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 within 1 year after the initial examination, then at least biennially thereafter (29 CFR 1910.1027(l)(4)(i)).
- 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 cadmium exposure; renal, cardiovascular, respiratory, hematopoietic, reproductive, and musculo-skeletal dysfunction; current medications with nephrotoxic side-effects; smoking history and status (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 exam — detailed medical + work history, or update thereof, with 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 (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 (14×17-inch or other reasonably-sized standard film or digital), expressly required at termination
- 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
- Entire termination examination is not required if the employee's last examination satisfied the components enumerated above (the 29 CFR 1910.1027(l)(4)(ii) examination protocol) and was less than 6 months prior to the date of termination — unless otherwise specified in 29 CFR 1910.1027(l)(3) (actions triggered by initial biological monitoring) or (l)(5) (actions triggered by medical examinations), either of which can still require an examination inside that 6-month window
- No termination examination is required for previously-exposed employees covered under 29 CFR 1910.1027(l)(1)(i)(B) whose periodic medical surveillance the employer has discontinued under 29 CFR 1910.1027(l)(4)(v)
⚠ Emergency / Post-Exposure
As soon as possible following an acute cadmium exposure
- Emergency exam — emphasis on the respiratory system, other organ systems considered appropriate by the examining physician, and symptoms of acute overexposure (App A, paragraphs II(B)(1)-(2) and IV)
- Emergency exam — detailed medical + work history, or update thereof, with 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 (App D respirator questions 3-11 and 25-32 for respirator wearers)
- 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 other reasonably-sized standard film or digital)
- 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
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
- A medical examination indicates any laboratory or clinical finding consistent with cadmium toxicity that does not require employer action under the biological-monitoring or periodic-surveillance provisions Actions triggered by medical examinations — findings consistent with cadmium toxicity: Within 30 days, reassess the employee's occupational exposure to cadmium and take corrective action until the physician determines the actions are no longer necessary. Tests: Periodically reassess — the employee's work practices and personal hygiene; the employee's respirator use, if any; the employee's smoking history and status; the respiratory protection program; the hygiene facilities; and the maintenance and effectiveness of the relevant engineering controls, Within 30 days after the reassessment, take all reasonable steps to correct the deficiencies found in the reassessment that may be responsible for the employee's excess exposure to cadmium, Semiannual medical reexaminations to evaluate the abnormal clinical sign(s) of cadmium toxicity until the results are normal or the employee is medically removed, Where the results of tests for total proteins in urine are abnormal, a more detailed medical evaluation of the toxic effects of cadmium on the employee's renal system
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 physician's written medical opinion to the examined employee within two weeks after receipt thereof (29 CFR 1910.1027(l)(15)(i)). Biological monitoring results and an explanation sheet (plain-language explanation per Appendix D) furnished to the employee within two weeks after receipt thereof. |
| 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 largely track 1910.1027, but the termination-of-employment examination differs: 1926.1127(l)(8)(i) requires the chest X-ray only where necessary, and (l)(8)(ii)'s discontinued-surveillance exception is unrestricted rather than limited to (l)(1)(i)(B) employees.
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 (29 CFR 1926.1127(l)(4)(i)).
- 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; and 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 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 at any prior time required to provide medical surveillance under 29 CFR 1926.1127(l)(1)(i) 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; and 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 other reasonably-sized standard film/digital)
- 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)
- Termination exam — biological monitoring: Beta-2-microglobulin in urine (β₂-M), standardized to µg/g Cr (pH specified)
- Termination exam — biological monitoring: 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 or procedures deemed appropriate by the examining physician
- Not required if the last examination satisfied the periodic-exam requirements of 29 CFR 1926.1127(l)(4)(ii) and was less than 6 months prior to the date of termination — unless an examination is otherwise required under 29 CFR 1926.1127(l)(3) or (l)(5)
- Not required where the employer has discontinued all periodic medical surveillance under 29 CFR 1926.1127(l)(4)(v)
⚠ 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 — 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; and 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)
- 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 other reasonably-sized standard film/digital; 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)
- Emergency exam — biological monitoring: Beta-2-microglobulin in urine (β₂-M), standardized to µg/g Cr (pH specified)
- Emergency exam — biological monitoring: 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 or procedures deemed appropriate by the examining physician
- Emergency exam — throughout, emphasis on the respiratory system, other organ systems considered appropriate by the examining physician, and symptoms of acute overexposure (App A sections 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 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.
