General Industry
Who is covered: Employees exposed at/above the AL unless exposure occurs fewer than 30 days/year (12-month period); previously-exposed employees with 60+ aggregated months in cadmium work before the effective date. Mirrors federal 1910.1027.
Evaluation performed by: Licensed physician (familiar with App A health effects, App F sampling protocol, and App D questionnaire; employer-selected, multiple-physician review available to employee)
🩺 Baseline / Pre-Placement
Initial exam within 30 days of initial assignment (or 90 days after the standard's effective date, whichever is later); not required if an adequate exam was performed in the preceding 12 months
- Detailed medical + work history — emphasis on past, present, and anticipated cadmium exposure; renal, cardiovascular, respiratory, hematopoietic, reproductive, and musculo-skeletal dysfunction; current medications with nephrotoxic side-effects; smoking history and status
- Biological monitoring: Cadmium in urine (CdU), standardized to g creatinine (µg/g Cr)
- Biological monitoring: Beta-2-microglobulin in urine (β₂-M), standardized to µg/g Cr (pH specified)
- Biological monitoring: Cadmium in blood (CdB), standardized to liters whole blood (µg/lwb)
🕒 Periodic / Routine
Interval-based while covered — NOT result-triggered
Schedule: Biological monitoring (CdU, β2-M, CdB) at least annually. Full medical examination within 1 year after the initial examination, then at least biennially thereafter (8 CCR 5207(l)(4)(A)).
- Biological monitoring at least annually: Cadmium in urine (CdU), standardized to g creatinine (µg/g Cr)
- Biological monitoring at least annually: Beta-2-microglobulin in urine (β₂-M), standardized to µg/g Cr (pH specified)
- Biological monitoring at least annually: Cadmium in blood (CdB), standardized to liters whole blood (µg/lwb)
- Biennial full exam — detailed medical + work history, or update thereof, with emphasis on past, present, and anticipated future exposure to cadmium; smoking history and current status; reproductive history; current use of medications with potential nephrotoxic side-effects; and any history of renal, cardiovascular, respiratory, hematopoietic, and/or musculo-skeletal system dysfunction — including App D questions 3-11 and 25-32 for employees who wear respirators
- Biennial full exam — complete physical examination with emphasis on blood pressure, the respiratory system, and the urinary system
- Biennial full exam — posterior-anterior chest X-ray (14×17-inch or equivalent standard film/digital; subsequent frequency per examining physician)
- Biennial full exam — pulmonary function tests: forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV₁)
- Biennial full exam — blood: blood urea nitrogen (BUN), complete blood count (CBC), serum creatinine
- Biennial full exam — urinalysis: albumin, glucose, and total and low-molecular-weight proteins
- Biennial full exam — prostate palpation (males over 40), or other at least as effective diagnostic test
- Any additional tests deemed appropriate by the examining physician
🚪 Exit / Termination
At termination of employment, for any employee to whom the employer was required to provide medical surveillance at any prior time under 8 CCR 5207(l)(1)(A) or (l)(7)
- Termination exam — detailed medical + work history, or update thereof, with emphasis on past, present, and anticipated future exposure to cadmium; smoking history and current status; reproductive history; current use of medications with potential nephrotoxic side-effects; and any history of renal, cardiovascular, respiratory, hematopoietic, and/or musculo-skeletal system dysfunction — including App D questions 3-11 and 25-32 for employees who wear respirators
- Termination exam — complete physical examination with emphasis on blood pressure, the respiratory system, and the urinary system
- Termination exam — posterior-anterior chest X-ray (14×17-inch or reasonably standard sized), expressly required as part of the termination examination
- Termination exam — pulmonary function tests: forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV₁)
