitting, use, and limitations 
of respirators;
    (iv) 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 and hazards to the fetus 
and additional precautions for employees who are pregnant);
    (v) The engineering controls and work practices associated with the 
employee's job assignment including training of employees to follow 
relevant good work practices described in Appendix B of this section;
    (vi) The contents of any compliance plan in effect;
    (vii) 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; and
    (viii) The employee's right of access to records under 29 CFR 
1910.20.
    (3) 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 affected 
employees and their designated representatives, and to the Assistant 
Secretary and the Director.
    (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 an employees exposure to lead is above the PEL.

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 assessment. (i) The employer shall 
establish and maintain an accurate record of all monitoring and other 
data used in conducting employee exposure assessments as required in 
paragraph (d) of this section.
    (ii) Exposure monitoring records shall include:
    (A) The date(s), number, duration, location and results of each of 
the samples taken if any, 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 monitoring and other exposure 
assessment records in accordance with the provisions of 29 CFR 1910.20.
    (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 on or for that 
employee and provided to the physician; and
    (D) Any employee medical complaints related to exposure to lead.

[[Page 98]]

    (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 medical records in accordance with the provisions of 29 CFR 
1910.20.
    (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 of 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 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) Objective data for exemption from requirement for initial 
monitoring. (i) For purposes of this section, objective data are 
information demonstrating that a particular product or material 
containing lead or a specific process, operation, or activity involving 
lead cannot release dust or fumes in concentrations at or above the 
action level under any expected conditions of use. Objective data can be 
obtained from an industry-wide study or from laboratory product test 
results from manufacturers of lead containing products or materials. The 
data the employer uses from an industry-wide survey must be obtained 
under workplace conditions closely resembling the processes, types of 
material, control methods, work practices and environmental conditions 
in the employer's current operations.
    (ii) The employer shall maintain the record of the objective data 
relied upon for at least 30 years.
    (5) Availability. The employer shall make available upon request all 
records required to be maintained by paragraph (n) of this section to 
affected employees, former employees, and their designated 
representatives, and to the Assistant Secretary and the Director for 
examination and copying.
    (6) 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 equipment, and shall require the 
observer to comply with all other applicable safety and health 
procedures.

[[Page 99]]

    (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 (Sec. 1926.62) shall become 
effective June 3, 1993.
    (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. (1) The requirements of paragraphs (c) through 
(o) of this section, including administrative controls and feasible work 
practice controls, but not including engineering controls specified in 
paragraph (e)(1) of this section, shall be complied with as soon as 
possible, but no later than 60 days from the effective date of this 
section.
    (2) Feasible engineering controls specified by paragraph (e)(1) of 
this section shall be implemented as soon as possible, but no later than 
120 days from the effective date of this section.

   Appendix A to Sec. 1926.62--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 interim final 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 several different occupations in 
the construction industry, including demolition or salvage of structures 
where lead or lead-containing materials are present; removal or 
encapsulation of lead-containing materials, new construction, 
alteration, repair, or renovation of structures that contain lead or 
materials containing lead; installation of products containing lead. In 
addition, there are construction related activities where exposure to 
lead may occur, including transportation, disposal, storage, or 
containment of lead or materials containing lead on construction sites, 
and maintenance operations associated with construction activities.
    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 interim final standard establishes an action 
level of 30 micrograms of lead per cubic meter of air (30 <greek-m>g/
m<SUP>3</SUP>), averaged over an 8-hour workday. The action level 
triggers several ancillary provisions of the standard such as exposure 
monitoring, medical surveillance, and training.

                         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 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

[[Page 100]]

