TABLE OF CONTENTS
| Topics | Sections |
|---|---|
| OVERVIEW | 4.1 What is the purpose of this chapter? 4.2 What is the scope of this chapter? 4.3 How does the Service use medical programs to ensure the safety and health of personnel who may be exposed to occupational hazards? 4.4 What are the authorities for this chapter? 4.5 What terms do you need to know to understand this chapter? |
| RESPONSIBILITIES | 4.6 Who is responsible for Service medical programs? |
| MEDICAL SURVELLIANCE AND OTHER PROGRAMS | 4.7 What constitutes a medical surveillance program, medical standards program, medical clearance exams, exposure-driven immunizations, and wellness services? 4.8 How does an employee know if a medical surveillance program is required? 4.9 How can duty stations start a medical program? 4.10 What Service activities require or may require medical surveillance, medical clearance exams, and medical standards programs? 4.11 Can medical programs be combined? |
| RECORDKEEPING REQUIREMENTS | 4.12 What are the recordkeeping requirements for medical programs? 4.13 May employees access their medical records? |
OVERVIEW
4.1 What is the purpose of this chapter? This chapter:
A. Establishes U.S. Fish and Wildlife Service (Service) requirements for medical programs that ensure the safety and health of our personnel who may be exposed to occupational hazards, and
B. Describes how we use:
(1) Medical surveillance to monitor possible health effects of occupational exposures;
(2) Medical standards to identify conditions of employment for particular activities, job series, or programs that are arduous or hazardous in nature;
(3) Medical clearance examinations to ensure that personnel meet job-specific medical requirements; and
(4) Exposure-driven immunizations to provide protection against potential exposures to occupational hazards.
4.2 What is the scope of this chapter?
A. This chapter applies to all employees whose duties:
(1) Require them to work with materials or to be physically present at Service facilities engaged in operations that have the potential to expose them to hazards above established permissible exposure limits, action levels, or threshold limit values;
(2) Expose them to hazards that may cause illness or disease; or
(3) Are arduous or hazardous in nature.
B. This chapter does not apply to volunteers, Youth Conservation Corps enrollees, and youth partner hires under the age of 18 who are not allowed to work in positions that require enrollment in a medical standard (i.e., work in arduous or hazardous operations; see section 4.7B for more information).
(1) Although we allow volunteers, Youth Conservation Corps enrollees, and youth partner hires who are 18 or older to participate in activities that require medical surveillance or clearance-type exams, we do not recommend their participation because of the associated high costs and turnover rates.
(2) Volunteers, Youth Conservation Corps enrollees, and youth partner hires who are 18 or older are subject to the same requirements as employees engaged in similar operations.
C. Project Leaders/Supervisors/Facility Managers have many responsibilities for this program. For simplicity, throughout this chapter we refer to them collectively as Project Leaders.
4.3 How does the Service use medical programs to ensure the safety and health of personnel who may be exposed to occupational hazards?
A. Project Leaders and servicing Human Resources staff must identify job series and operations that may warrant the establishment of medical programs.
B. As relevant operations are identified, we establish medical programs that:
(1) Assess and monitor the impact(s) to employees from workplace exposures to chemical, physical, and biological hazards;
(2) Provide medical surveillance for those employees who are, or may be, exposed to known hazards above established permissible exposure limits or action levels;
(3) Develop medical standards for operations, job series, and mission programs considered arduous or hazardous in nature;
(4) Provide exposure-driven immunizations for those employees who work in areas with exposures to infectious agents (e.g., hepatitis, tetanus, rabies); and
(5) Maintain medical surveillance, medical standards, medical clearance examinations, and exposure-driven immunizations that follow current regulations and medical procedures.
4.4 What are the authorities for this chapter?
A. Basic Program Elements for Federal Employee Occupational Safety and Health Programs and Related Matters (29 CFR 1960).
B. Department of the Interior (Department) Occupational Medicine Program Handbook, Tabs 8 and 12(E2), Specific Medical Program Requirements.