- Termination exam — biological monitoring: cadmium in urine (CdU) standardized to g creatinine (µg/g Cr); beta-2-microglobulin in urine (β₂-M) standardized to µg/g Cr with pH specified; cadmium in blood (CdB) standardized to liters whole blood (µg/lwb)
- Termination exam — blood: blood urea nitrogen (BUN), complete blood count (CBC), serum creatinine
- Termination exam — urinalysis: albumin, glucose, and total and low-molecular-weight proteins
- Termination exam — prostate palpation (males over 40), or other at least as effective diagnostic test
- Termination exam — any additional tests deemed appropriate by the examining physician
- Required unless a qualifying examination meeting all of the above requirements was completed less than 6 months prior to the date of termination — and required even then where an elevated biological-monitoring result or an abnormal medical-examination finding independently calls for an examination under 8 CCR 5207(l)(3) or (l)(5)
- Not required for previously-exposed employees whose periodic medical surveillance has been discontinued under 8 CCR 5207(l)(4)(E)
⚠ Emergency / Post-Exposure
As soon as possible following an acute cadmium exposure because of an emergency
- Emergency exam — detailed medical + work history, or update thereof, with emphasis on past, present, and anticipated future exposure to cadmium; smoking history and current status; reproductive history; current use of medications with potential nephrotoxic side-effects; and any history of renal, cardiovascular, respiratory, hematopoietic, and/or musculo-skeletal system dysfunction — including App D questions 3-11 and 25-32 for employees who wear respirators
- Emergency exam — complete physical examination with emphasis on blood pressure, the respiratory system, and the urinary system
- Emergency exam — posterior-anterior chest X-ray (14×17-inch or reasonably standard sized; subsequent frequency per examining physician)
- Emergency exam — pulmonary function tests: forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV₁)
- Emergency exam — biological monitoring: cadmium in urine (CdU) standardized to g creatinine (µg/g Cr); beta-2-microglobulin in urine (β₂-M) standardized to µg/g Cr with pH specified; cadmium in blood (CdB) standardized to liters whole blood (µg/lwb)
- Emergency exam — blood: blood urea nitrogen (BUN), complete blood count (CBC), serum creatinine
- Emergency exam — urinalysis: albumin, glucose, and total and low-molecular-weight proteins
- Emergency exam — prostate palpation (males over 40), or other at least as effective diagnostic test
- Emergency exam — any additional tests deemed appropriate by the examining physician
- Additional emphasis throughout on the respiratory system, other organ systems considered appropriate by the examining physician, and symptoms of acute overexposure as identified in App A subsections II2.(1)-(2) and IV
Abnormal results & exposure-event protocols
Abnormal Results & Exposure-Event Protocols
- Initial biological result CdU >3 µg/g Cr, OR β₂-M >300 µg/g Cr, OR CdB >5 µg/lwb Elevated biomonitoring response: Within 2 weeks reassess occupational exposure (work practices, respirator use, hygiene, engineering controls, smoking); within 30 days correct deficiencies; within 90 days provide a full medical examination. If not removed, continue semiannual biological monitoring and annual full exams until CdU ≤3, β₂-M ≤300, and CdB ≤5. Tests: Repeat biological monitoring: CdU, β₂-M, CdB, Full medical examination within 90 days
- Mandatory removal when both the initial and confirmatory biological results show CdU >7 µg/g Cr, OR CdB >10 µg/lwb, OR β₂-M >750 µg/g Cr — AND concurrently CdU >3 or CdB >5. Pre-1999 absolute triggers (CdU >15, CdB >15, or β₂-M >1,500 with concurrent CdU >3 or CdB >5) also apply. Medical Removal Protection — post-1999 trigger levels (in force): Remove the employee from work where exposure is at/above the action level (or above the PEL if the basis is inability to wear a respirator). During removal, provide follow-up biological monitoring at least every 3 months and follow-up medical examinations at least every 6 months. Maintain MRP wage/benefit protection up to 18 months. Tests: Quarterly biological monitoring during removal: CdU, β₂-M, CdB, Semiannual follow-up medical examination during removal