which develops quickly to seizures, coma, 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 a worker's blood lead level (BLL, also 
expressed as PbB) be maintained at or below forty micrograms per 
deciliter of whole blood (40 <greek-m>g/dl). The blood lead levels of 
workers (both male and female workers) who intend to have children 
should be maintained below 30 <greek-m>g/dl to minimize adverse 
reproductive health effects to the parents and to the developing fetus. 
The measurement of your blood lead level (BLL) is the most useful 
indicator of the amount of lead being absorbed by your body. Blood lead 
levels 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 
milliliters (100 ml) or deciliter (dl) of blood. These three units are 
essentially the same. Sometime BLLs are expressed in the form of mg% or 
<greek-m>g%. This is a shorthand notation for 100g, 100 ml, or dl. 
(References to BLL measurements in this standard are expressed in the 
form of <greek-m>g/dl.)
    BLL 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. BLL 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 BLLs and various diseases. As a result, your BLL 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/dl, your risk 
of disease increases. There is a wide variability of individual response 
to lead, thus it is difficult to say that a particular BLL in a given 
person will cause a particular effect. Studies have associated fatal 
encephalopathy with BLLs as low as 150 <greek-m>g/dl. Other studies have 
shown other forms of diseases in some workers with BLLs well below 80 
<greek-m>g/dl. Your BLL 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

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had elevated BLLs. The longer you have an elevated BLL, 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 BLL below 40 <greek-m>g/dl. 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 or her 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 or 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 your employer selected the 
initial physician.

          Appendix B to Sec. 1926.62--Employee Standard Summary

    This appendix summarizes key provisions of the interim final 
standard for lead in construction that you as a worker should become 
familiar with.

           I. Permissible Exposure Limit (PEL)--Paragraph (C)

    The standard sets a permissible exposure limit (PEL) of 50 
micrograms of lead per cubic meter of air (50 <greek-m>g/m<SUP>3</SUP>), 
averaged over an 8-hour workday which is referred to as a time-weighted 
average (TWA). This is the highest level of lead in air to which you may 
be permissibly exposed over an 8-hour workday. However, since this is an 
8-hour average, short exposures above the PEL are permitted so long as 
for each 8-hour work day your average exposure does not exceed this 
level. This interim final standard, however, takes into account the fact 
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 situation, 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 Assessment--Paragraph (D)

    If lead is present in your workplace in any quantity, your employer 
is required to make an initial determination of whether any employee's 
exposure to lead exceeds the action level (30 <greek-m>g/m<SUP>3</SUP> 
averaged over an 8-hour day). Employee exposure is that exposure which 
would occur if the employee were not using a respirator. This initial 
determination requires your employer to monitor workers' exposures 
unless he or she has objective data which can demonstrate conclusively 
that no employee will be exposed to lead in excess of the action level. 
Where objective data is used in lieu of actual monitoring the employer 
must establish and maintain an accurate record, documenting its 
relevancy in assessing exposure levels for current job conditions. If 
such objective data is available, the employer need proceed no further 
on employee exposure assessment until such time that conditions have 
changed and the determination is no longer valid.
    Objective data may be compiled from various sources, e.g., insurance 
companies and trade associations and information from suppliers or 
exposure data collected from similar operations. Objective data may also 
comprise previously-collected sampling data including area monitoring. 
If it cannot be determined through using objective data that worker 
exposure is less than the action level, your employer must conduct 
monitoring or must rely on relevant previous personal sampling, if 
available. Where monitoring is required for the initial determination, 
it may be limited to a representative number of employees who are 
reasonably expected to have the highest exposure levels. If your 
employer has conducted appropriate air sampling for lead in the past 12 
months, he or she may use these results, provided they are applicable to 
the same employee tasks and exposure conditions and meet the 
requirements for accuracy as specified in the standard. As with 
objective data, if such results are relied upon for the initial 
determination, your employer must establish and maintain a record as to 
the relevancy of such data to current job conditions.
    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,

