Who is covered: Health care facilities (hospitals, skilled nursing, clinics, outpatient medical offices, home health, hospice, paramedic/EMS); high-risk facilities (correctional facilities, homeless shelters, drug-treatment programs); public-health operations (contact tracing, screening); police during transport/detention of suspected ATD cases; laboratories handling aerosol-transmissible pathogens; cadaver-handling operations (pathology labs, medical examiners, coroners, mortuaries); and contaminated air-handling maintenance. Limited exceptions for certain outpatient dental/specialty practices with screening — 8 CCR 5199(a).
Evaluation performed by: PLHCP knowledgeable in occupational TB/ATD evaluation (TB management referrals to a PLHCP knowledgeable in TB diagnosis/treatment)
🩺 Baseline / Pre-Placement
On hire/assignment into an ATD exposure-risk classification — 8 CCR 5199(h)
- Baseline TB screening/testing for new hires in exposure-risk job classifications (TB skin test or IGRA blood test, per the facility's program) — 8 CCR 5199(h)
- Vaccines listed in Appendix E of 8 CCR 5199 made available at no cost to all susceptible health care workers with occupational exposure within 10 working days of initial assignment (unless previously vaccinated, immune, or medically contraindicated) — 8 CCR 5199(h)(5)(A). [Appendix E vaccine list must be confirmed against enrolled California Code of Regulations text — Appendix E was not fully reproduced in independently fetched source.]
- Medical-history/screening as part of program enrollment
🕒 Periodic / Routine
Interval-based for exposed employees — NOT result-triggered
Schedule: Annual TB testing/assessment for all exposed employees — 8 CCR 5199(h)(3)
- Annual TB testing/assessment for exposed employees [8 CCR 5199(h)(3)(A)]
- Employees with a negative baseline TB test: annual TB test using either a Tuberculin Skin Test (TST) or a Blood Assay for M. Tuberculosis (BAMT)/Interferon Gamma Release Assay (IGRA) (FDA-approved and CDC-recommended)
- Employees with a baseline-positive TB test: annual symptom screen only (not a repeat TST/IGRA)
- More frequent testing required if applicable public health guidelines or the local health officer recommends it
Abnormal results & exposure-event protocols
Abnormal Results & Exposure-Event Protocols
- Employee TB test conversion (new positive) 8 CCR 5199(h)(3): Provide a medical evaluation and refer the employee to a PLHCP knowledgeable in the diagnosis/treatment of TB for further evaluation and management. Tests: Medical evaluation of the TB conversion, Referral to a PLHCP knowledgeable in TB diagnosis and treatment, Symptom assessment and chest imaging as clinically indicated by the PLHCP
- Significant exposure incident / suspected or confirmed ATD case exposure 8 CCR 5199(h)(6): Conduct an exposure analysis within 72 hours; provide a post-exposure MEDICAL EVALUATION within 96 hours of the exposure; report suspected reportable ATD cases to the local health officer; notify other potentially exposed employers within 72 hours. Tests: Exposure incident analysis (determination of which employees had significant exposures) within 72 hours of the employer's report to the local health officer or receipt of notification [8 CCR 5199(h)(6)(C)1], Notification of employees with significant exposures of the date, time, and nature of the exposure within 96 hours of becoming aware of the potential exposure [8 CCR 5199(h)(6)(C)2], Post-exposure medical evaluation provided 'as soon as feasible' to all employees with significant exposures (no fixed-hour deadline) [8 CCR 5199(h)(6)(C)3], Reporting of suspected/confirmed ATD case to the local health officer, Notification of other potentially exposed employers within 72 hours of the report to the local health officer [8 CCR 5199(h)(6)(B)], Post-exposure prophylaxis/treatment as recommended by the PLHCP
Reporting Requirements
| Who performs the evaluation | PLHCP (referrals for TB conversion to a PLHCP knowledgeable in TB diagnosis/treatment) — 8 CCR 5199(h). |
|---|---|
| Reported to employer | Employer receives the PLHCP's written opinion/recommendation on work status and any work restrictions related to ATD exposure; clinical details remain confidential. |
| Reported to / for the employee | Employee informed of TB test results, conversion status, exposure-incident findings, and any need for further evaluation/treatment; copy of the written opinion provided. |
| Time limits | Written opinion from PLHCP provided to employee within 15 working days of completion of all required medical evaluations — 8 CCR 5199(h)(9)(A). |
| Recordkeeping | Confidential ATD medical records retained per 8 CCR 5199(j)(1)(A): at least the duration of employment plus 30 years; may be combined with the 8 CCR 5193 medical record. |
Medical Removal Protection
No MRP. Program is baseline + annual TB surveillance plus event-triggered TB-conversion evaluation and post-exposure response (see abnormal_protocols). Medical records may be combined with the 5193 (bloodborne) medical record — 8 CCR 5199(j)(1)(A) — though the two standards cover non-overlapping disease routes (airborne vs. bloodborne).
Required Forms & Reference Definitions
Appendix E — Vaccination recommendations for susceptible health care workers 8 CCR 5199 App. E (Mandatory)
The Cal/OSHA list of vaccine doses the employer must make available at no cost to susceptible health care workers with occupational exposure: influenza (annual), measles (2 doses), mumps (2 doses), rubella (1 dose), Tdap (1 dose with recommended boosters), and varicella-zoster (2 doses), unless the worker is already immune or vaccination is medically contraindicated.