- Employee removed under the MRP trigger levels Return to work / 18-month final determination: Return permitted only when CdU falls to ≤3 µg/g Cr AND CdB ≤5 µg/lwb AND β₂-M ≤300 µg/g Cr (physician may override with special-circumstances finding of no increased risk). After 18 months of unresolved removal, a final medical determination exam decides return-to-former-status vs. permanent removal. Tests: Confirmatory biological monitoring (CdU, CdB, β₂-M) to establish return eligibility
Reporting Requirements
| Who performs the evaluation | Licensed physician (familiar with App A, App D, App F) |
|---|---|
| Reported to employer | Prompt written medical opinion containing: the physician's diagnosis; whether the employee has a detected condition increasing risk of material impairment from cadmium (including potential cadmium toxicity); results of biological/other tests assessing cadmium absorption; any recommended removal or limitation on duties/PPE; and a statement that the physician explained the results (including all biomonitoring and any condition needing further evaluation, plus diet/medication limits) to the employee. Physician instructed NOT to reveal findings/diagnoses unrelated to cadmium. |
| Reported to / for the employee | Employer furnishes a copy of the written opinion to the employee within 2 weeks of receipt; biological monitoring results plus an explanation sheet furnished within 2 weeks of receipt. |
| Time limits | Written opinion and biomonitoring explanation furnished to the employee within 2 weeks of employer receipt; employee must initiate second-physician review within 15 days of notice. |
| Second-opinion / multi-physician review | Multiple-physician review: employer must notify the employee of the right to a second opinion after each employer-arranged exam; employee designates a second physician; unresolved disagreements go to a jointly-designated third physician whose findings control. |
| Recordkeeping | Medical records retained for the duration of employment plus 30 years, in accordance with 8 CCR 5207(n)(3)(C) (citing section 3204 for access). Mirrors federal 1910.1027(n)(3)(iii). |
Medical Removal Protection
Mandatory removal at post-1999 confirmed CdU >7 / CdB >10 / β₂-M >750 (with concurrent CdU >3 or CdB >5); return at CdU ≤3 AND CdB ≤5 AND β₂-M ≤300; MRP wage/benefit protection up to 18 months; quarterly biomonitoring and semiannual exams during removal.
Construction
Who is covered: California construction cadmium standard; coverage and requirements mirror 8 CCR 5207 and federal 1926.1127.
Evaluation performed by: Licensed physician (familiar with App A health effects, App F sampling protocol, and App D questionnaire; employer-selected, multiple-physician review available to employee)
🩺 Baseline / Pre-Placement
Initial exam within 30 days of initial assignment (or 90 days after the standard's effective date, whichever is later); not required if an adequate exam was performed in the preceding 12 months
- Detailed medical + work history — emphasis on past, present, and anticipated cadmium exposure; renal, cardiovascular, respiratory, hematopoietic, reproductive, and musculo-skeletal dysfunction; current medications with nephrotoxic side-effects; smoking history and status
- Biological monitoring: Cadmium in urine (CdU), standardized to g creatinine (µg/g Cr)
- Biological monitoring: Beta-2-microglobulin in urine (β₂-M), standardized to µg/g Cr (pH specified)
- Biological monitoring: Cadmium in blood (CdB), standardized to liters whole blood (µg/lwb)
🕒 Periodic / Routine
Interval-based while covered — NOT result-triggered
Schedule: Biological monitoring (CdU, β2-M, CdB) at least annually. Full medical examination within 1 year after the initial examination, then at least biennially thereafter (8 CCR 1532(l)(4)(A)).