C. Executive Order 12196, Occupational Safety and Health Programs for Federal Employees.
D. Executive Order 12564, Drug-Free Federal Workplace.
E. Occupational Safety and Health Act, Federal Agency Safety Programs and Responsibilities (Public Law 91-596, Sec.19).
F. Occupational Safety and Health Administration (OSHA) Standards, Occupational Safety and Health Standards (29 CFR 1910.95 and 29 CFR 1910.1000 through 1450).
G. Privacy Act of 1974; Personnel Records, Medical Qualification Determinations of 2002, and Records Maintained on Individuals (5 U.S.C. 293, 339, and 552a).
H. 485 Departmental Manual (DM) 17, Industrial Hygiene Program, and 485 DM 18, Occupational Medicine Program.
4.5 What terms do you need to know to understand this chapter?
A. Clinical laboratory tests are portions of a medical surveillance examination that a doctor uses to detect the absorption of toxic agents, or the physiological or pathological effects caused by their absorption.
B. Medical programs are a collection of medical examinations, testing, and physical fitness tests that are part of medical surveillance, medical standards, medical clearances, and immunizations.
C. Medical surveillance action level is the minimum threshold of occupational exposure to hazards used as a trigger in implementing medical surveillance examinations or continued health monitoring. These action levels are hazard-specific and driven by regulations.
D. Medical surveillance examination is an occupationally related medical history, physical evaluation, or series of clinical laboratory tests that an Occupational Health Physician performs to assess the impacts of workplace exposure to an employee’s health. Table 4-1 describes the different medical surveillance exam types.
Table 4-1: Medical Surveillance Exam Types
| Medical Surveillance Exam Type | Definition |
|---|---|
Baseline | An exam provided generally prior to initial exposure to establish evaluation levels before workplace exposure. |
Interim/periodic | Followup exam(s) provided to monitor effects of workplace hazards. This information is used to compare to baseline results to discover changes and determine evidence of exposure to specific physical, environmental, or other occupational hazards. |
Special | Exam provided when an employee experiences accidental exposure or suffers health effects consistent with exposure. |
Exit medical evaluation | Exam provided when: (1) The work process is changed to reduce or eliminate the exposure to a hazard, (2) The employee is reassigned so that the exposure hazard is eliminated, or (3) The employee leaves the Service. |
E. Occupational exposure assessment is the process of evaluating, estimating, and documenting exposures and developing controls, including the need for medical surveillance.
F. Occupational Health Physician (OHP) is a doctor certified by the American College of Occupational Medicine or trained in occupational health medicine. An OHP:
(1) Focuses on medical surveillance of employees potentially exposed to hazards in the workplace and the diagnosis and treatment of occupational injuries and illnesses, and
(2) Provides medical services in accordance with OSHA and Departmental and Service policies.
G. Occupationally related medical history is a person's medical background, including occupational exposures, family health, and personal health.
H. Workplace exposure monitoring is a process of air, surface, or other sampling conducted to assess potential health risks due to the presence of physical, chemical, or biological hazards at work. An industrial hygienist or other qualified safety and health professional conducts workplace exposure monitoring.