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this must also be considered as part of the initial determination.
    If this initial determination shows that a reasonable possibility 
exists that any employee may be exposed, without regard to respirators, 
over the action level, your employer must set up an air monitoring 
program to determine the exposure level representative of each 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 or she 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 represent full shift 
exposure. In addition, these air samples must be taken under conditions 
which represent each employee's regular, daily exposure to lead. 
Sampling performed in the past 12 months may be used to determine 
exposures above the action level if such sampling was conducted during 
work activities essentially similar to present work conditions.
    The standard lists certain tasks which may likely result in 
exposures to lead in excess of the PEL and, in some cases, exposures in 
excess of 50 times the PEL. If you are performing any of these tasks, 
your employer must provide you with appropriate respiratory protection, 
protective clothing and equipment, change areas, hand washing 
facilities, biological monitoring, and training until such time that an 
exposure assessment is conducted which demonstrates that your exposure 
level is below the PEL.
    If you are exposed to lead and air sampling is performed, your 
employer is required to notify you in writing within 5 working days of 
the air monitoring results which represent your exposure. If the results 
indicate that your exposure exceeds the PEL (without regard to your use 
of a respirator), then your employer must also notify you of this in 
writing, and provide you with a description of the corrective action 
that has been taken or will be taken to reduce your exposure.
    Your exposure must be rechecked by monitoring, at least every six 
months if your exposure is at or over the action level but below the 
PEL. Your employer may discontinue monitoring for you if 2 consecutive 
measurements, taken at least 7 days apart, are at or below the action 
level. Air monitoring must be repeated every 3 months if you are exposed 
over the PEL. Your employer must continue monitoring for you at this 
frequency until 2 consecutive measurements, taken at least 7 days apart, 
are below the PEL but above the action level, at which time your 
employer must repeat monitoring of your exposure every six months and 
may discontinue monitoring only after your exposure drops to or below 
the action level. However, whenever there is a change of equipment, 
process, control, or personnel or a new type of job is added at your 
workplace 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 as an 8-hour TWA. The interim final standard 
for lead in construction requires employers to institute engineering and 
work practice controls including administrative controls to the extent 
feasible to reduce employee exposure to lead. Where such controls are 
feasible but not adequate to reduce exposures below the PEL they must be 
used nonetheless to reduce exposures to the lowest level that can be 
accomplished by these means and then supplemented with appropriate 
respiratory protection.
    Your employer is required to develop and implement a written 
compliance program prior to the commencement of any job where employee 
exposures may reach the PEL as an 8-hour TWA. The interim final standard 
identifies the various elements that must be included in the plan. For 
example, employers are required to include a description of operations 
in which lead is emitted, detailing other relevant information about the 
operation such as the type of equipment used, the type of material 
involved, employee job responsibilities, operating procedures and 
maintenance practices. In addition, your employer's compliance plan must 
specify the means that will be used to achieve compliance and, where 
engineering controls are required, include any engineering plans or 
studies that have been used to select the control methods. If 
administrative controls involving job rotation are used to reduce 
employee exposure to lead, the job rotation schedule must be included in 
the compliance plan. The plan must also detail the type of protective 
clothing and equipment, including respirators, housekeeping and hygiene 
practices that will be used to protect you from the adverse effects of 
exposure to lead.
    The written compliance program must be made available, upon request, 
to affected employees and their designated representatives, the 
Assistant Secretary and the Director.
    Finally, the plan must be reviewed and updated at least every 6 
months to assure it reflects the current status in exposure control.

                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 is not above the PEL. You

[[Page 103]]

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 types 
listed in Table I of the Respiratory Protection section of the standard 
(Sec. 1926.62 (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 as an 8-hour TWA, without 
regard to your use of a respirator, 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. In addition, your employer is responsible for 
providing repairs and replacement as necessary, and also is responsible 
for the cleaning, laundering or disposal of protective clothing and 
equipment.
    The interim final standard requires that your employer assure that 
you follow good work practices when you are working in areas where your 
exposure to lead may exceed the PEL. With respect to protective clothing 
and equipment, where appropriate, the following procedures should be 
observed prior to beginning work:
    1. Change into work clothing and shoe covers in the clean section of 
the designated changing areas;
    2. Use work garments of appropriate protective gear, including 
respirators before entering the work area; and
    3. Store any clothing not worn under protective clothing in the 
designated changing area.
    Workers should follow these procedures upon leaving the work area:
    1. HEPA vacuum heavily contaminated protective work clothing while 
it is still being worn. At no time may lead be removed from protective 
clothing by any means which result in uncontrolled dispersal of lead 
into the air;
    2. Remove shoe covers and leave them in the work area;

[[Page 104]]

    3. Remove protective clothing and gear in the dirty area of the 
designated changing area. Remove protective coveralls by carefully 
rolling down the garment to reduce exposure to dust.
    4. Remove respirators last; and
    5. Wash hands and face.
    Workers should follow these procedures upon finishing work for the 
day (in addition to procedures described above):
    1. Where applicable, place disposal coveralls and shoe covers with 
the abatement waste;
    2. Contaminated clothing which is to be cleaned, laundered or 
disposed of must be placed in closed containers in the change room.
    3. Clean protective gear, including respirators, according to 
standard procedures;
    4. Wash hands and face again. If showers are available, take a 
shower and wash hair. If shower facilities are not available at the work 
site, shower immediately at home and wash hair.