Shipyard / Maritime
Who is covered: Shipyard employees who are or may be exposed to cadmium at/above the action level, unless the employer demonstrates the employee is not and will not be exposed at/above the AL on 30 or more days per year (twelve consecutive months); also previously-exposed employees (pre-effective-date exposure at/above the AL by the employer) unless the employer demonstrates the employee worked no more than an aggregated total of 60 months in jobs with cadmium exposure. 29 CFR 1915.1027 imposes requirements identical to those set forth at 29 CFR 1910.1027; it states no shipyard-specific exclusion.
Evaluation performed by: Licensed physician (has read and is familiar with the App A health effects section, the regulatory text, the App F sample-handling and laboratory protocol, and the App D questionnaire; employer-selected, multiple-physician review available to employee)
🩺 Baseline / Pre-Placement
Initial (preplacement) examination within 30 days after initial assignment to a job with exposure to cadmium, or no later than 90 days after the standard's effective date, whichever is later; not required if adequate records show a qualifying examination within the past 12 months
- Detailed medical and work history — emphasis on past, present, and anticipated future exposure to cadmium; any history of renal, cardiovascular, respiratory, hematopoietic, reproductive, and/or musculo-skeletal system dysfunction; current usage of medication with potential nephrotoxic side-effects; and smoking history and current status
- Biological monitoring: cadmium in urine (CdU), standardized to grams of creatinine (µg/g Cr)
- Biological monitoring: beta-2 microglobulin in urine (β₂-M), standardized to grams of creatinine (µg/g Cr), with pH specified
- Biological monitoring: cadmium in blood (CdB), standardized to liters of whole blood (µg/lwb)
🕒 Periodic / Routine
Interval-based while covered by medical surveillance — NOT result-triggered
Schedule: Periodic medical examination within one year after the initial examination and at least biennially thereafter; biological sampling at least annually, either as part of a periodic medical examination or separately as periodic biological monitoring (29 CFR 1910.1027(l)(4)(i), as incorporated by 29 CFR 1915.1027). A routine biennial examination is not required if adequate records show a qualifying examination within the past 12 months.
- Biological monitoring at least annually: cadmium in urine (CdU), standardized to grams of creatinine (µg/g Cr)
- Biological monitoring at least annually: beta-2 microglobulin in urine (β₂-M), standardized to grams of creatinine (µg/g Cr), with pH specified
- Biological monitoring at least annually: cadmium in blood (CdB), standardized to liters of whole blood (µg/lwb)
- Biennial full exam — detailed medical and work history, or update thereof — 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 (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 other reasonably-sized standard film or digital; after the initial X-ray the frequency is determined by the examining physician)
- Biennial full exam — pulmonary function tests, including forced vital capacity (FVC) and forced expiratory volume at 1 second (FEV₁)
- Biennial full exam — biological monitoring: cadmium in urine (CdU) standardized to grams of creatinine (µg/g Cr); beta-2 microglobulin in urine (β₂-M) standardized to µg/g Cr with pH specified; and cadmium in blood (CdB) standardized to liters of whole blood (µg/lwb)
- Biennial full exam — blood analysis, in addition to biological monitoring — blood urea nitrogen (BUN), complete blood count (CBC), and serum creatinine
- Biennial full exam — urinalysis, in addition to biological monitoring — determination of albumin, glucose, and total and low molecular weight proteins
- Biennial full exam — prostate palpation for males over 40 years old, or other at least as effective diagnostic test(s)
- Biennial full exam — any additional tests deemed appropriate by the examining physician
🚪 Exit / Termination
At termination of employment, for any employee to whom at any prior time the employer was required to provide medical surveillance (including following an emergency examination). Not required for previously-exposed employees whose periodic medical surveillance has been discontinued under 29 CFR 1910.1027(l)(4)(v).