- Biological monitoring at least annually: Cadmium in urine (CdU), standardized to g creatinine (µg/g Cr)
- Biological monitoring at least annually: Beta-2-microglobulin in urine (β₂-M), standardized to µg/g Cr (pH specified)
- Biological monitoring at least annually: Cadmium in blood (CdB), standardized to liters whole blood (µg/lwb)
- Biennial full exam — detailed medical + work history or update thereof, emphasis on past, present, and anticipated future cadmium exposure; smoking history and current status; reproductive history; current use of medications with potential nephrotoxic side-effects; any history of renal, cardiovascular, respiratory, hematopoietic, and/or musculo-skeletal system dysfunction (App D respirator questions 3-11 and 25-32 for respirator wearers)
- Biennial full exam — complete physical examination with emphasis on blood pressure, the respiratory system, and the urinary system
- Biennial full exam — posterior-anterior chest X-ray, 14×17-inch or a reasonably standard size (after the initial X-ray, frequency is determined by the examining physician)
- Biennial full exam — pulmonary function tests: forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV₁)
- Biennial full exam — blood: blood urea nitrogen (BUN), complete blood count (CBC), serum creatinine
- Biennial full exam — urinalysis: albumin, glucose, and total and low-molecular-weight proteins
- Biennial full exam — prostate palpation (males over 40), or other at least as effective diagnostic test
- Biennial full exam — any additional tests deemed appropriate by the examining physician
🚪 Exit / Termination
At termination of employment, for any employee to whom the employer was at any prior time required to provide medical surveillance under 8 CCR 1532(l)(1)(A) or (l)(7)
- Termination exam — detailed medical + work history or update thereof, emphasis on past, present, and anticipated future cadmium exposure; smoking history and current status; reproductive history; current use of medications with potential nephrotoxic side-effects; any history of renal, cardiovascular, respiratory, hematopoietic, and/or musculo-skeletal system dysfunction (App D respirator questions 3-11 and 25-32 for respirator wearers)
- Termination exam — complete physical examination with emphasis on blood pressure, the respiratory system, and the urinary system
- Termination exam — posterior-anterior chest X-ray where necessary, 14×17-inch or a reasonably standard size
- Termination exam — pulmonary function tests: forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV₁)
- Termination exam — biological monitoring: cadmium in urine (CdU) standardized to g creatinine (µg/g Cr); beta-2-microglobulin in urine (β₂-M) standardized to µg/g Cr (pH specified); cadmium in blood (CdB) standardized to liters whole blood (µg/lwb)
- Termination exam — blood: blood urea nitrogen (BUN), complete blood count (CBC), serum creatinine
- Termination exam — urinalysis: albumin, glucose, and total and low-molecular-weight proteins
- Termination exam — prostate palpation (males over 40), or other at least as effective diagnostic test
- Termination exam — any additional tests deemed appropriate by the examining physician
- Not required if the last examination meeting these requirements was less than 6 months prior to the date of termination, unless otherwise specified in 8 CCR 1532(l)(3) or (l)(5); also not required if the employer has discontinued all periodic medical surveillance under 8 CCR 1532(l)(4)(E)
⚠ Emergency / Post-Exposure
As soon as possible following an acute cadmium exposure because of an emergency
- Post-exposure exam — detailed medical + work history or update thereof, emphasis on past, present, and anticipated future cadmium exposure; smoking history and current status; reproductive history; current use of medications with potential nephrotoxic side-effects; any history of renal, cardiovascular, respiratory, hematopoietic, and/or musculo-skeletal system dysfunction (App D respirator questions 3-11 and 25-32 for respirator wearers)
- Post-exposure exam — complete physical examination with emphasis on blood pressure, the respiratory system, and the urinary system
- Post-exposure exam — posterior-anterior chest X-ray, 14×17-inch or a reasonably standard size (after the initial X-ray, frequency is determined by the examining physician)
- Post-exposure exam — pulmonary function tests: forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV₁)