                     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 
generally prohibited unless removal with compressed air is done in 
conjunction with ventilation systems designed to contain dispersal of 
the lead dust. Dry or wet sweeping, shoveling, or brushing may not be 
used except where vacuuming or other equally effective methods have been 
tried and do not work. Vacuums must be used equipped with a special 
filter called a high-efficiency particulate air (HEPA) filter 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 hand washing facilities be provided where 
occupational exposure to lead occurs. In addition, change areas, showers 
(where feasible), and lunchrooms or eating areas are to be made 
available to workers exposed to lead above the PEL. Your employer must 
assure that except in these facilities, food and beverage is not present 
or consumed, tobacco products are not present or used, and cosmetics are 
not applied, where airborne exposures are above the PEL. Change rooms 
provided by your employer must be equipped with separate storage 
facilities for your protective clothing and equipment and street clothes 
to avoid cross-contamination. After showering, no required protective 
clothing or equipment worn during the shift may be worn home. It is 
important that contaminated clothing or equipment be removed in change 
areas and not be worn home or you will extend your exposure and expose 
your family since lead from your clothing can accumulate in your house, 
car, etc.
    Lunchrooms or eating areas 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 interim final 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. 
Full medical surveillance must be made available to all employees who 
are or may be exposed to lead in excess of the action level for more 
than 30 days a year

[[Page 105]]

and whose blood lead level exceeds 40 <greek-m>g/dl. Initial medical 
surveillance consisting of blood sampling and analysis for lead and zinc 
protoporphyrin must be provided to all employees exposed at any time (1 
day) above the action level.
    Biological monitoring under the standard must be provided at least 
every 2 months for the first 6 months and every 6 months thereafter 
until your blood lead level is below 40 <greek-m>g/dl. A zinc 
protoporphyrin (ZPP) test is a very useful blood test which measures an 
adverse metabolic effect of lead on your body and is therefore an 
indicator of lead toxicity.
    If your BLL exceeds 40 <greek-m>g/dl the monitoring frequency must 
be increased from every 6 months to at least every 2 months and not 
reduced until two consecutive BLLs indicate a blood lead level below 40 
<greek-m>g/dl. Each time your BLL is determined to be over 40 
<greek-m>g/dl, your employer must notify you of this in writing within 
five working days of his or her receipt of the test results. The 
employer must also inform you that the standard requires temporary 
medical removal with economic protection when your BLL exceeds 50 
<greek-m>g/dl. (See Discussion of Medical Removal Protection-Paragraph 
(k).) Anytime your BLL exceeds 50 <greek-m>g/dl your employer must make 
available to you within two weeks of receipt of these test results a 
second follow-up BLL test to confirm your BLL. If the two tests both 
exceed 50 <greek-m>g/dl, and you are temporarily removed, then your 
employer must make successive BLL 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/dl at 
any time during the preceding year and you are being exposed above the 
airborne action level of 30 <greek-m>g/m<SUP>3</SUP> for 30 or more days 
per year. The initial examination will provide information to establish 
a baseline to which subsequent data can be compared.
    An initial medical examination to consist of blood sampling and 
analysis for lead and zinc protoporphyrin 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 at any time. 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, including an evaluation of your pulmonary status 
if you will be required to use a respirator; (3) a blood pressure 
measurement; and (4) 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 will give you a chance to 
have a physician of your choice directly participate in the medical 
surveillance program. If you are dissatisfied with an examination by a 
physician chosen by your employer, you can 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 occupational lead exposure, (3) your exposure 
level or anticipated exposure level, (4) a description of any 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

[[Page 106]]

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 interim 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-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 Na2 
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 temporary 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. For up to 18 months, or for as long as the job the 
employee was removed from lasts, 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.
    You may also be removed from exposure even if your blood lead level 
is below 50 <greek-m>g/dl if a final medical determination indicates

[[Page 107]]

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 compounds such as lead 
arsenate or lead azide. The program must train these employees regarding 
the specific hazards associated with their work environment, protective 
measures which can be taken, including the contents of any compliance 
plan in effect, the danger of lead to their bodies (including their 
reproductive systems), and their rights under the standard. All 
employees must be trained prior to initial assignment to areas where 
there is a possibility of exposure over the action level.
    This training program must also be provided at least annually 
thereafter unless further exposure above the action level will not 
occur.

