General Industry
Who is covered: Employees exposed at/above the AL unless exposure occurs fewer than 30 days/year over 12 consecutive months; previously-exposed employees (pre-effective-date exposure at/above AL) unless fewer than 60 aggregated months in cadmium work
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 at least once every 2 years (biennial).
- 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 — updated medical + work history (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 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 employees under medical surveillance
- Termination medical examination including chest X-ray — required unless a qualifying periodic exam was completed within the preceding 6 months
- Biological monitoring: CdU, β₂-M, CdB
⚠ Emergency / Post-Exposure
As soon as possible following an acute cadmium exposure
- Full periodic-exam content with emphasis on the respiratory system, other organ systems the physician deems appropriate, and symptoms of acute overexposure
- Biological monitoring: CdU, β₂-M, CdB
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 surveillance records retained for the duration of employment plus 30 years (29 CFR 1910.1020). |
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: Same coverage as GI 1910.1027; scope covers demolition, cutting/brazing cadmium-plated steel, cadmium welding, cadmium-painted surfaces, and electrical grounding with cadmium weld connections. Requirements are identical to 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 at least once every 2 years (biennial).
- 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 — updated medical + work history (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 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 employees under medical surveillance
- Termination medical examination including chest X-ray — required unless a qualifying periodic exam was completed within the preceding 6 months
- Biological monitoring: CdU, β₂-M, CdB
⚠ Emergency / Post-Exposure
As soon as possible following an acute cadmium exposure
- Full periodic-exam content with emphasis on the respiratory system, other organ systems the physician deems appropriate, and symptoms of acute overexposure
- Biological monitoring: CdU, β₂-M, CdB
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 surveillance records retained for the duration of employment plus 30 years (29 CFR 1910.1020). |
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.