RESPONSIBILITIES
4.6 Who is responsible for Service medical programs? See Table 4-2.
Table 4-2: Responsibilities for the Service’s Medical Programs
| These employees… | Are responsible for… |
|---|---|
| A. The Director | Approving or declining to approve Servicewide policy. |
| B. The Assistant Director – Management and Administration (AD-MA), who serves as our bureau’s Designated Agency Safety and Health Official | (1) Overseeing the establishment and management of overall policy and guidance for effective medical programs; and (2) Providing sufficient support and resources to the Chief, Joint Administrative Operations (JAO) Safety Operations, to ensure that the Chief can accomplish program goals. |
| C. Directorate members | Ensuring that there are sufficient resources and support in place to implement an effective and comprehensive medical program within their areas of responsibility. |
D. The Chief, Safety Operations (under the JAO organization) | (1) Revising and updating this chapter, and (2) Interpreting the requirements of this chapter and working to resolve Servicewide issues and questions about Service medical programs. |
E. Responsible JAO Safety Managers/Specialists/Industrial Hygienists
| (1) Advising managers and Collateral Duty Safety Officers about the Service’s medical programs in their areas of responsibility; (2) Interpreting program requirements and working to resolve issues and questions; (3) Assisting with workplace assessments to determine the need for medical programs; (4) Providing guidance on the following: (a) Using engineering or administrative controls when workers are, or may be, occupationally exposed to chemical, physical, or biological hazards at or above established permissible exposure limits, action levels, or threshold limit values; and (b) Selecting and using Personal Protective Equipment (PPE) when engineering and administrative controls are not adequate (see 241 FW 3); and (5) Evaluating the management of medical programs during duty station formal safety and health inspections. |
| F. Responsible Servicing Human Resources (HR) Specialists | (1) Ensuring that position descriptions are annotated with the medical requirements and that these requirements are a condition of employment; (2) Ensuring vacancy announcements include information about pre-employment medical exams and any required medical standards or medical surveillance; (3) Ensuring that potential new hires under a medical standards program, which is a condition of employment, have completed a satisfactory medical examination before making an official job offer; (4) Advising Project Leaders on appropriate action for employees who fail to meet the medical standards for a position; and (5) Managing employee medical records appropriately (see section 4.12 and Parts 240 through 243 in the Service Manual). Currently applies to HR Specialists in the Albuquerque, New Mexico office only. |
| G. Project Leaders (collective term that refers to Project Leaders, Supervisors, and Facility Managers) | (1) Evaluating operations, including the development of Job Hazard Assessments (JHA), to identify potential exposure to workplace chemical, physical, or biological hazards (see 240 FW 1); (2) Identifying positions and employees who may need medical surveillance; (3) Assisting tentatively selected candidates with any issues regarding pre-employment medical examinations; (4) Requesting advice and guidance from the servicing Human Resources Specialist when employees fail to meet the medical standards for a position; (5) Consulting with appropriate personnel (e.g., in the servicing Contracting office and JAO Safety Operations) when developing medical services contracts with health providers (e.g., the U.S. Public Health Service, Federal Occupational Health, Home – Acuity International, local physicians); (6) Providing access to medical service providers for those employees who experience ill effects from working with or being exposed to workplace hazards. These medical services are provided at no cost to the employee. Medical coverage must be consistent with the Federal Employee’s Compensation Act; and (7) Ensuring appropriate personal exposure sampling data are included in employee medical files (Standard Form (SF)-66D). Appropriate sampling data is information collected to comply with OSHA regulations (e.g., audiograms (see 242 FW 3) and formaldehyde sampling data (see 242 FW 9)). |
| H. Employees | Complying with all aspects of the medical program applicable to their duties by: (1) Wearing PPE in the manner it was designed to be worn when its use is necessary to reduce or eliminate potential workplace exposures; (2) Maintaining PPE in an appropriate manner to ensure its effectiveness; (3) Not eating, smoking, or drinking in or near the work area where chemicals or other materials present a hazard; (4) Notifying their Project Leader of any adverse health effects they are experiencing that they believe to be the result of their job duties; (5) Completing and filling out paperwork necessary for medical services in a timely manner; and (6) Attending necessary medical appointments. |
MEDICAL SURVELLIANCE AND OTHER PROGRAMS
4.7 What constitutes a medical surveillance program, medical standards program, medical clearance exams, exposure-driven immunizations, and wellness services?
A. Medical surveillance program. A medical surveillance program is the process of evaluating employee health as it relates to actual or potential exposures to hazardous agents in the workplace. The evaluation process involves:
(1) The use of an occupational exposure assessment (see Exhibit 1) that includes JHAs, workplace exposure monitoring, and medical exams that may include bloodwork;
(2) Pre-placement and baseline, periodic, special, and termination exams (see Table 4-1);
(3) Mandatory participation when an occupational exposure assessment warrants it and when it is part of a medical standard program; and
(4) Notifying employees of results.