                        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
POISON
NO SMOKING OR EATING

    These signs are to be posted and maintained in a manner which 
assures that the legend is readily visible.

                    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 
analytical techniques, the results of this sampling, and

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the type of respiratory protection being worn by the person sampled. 
Such records are to be retained for at least 30 years. Your employer is 
also required to keep all records of biological monitoring and medical 
examination results. These records must include the names of the 
employees, the physician's written opinion, and a copy of the results of 
the examination. Medical records must be preserved and maintained for 
the duration of employment plus 30 years. However, if the employee's 
duration of employment is less than one year, the employer need not 
retain that employee's medical records beyond the period of employment 
if they are provided to the employee upon termination of employment.
    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 BLL'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. Observation 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 date is June 3, 1993. Employer obligations 
under the standard begin as of that date with full implementation of 
engineering controls as soon as possible but no later than within 4 
months, and all other provisions completed as soon as possible, but no 
later than within 2 months from the effective date.

                     XV. For Additional Information

    A. A copy of the interim standard for lead in construction can be 
obtained free of charge by calling or writing the OSHA Office of 
Publications, room N-3101, United States Department of Labor, 
Washington, DC 20210: Telephone (202) 219-4667.
    B. Additional information about the standard, its enforcement, and 
your employer's 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. 1926.62--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 interim final 
occupational health standard for lead in construction is designed to 
protect workers exposed to inorganic lead including metallic lead, all 
inorganic lead compounds and organic lead soaps.
    Under this interim final standard 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 
permissible exposure limit (PEL) must be achieved through a combination 
of engineering, work practice and administrative controls to the extent 
feasible. Where these controls are in place but are found not to reduce 
employee exposures to or below the PEL, they must be used nonetheless, 
and supplemented with respirators to meet the 50 <greek-m>g/
m<SUP>3</SUP> exposure limit.
    The standard also provides for a program of biological monitoring 
for employees exposed to lead above the action level at any time, and 
additional medical surveillance for all employees exposed to levels of 
inorganic lead above 30 <greek-m>g/m<SUP>3</SUP> (TWA) for more than 30 
days per year and whose BLL exceeds 40 <greek-m>g/dl.
    The purpose of this document is to outline the medical surveillance 
provisions of the interim standard for inorganic lead in construction, 
and to provide further information to the physician regarding the 
examination and evaluation of workers exposed to inorganic lead.

[[Page 109]]

    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.

I. Medical Surveillance and Monitoring Requirements for Workers Exposed 
                            to Inorganic Lead

    Under the interim final standard for inorganic lead in the 
construction industry, initial medical surveillance consisting of 
biological monitoring to include blood lead and ZPP level determination 
shall be provided to employees exposed to lead at or above the action 
level on any one day. In addition, a program of biological monitoring is 
to be made available to all employees exposed above the action level at 
any time and additional medical surveillance is to be made available to 
all employees exposed to lead above 30 <greek-m>g/m<SUP>3</SUP> TWA for 
more than 30 days each year and whose BLL exceeds 40 <greek-m>g/dl. 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, and the clinical assessment of the 
examining physician.
    Under this program, the blood lead level (BLL) of all employees who 
are exposed to lead above 30 <greek-m>g/m<SUP>3</SUP> for more than 30 
days per year or whose blood lead is above 40 <greek-m>g/dl but exposed 
for no more than 30 days per year is to be determined at least every two 
months for the first six months of exposure and every six months 
thereafter. The frequency is increased to every two months for employees 
whose last blood lead level was 40 <greek-m>g/dl or above. 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) measurement is strongly recommended 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 exposed above 30 <greek-m>g/m<SUP>3</SUP> for more than 30 days 
per year 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/dl. 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 30 <greek-m>g/m<SUP>3</SUP> for more 
than 30 days per year. 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.
    Under the standard's ultimate worker removal criteria, a worker is 
to be removed from any work having an eight hour TWA exposure to lead of 
30 <greek-m>g/m<SUP>3</SUP> when his or her blood lead level reaches 50 
<greek-m>g/dl and is 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. Return of the employee to his or her job 
status depends on a worker's blood lead level declining to 40 
<greek-m>g/dl.
    As part of the interim standard, the employer is required to notify 
in writing each employee whose blood lead level exceeds 40 <greek-m>g/
dl. 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 limit.
    In addition to the above blood lead level criterion, temporary 
worker removal may

