(785) 842-6382

In-house Management: Medical Monitoring

In-house Management: Medical Monitoring

In-house Management: Medical Monitoring

A successful asbestos in-house management program has many components. These include well written and up to date standard operating procedures, properly trained staff who understand the limitations of their qualifications, proper equipment and supplies, including personal protective equipment, and proper communication with all parties including building occupants, other building employees, and short term workers. In-house management programs can have deficiencies.

There are a few states that have regulations impacting the type of asbestos management programs limited to small scale projects, including but not limited to Minnesota, Texas, and Louisiana. AHERA requirements for public and private, primary and secondary schools add a few requirements. But the most comprehensive and far-ranging rules applying to such programs are contained in the OSHA Construction and General Industry Standards for Asbestos, and the OSHA Respiratory Protection Standard.

In many areas, OSHA builds on the older AHERA rule with more detailed requirements. About half the states, where federal OSHA enforces rules in the private sector, the OSHA asbestos rules are enforced by EPA under the Worker Protection Rule for state and local government employees not covered by federal OSHA. In the other half, OSHA has delegated enforcement to state run programs for both the private and governmental sector. State programs can and do set their own enforcement priorities.

In our years of training maintenance workers, we have discovered common deficiencies in these in house management programs, all related to OSHA compliance

Common Deficiency 1

The first common deficiency of in-house asbestos maintenance programs is failure to perform annual medical monitoring.  The OSHA Respiratory Protection Standard requires initial medical monitoring, then additional monitoring as needed (not necessarily as frequently as annually). OSHA asbestos standards require an annual exam.

There are two types of exams. One is a respirator screen exam-there is no specified protocol. Users must be physically capable of wearing a respirator in order to receive one. This exam is sufficient for up to 30 days of asbestos work a year.

The second type of exam has to be done within 10 days of the 30th day of asbestos work in a year. It includes completing the OSHA asbestos medical questionnaire, a pulmonary function test, a general physical, and a chest X-Ray at the Doctor’s discretion. OSHA says the exam must be done by a licensed physician. An OSHA Interpretation letter of 9/24/12 allows digital radiography in lieu of X-Rays

We have found that in-house asbestos maintenance staff who only do occasional work often do not have a current medical clearance to wear a respirator. The cost of the full asbestos exam, plus the time and expense involved to get to an occupational health clinic, is difficult for schools and businesses to justify.

Medical Monitoring in Health Clinics

Selecting an occupational health clinic for the full asbestos physical is also a challenge. We have had experience with deficiencies in the asbestos medical exams for our staff. Several times it has been a nurse practitioner or other none-physician signing the exam results. The questionnaire from the Respirator Standard has been used rather than the Asbestos questionnaire from the asbestos standard. We have even had clinics neglect conducting the pulmonary function test. All of these deficiencies were violations that if not corrected could result in an enforcement actions against us.

The discretionary chest X-Ray is a potential management issue. Some clinics unnecessarily perform the procedure routinely, every year. The reason the X-Ray is not an annual requirement is that the benefit of frequent X-Rays does not outweigh the health risk of an X-Ray for most employees. If that is the case the cost is not necessary for the employer!  A baseline to document status at the beginning of employment followed by a frequency determined by age and other risk factors is more appropriate.

Most asbestos maintenance workers do not work with asbestos frequently, and do not require the full asbestos exam. Fortunately, there is a simple, inexpensive, and compliant solution for the respirator screen. There are on-line vendors for the screening procedure.  The subject fills out the questionnaire from the OSHA Respiratory Protection Standard.  If there are no issues, a certificate signed be a physician is immediately available for printing. In the unlikely case that the questionnaire reveals issues, the employee will take an in-person exam. For asbestos the exam is good for one year. The cost is less than $30/person. 3M is one of the vendors at www.respexam.com.


META Environmental does not perform medical screening. We offer the fit testing of respirator users with either qualitative or quantitative methods. META will also create the OSHA required written respiratory protection program. We also provide required respirator user training.

linkedin facebook pinterest youtube rss twitter instagram facebook-blank rss-blank linkedin-blank pinterest youtube twitter instagram