B. Medical standards program. A medical standards program is a mandatory, condition-of-employment program instituted for activities, job series, or programs that are arduous or hazardous in nature and that require employees to meet mandatory physical standards to remain eligible to perform their duties. Standards are developed through an extensive process of identifying a series of physical performance and medical examination requirements for a particular activity, job series, or program.
(1) A team of professionals develop program requirements. The team includes an OHP and at least one representative from the:
(a) Program requesting the standard,
(b) JAO Safety Operations,
(c) Servicing Human Resources Operations office,
(d) Office of Personnel Management (OPM) (if applicable and available), and
(e) Department’s Office of Health and Safety.
(2) Only an OHP or a licensed health care professional under the supervision of an OHP (e.g., a registered nurse or a physician's assistant) may perform these examinations.
(3) All medical standards require approval from OPM and acceptance from Service management before implementation.
(4) The Service may add to existing standards or request the development of new medical standards in the future.
C. Medical clearance exams. Medical clearance exams are those tests that employees must pass to perform specific duties, such as having Commercial Driver’s Licenses (CDL), using respirators, and underwater diving.
D. Exposure-driven immunizations. Exposure-driven immunizations are the injections administered for protection against potential exposure to occupational hazards such as hepatitis B, rabies, tetanus, etc. Immunizations are routinely administered pre-exposure, but in some cases may be administered post-exposure and within a certain time window. Employees should consult with their Project Leader, responsible JAO Safety Manager/Specialist/Industrial Hygienist, or OHP for more information.
E. Wellness services. Wellness services are those general immunizations or exams the Service may provide to maintain an employee’s health and wellness. These services are not required, and we provide them on a case-by-case basis.
4.8 How does an employee know if a medical surveillance program is required?
A. When exposure levels to physical and chemical workplace hazards are known to exceed OSHA’s permissible exposure limits or action levels (see 29 CFR 1910.1000) medical surveillance is warranted.
B. When exposures to a workplace hazard are unknown, the Project Leader must consider including employees based on anticipated exposures determined during collaboration with the JAO Safety Manager/Specialist/Industrial Hygienist. JAO Safety Operations reviews any reported workplace illnesses, answers to employee questionnaires (see the Department’s Occupational Medicine Program Handbook, Tab 12, Attachment D2(c)), JHAs, and exposure monitoring data to make a determination.
4.9 How can duty stations start a medical program? Project Leaders (or their designees) should contact their JAO Safety Manager/Specialist/Industrial Hygienists for guidance on where to get started.
4.10 What Service activities require or may require medical surveillance, medical clearance exams, and medical standards programs? See Table 4-3
Table 4-3: Activities That Require or May Require a Medical Surveillance, Medical Clearance Exam, or Medical Standards Program
| Activity | Type/Program | Required/May Be Required |
|---|---|---|
| Application of pesticides (see 242 FW 7) | Medical surveillance | May be required |
| Aviation | Medical standards program | Required |
| Chemical exposure over regulated action levels | Medical surveillance | May be required |
| Commercial Driver’s Licenses (CDL) (see 321 FW 1) | Medical clearance exam | Required |
| Environmental contaminants work | Medical surveillance | May be required |
| Hazardous materials response (see 242 FW 6) | Medical surveillance | May be required |
| Office of Law Enforcement (Special Agents) | Medical standards program | Required |
| Office of Law Enforcement (Wildlife Inspectors, Evidence Custodians, Repository staff, and Forensics Laboratory staff) | Medical surveillance | Required |
| Operation of noisy equipment or working in a noisy area (see 242 FW 3) | Medical surveillance | May be required |
| Federal Wildlife Officers (within the National Wildlife Refuge System) | Medical standards program | Required |
| Respirator use (see 242 FW 14) | Medical clearance exam | May be required |
| Sea lamprey program | Medical standards program | Required |
| Underwater diving (see 241 FW 10) | Medical clearance exam | Required |
| Use of formaldehyde (see 242 FW 9) | Medical surveillance | May be required |
| Wildlife fire program | Medical standards program | Required |
4.11 Can medical programs be combined?
A. Yes. Project Leaders may combine some medical programs for Service personnel who perform activities that have different medical program requirements.
