Section 325.51871. Periodic medical examinations.

(1) For each employee who is covered by the provisions of R 325.51868(1)(a) or (2)(a) and (b) because of current or  anticipated exposure to cadmium, an employer shall provide at least a minimum level of periodic medical surveillance  that   consists  of    periodic   medical examinations   and   periodic biological  monitoring.   A   periodic   medical examination  shall  be   provided  within

12  months    after   the    initial examination that is required pursuant to the provisions of R 325.51869 and not more than once every 24 months thereafter. Biological sampling shall be provided every 12  months  either  as  part  of  a   periodic  medical examination or separately as periodic biological monitoring.

(2)  A periodic medical examination shall include all of the following:

(a)  ) A detailed medical and work history,  or  update   thereof,    with   an emphasis on all of the following:

(i)   Past, present, and anticipated future exposure to cadmium.

(ii)   Smoking history and current status.

(iii)   Reproductive history.

(iv)   Current use of medications with potential nephrotoxic side effects.

(v)      Any  history   of  renal,  cardiovascular,       respiratory,      hematopoietic,      or musculoskeletal system dysfunction.

(vi)   For employees who wear respirators, answers to questions   3    to   11 and 25 to 32 in appendix D to these rules.

(b)   A complete physical examination with an emphasis    on   blood      pressure, the respiratory system, and the urinary system.

(c)   A posterior-anterior chest X ray.  After  the  initial    X    ray,    the frequency of chest X rays shall be determined by the examining  physician.

(d)   Pulmonary function tests, including forced vital  capacity  (FVC)    and forced expiratory volume at 1 second (FEV1).

(e)     Biological monitoring, as   required  by  the  provisions  of R 325.51869(2).

(f)   Additional blood analyses, including blood   urea     nitrogen,       complete blood count, and serum creatinine.

(g)  Additional   urinalysis,  including  the   determination   of    albumin, glucose, and total and low molecular weight proteins.

(h)  For males  over  40  years  of  age,   prostate   palpation   or    other diagnostic test that is at least as effective.

(i)   Any additional tests that are deemed appropriate   by  the   examining physician.

(3)    Periodic biological monitoring shall be performed in accordance with the provisions of R 325.51869(2)(b). If the results of periodic biological monitoring or the results of biological monitoring performed as part  of   the  periodic  medical examination show the level of  the  employee's  CdU, B2-M, or CdB to be more than the levels specified in R 325.51870(2) or (3) or, beginning on January 1, 1999, more than the levels specified in R 325.51870(2), (4), or (5), an employer shall take the appropriate   actions specified in R 325.51870(2) to (5).

(4)     For previously exposed employees as specified by the provisions of R 325.51868(1)(b) or (2)(c), all of the following provisions apply:

(a)   If the employee's level of CdU was not more than 3 ug/g Cr, CdB was not more than 5 ug/lwb, and B2-M was not more than 300 ug/g Cr in  the initial biological monitoring tests, and if the results of the follow-up biological monitoring required by R 325.51870(1)(b) 1 year after the initial examination confirms the previous results, an  employer  may discontinue all periodic medical surveillance for that employee.

(b)   If the initial biological monitoring results for CdU, CdB, or B2-M were more than the levels specified in subdivision (a) of this subrule, but subsequent biological monitoring results required by the provisions of R 325.51870(2) to (5) show that the employee's CdU level is not more than 3 ug/g Cr, the CdB level is not more than 5 ug/lwb, and B2-M level is not more than 300 ug/g Cr, an employer shall provide follow-up biological monitoring for CdU, CdB, and B2-M 1 year after the most recent biological monitoring results. If the results of this follow-up biological monitoring confirm the previous results, an employer may discontinue all periodic medical surveillance for that employee.

(c)   If the results of the follow-up tests specified in subdivision (a) or (b) of this subrule indicate that the level of the employee's CdU, B2-M, or CdB is more than the levels specified in subdivision (b) of this subrule, an employer is required to provide annual medical examinations in accordance with the provisions of subrule (2) of this rule until the results of biological monitoring are consistently below the levels specified in subdivision (b) of this subrule or until the  examining   physician determines, in a written medical opinion, that further medical  surveillance  is   not required to protect the employee's health.

(5)    A routine, once every 24 months, medical examination is not required to be provided in accordance with the  provisions  of  R  325.51870(1)   and subrule (1) of this rule if adequate medical records show that the employee has been examined in accordance with the requirements  of   subrule

(2)   of this rule within the past 12 months. In that case, the records shall be maintained by the employer as part of the employee's medical record and the next routine, periodic medical examination  shall   be    made available to the employee within 2 years of the previous examination.

History: 1993 AACS.