- Post-exposure exam — biological monitoring: cadmium in urine (CdU) standardized to g creatinine (µg/g Cr); beta-2-microglobulin in urine (β₂-M) standardized to µg/g Cr (pH specified); cadmium in blood (CdB) standardized to liters whole blood (µg/lwb)
- Post-exposure exam — blood: blood urea nitrogen (BUN), complete blood count (CBC), serum creatinine
- Post-exposure exam — urinalysis: albumin, glucose, and total and low-molecular-weight proteins
- Post-exposure exam — prostate palpation (males over 40), or other at least as effective diagnostic test
- Post-exposure exam — any additional tests deemed appropriate by the examining physician
- Examination emphasis — the respiratory system, other organ systems considered appropriate by the examining physician, and symptoms of acute overexposure as identified in App A subsections II(B)(1)-(2) and IV
Abnormal results & exposure-event protocols
Abnormal Results & Exposure-Event Protocols
- Initial biological result CdU >3 µg/g Cr, OR β₂-M >300 µg/g Cr, OR CdB >5 µg/lwb Elevated biomonitoring response: Within 2 weeks reassess occupational exposure (work practices, respirator use, hygiene, engineering controls, smoking); within 30 days correct deficiencies; within 90 days provide a full medical examination. If not removed, continue semiannual biological monitoring and annual full exams until CdU ≤3, β₂-M ≤300, and CdB ≤5. Tests: Repeat biological monitoring: CdU, β₂-M, CdB, Full medical examination within 90 days
- Mandatory removal when both the initial and confirmatory biological results show CdU >7 µg/g Cr, OR CdB >10 µg/lwb, OR β₂-M >750 µg/g Cr — AND concurrently CdU >3 or CdB >5. Pre-1999 absolute triggers (CdU >15, CdB >15, or β₂-M >1,500 with concurrent CdU >3 or CdB >5) also apply. Medical Removal Protection — post-1999 trigger levels (in force): Remove the employee from work where exposure is at/above the action level (or above the PEL if the basis is inability to wear a respirator). During removal, provide follow-up biological monitoring at least every 3 months and follow-up medical examinations at least every 6 months. Maintain MRP wage/benefit protection up to 18 months. Tests: Quarterly biological monitoring during removal: CdU, β₂-M, CdB, Semiannual follow-up medical examination during removal
- Employee removed under the MRP trigger levels Return to work / 18-month final determination: Return permitted only when CdU falls to ≤3 µg/g Cr AND CdB ≤5 µg/lwb AND β₂-M ≤300 µg/g Cr (physician may override with special-circumstances finding of no increased risk). After 18 months of unresolved removal, a final medical determination exam decides return-to-former-status vs. permanent removal. Tests: Confirmatory biological monitoring (CdU, CdB, β₂-M) to establish return eligibility
Reporting Requirements
| Who performs the evaluation | Licensed physician (familiar with App A, App D, App F) |
|---|---|
| Reported to employer | Prompt written medical opinion containing: the physician's diagnosis; whether the employee has a detected condition increasing risk of material impairment from cadmium (including potential cadmium toxicity); results of biological/other tests assessing cadmium absorption; any recommended removal or limitation on duties/PPE; and a statement that the physician explained the results (including all biomonitoring and any condition needing further evaluation, plus diet/medication limits) to the employee. Physician instructed NOT to reveal findings/diagnoses unrelated to cadmium. |
| Reported to / for the employee | Employer furnishes a copy of the written opinion to the employee within 2 weeks of receipt; biological monitoring results plus an explanation sheet furnished within 2 weeks of receipt. |
| Time limits | Written opinion and biomonitoring explanation furnished to the employee within 2 weeks of employer receipt; employee must initiate second-physician review within 15 days of notice. |
| Second-opinion / multi-physician review | Multiple-physician review: employer must notify the employee of the right to a second opinion after each employer-arranged exam; employee designates a second physician; unresolved disagreements go to a jointly-designated third physician whose findings control. |
| Recordkeeping | Medical records retained for the duration of employment plus 30 years (8 CCR 3204). |
Medical Removal Protection
Mandatory removal at post-1999 confirmed CdU >7 / CdB >10 / β₂-M >750 (with concurrent CdU >3 or CdB >5); return at CdU ≤3 AND CdB ≤5 AND β₂-M ≤300; MRP wage/benefit protection up to 18 months; quarterly biomonitoring and semiannual exams during removal.