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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 30 <greek-m>g/
m<SUP>3</SUP>. 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, and other 
employment rights and benefits (as though the worker had not been 
removed) for a period of up to 18 months or for as long as the job the 
employee was removed from lasts if less than 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.
    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 or anticipated 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 are not effective. 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.

[[Page 111]]

    In its interim final standard on occupational exposure to inorganic 
lead in the construction industry, 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. 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 assessment, including environmental monitoring, 
medical surveillance, and medical removal for each employee. Exposure 
assessment records must be kept for at least 30 years. Medical 
surveillance records must be kept for the duration of employment plus 30 
years except in cases where the employment was less than one year. If 
duration of employment is less than one year, the employer need not 
retain this record beyond the term of employment if the record is 
provided to the employee upon termination of employment. Medical removal 
records also 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 30 <greek-m>g/m<SUP>3</SUP> 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/dl 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/dl 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/dl. At a blood lead level of 40 
<greek-m>g/dl, 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/dl.
    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

[[Page 112]]

<greek-m>g/dl 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/dl 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/dl 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/dl. Inhibited hemoglobin synthesis is more 
common in chronic cases whereas shortened erythrocyte life span is more 
common in acute cases.
    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, delirium, 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/dl whole 
blood and therefore recommend a 40 <greek-m>g/dl 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/dl 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/dl 
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/
dl 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/dl.
    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

[[Page 113]]

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/
dl and hypospermia and asthenospermia at 41 <greek-m>g/dl. 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 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/dl in children can cause significant 
neurobehavioral impairments and there is evidence of hyperactivity at 
blood levels as low as 25 <greek-m>g/dl. 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/dl with a population mean of 15 <greek-m>g/dl. Blood 
lead levels in the fetus and newborn likewise should not exceed 30 
<greek-m>g/dl.
    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/dl 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 electrocardiographic 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 many 
occupations in the construction industry, including demolition and 
salvaging operations, removal or encapsulation of materials containing 
lead, construction, alteration, repair or renovation of structures 
containing lead, transportation, disposal, storage or containment of 
lead or lead-containing materials on construction sites, and maintenance 
operations associated with construction activities.
    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 job 
description, exposure to fumes or dust, known exposures to lead or other 
toxic substances, a description of any personal protective equipment 
used, and previous medical surveillance should all be included in the 
worker's record. Where exposure to

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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 of systems 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:
    1. General--weight loss, fatigue, decreased appetite.
    2. Head, Eyes, Ears, Nose, Throat (HEENT)--headaches, visual 
disturbances or decreased visual acuity, hearing deficits or tinnitus, 
pigmentation of the oral mucosa, or metallic taste in mouth.
    3. Cardio-pulmonary--shortness of breath, cough, chest pains, 
palpitations, or orthopnea.
    4. Gastrointestinal--nausea, vomiting, heartburn, abdominal pain, 
constipation or diarrhea.
    5. 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.
    6. Hematologic--pallor, easy fatigability, abnormal blood loss, 
melena.
    7. 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.
    8. 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 interim 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.

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    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 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 
OSHA. 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/dl in some workers. Once the blood 
lead level has reached 40 <greek-m>g/dl there is more marked rise in the 
ZPP value from its normal range of less than 100 <greek-m>g/dl100 ml. 
Increases in blood lead levels beyond 40 <greek-m>g/100 g are associated 
with exponential increases in ZPP.

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    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 an OSHA 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 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/l 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 interim 
standard for inorganic lead in the construction industry places 
significant emphasis on the medical surveillance of all workers exposed 
to levels of inorganic lead above 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.

[58 FR 26627, May 4, 1993, as amended at 58 FR 34218, June 24, 1993; 61 
FR 5510, Feb. 13, 1996; 63 FR 1296, Jan. 8, 1998]