B. Combining medical programs may reduce the time an employee spends away from the office and reduce medical exam costs. For example, a Federal Wildlife Officer under a medical standards program also may fight wildland fires. For those Federal Wildlife Officers who participate in wildland fire activities, the Division of Refuge Law Enforcement accepts the fire medical exam in lieu of a law enforcement exam so that officers are not required to take both programmatic exams in the same year.
C. Managers and employees should contact their responsible JAO Safety Manager/Specialist/Industrial Hygienist for guidance.
RECORDKEEPING REQUIREMENTS
4.12 What are the recordkeeping requirements for medical programs?
A. Tables 4-4 and 4-5 summarize the disposition of medical records and where to find more information.
Table 4-4: Recordkeeping Requirements for Job Hazard Assessments/Medical Surveillance/Clearance Exams/Immunizations
| Record Type | File Location | Length of Maintenance | For More Information |
|---|---|---|---|
| Occupational exposure assessment (i.e., JHAs) | Duty Station Project Leader’s files | Life of operations or until operations change | 240 FW 1 |
| Personal sampling data (employee medical file) | Duty Station Project Leader’s files | Based on individual regulation’s records maintenance requirements | OSHA regulationsat 29 CFR 1910.95, and 29 CFR 1910.1000 through 1450 |
| Physicians’ opinions and qualifications statements | Duty Station Project Leader’s files and the servicing HR office (currently located in Albuquerque, New Mexico) | Duration of employment + 30 years | |
| Medical exam results | Servicing HR office (currently located in Albuquerque, New Mexico) | Duration of employment + 30 years | |
| Personal sampling data (immunizations) | Servicing HR office (currently located in Albuquerque, New Mexico) | Depends on the type of exposure sampling (see OSHA regulations) | OSHA regulations at 29 CFR 1910.95, and 29 CFR 1910.1000 through 1450 |
Table 4-5: Recordkeeping Requirements for Medical Standards
| Record Type | File Location | Length of Maintenance | For More Information |
|---|---|---|---|
| Office of Law Enforcement | Managed and stored by Office of Law Enforcement Headquarters | Duration of employment + 30 years | 5 CFR Part 293, Subpart E |
| Refuge Law Enforcement | Duty Station Project Leader’s files | Until operations cease | 240 FW 1 |
| Sea lamprey | Servicing HR office (currently located in Albuquerque, New Mexico)/Employee Medical File, SF-66D-Employee Medical Folder | Duration of employment + 30 years | 5 CFR Part 293, Subpart E |
| Wildland fire | Managed and stored by medical provider. | Depends on the type of sampling (e.g., sampling related to asbestos and formaldehyde have specific recordkeeping requirements) | OSHA regulations at 29 CFR 1910.95, and 29 CFR 1910.1000 through 1450 |
B. Those employees who collect and maintain medical records with personal information (e.g., medical evaluations and physician statements, etc.) must do so in compliance with 5 U.S.C. 552a (Privacy Act of 1974). Those tasked with storing and maintaining such records must read and be familiar with OPM/GOVT-10, Employee Medical File System of Records. These records:
(1) Are sensitive and protected by the Privacy Act (see 204 FW 1);
(2) Must only be available to staff on a need-to-know basis;
(3) If electronic, must be password-protected and only used in accordance with the routine uses identified in OPM/GOVT-10; and
(4) If hardcopy, must be protected in a locked file and locked room that is available only to staff who have a need to know this information.
C. Copies of records for medical exam results and personal exposure data must be mailed to the servicing Human Resources office (see Medical Programs SharePoint page,)
4.13 May employees access their medical records? Yes. The employee must make a written request. Submit a mySupport HR Records & Systems Request or a mySupport HR Consultation Request for assistance.