- Termination examination — detailed medical and work history, or update thereof — 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 (App D respirator questions 3-11 and 25-32 for respirator wearers)
- Termination examination — complete physical examination with emphasis on blood pressure, the respiratory system, and the urinary system
- Termination examination — posterior-anterior chest X-ray (14×17-inch or other reasonably-sized standard film or digital; after the initial X-ray the frequency is determined by the examining physician)
- Termination examination — pulmonary function tests, including forced vital capacity (FVC) and forced expiratory volume at 1 second (FEV₁)
- Termination examination — biological monitoring: cadmium in urine (CdU) standardized to grams of creatinine (µg/g Cr); beta-2 microglobulin in urine (β₂-M) standardized to µg/g Cr with pH specified; and cadmium in blood (CdB) standardized to liters of whole blood (µg/lwb)
- Termination examination — blood analysis, in addition to biological monitoring — blood urea nitrogen (BUN), complete blood count (CBC), and serum creatinine
- Termination examination — urinalysis, in addition to biological monitoring — determination of albumin, glucose, and total and low molecular weight proteins
- Termination examination — prostate palpation for males over 40 years old, or other at least as effective diagnostic test(s)
- Termination examination — any additional tests deemed appropriate by the examining physician
- Termination examination — required unless a qualifying periodic exam was completed within the preceding 6 months
⚠ Emergency / Post-Exposure
As soon as possible for any employee who may have been acutely exposed to cadmium because of an emergency — in addition to the medical surveillance required in paragraphs (l)(2)-(6)
- Emergency examination — detailed medical and work history, or update thereof — 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 (App D respirator questions 3-11 and 25-32 for respirator wearers)
- Emergency examination — complete physical examination with emphasis on blood pressure, the respiratory system, and the urinary system
- Emergency examination — posterior-anterior chest X-ray (14×17-inch or other reasonably-sized standard film or digital; after the initial X-ray the frequency is determined by the examining physician)
- Emergency examination — pulmonary function tests, including forced vital capacity (FVC) and forced expiratory volume at 1 second (FEV₁)
- Emergency examination — biological monitoring: cadmium in urine (CdU) standardized to grams of creatinine (µg/g Cr); beta-2 microglobulin in urine (β₂-M) standardized to µg/g Cr with pH specified; and cadmium in blood (CdB) standardized to liters of whole blood (µg/lwb)
- Emergency examination — blood analysis, in addition to biological monitoring — blood urea nitrogen (BUN), complete blood count (CBC), and serum creatinine
- Emergency examination — urinalysis, in addition to biological monitoring — determination of albumin, glucose, and total and low molecular weight proteins
- Emergency examination — prostate palpation for males over 40 years old, or other at least as effective diagnostic test(s)
- Emergency examination — any additional tests deemed appropriate by the examining physician
- Emergency examination — emphasis on the respiratory system, other organ systems considered appropriate by the examining physician, and symptoms of acute overexposure as identified in App A paragraphs II(B)(1)-(2) and IV
Abnormal results & exposure-event protocols
Abnormal Results & Exposure-Event Protocols
- Biological monitoring shows CdU >3 µg/g Cr, OR β₂-M >300 µg/g Cr, OR CdB >5 µg/lwb 29 CFR 1910.1027(l)(3)(ii) (incorporated by 29 CFR 1915.1027) — elevated biological monitoring: Within two weeks after receipt of results, reassess occupational exposure (work practices and personal hygiene, respirator use and the respirator program, hygiene facilities, maintenance and effectiveness of engineering controls, and smoking history and status). Within 30 days after that reassessment, take reasonable steps to correct deficiencies. Within 90 days after receipt of results, provide a full medical examination; the examining physician then determines in a written opinion whether to medically remove the employee. If the employee is not removed, continue until CdU falls to ≤3 µg/g Cr, β₂-M to ≤300 µg/g Cr, and CdB to ≤5 µg/lwb. Tests: Semiannual biological monitoring (CdU, β₂-M, CdB) until levels fall to or below the trigger values, Annual medical examinations until levels fall to or below the trigger values
- Beginning January 1, 1999 and in lieu of the pre-1999 triggers: mandatory removal when both the initial biological monitoring results and the results obtained during the medical examination show CdU >7 µg/g Cr, OR CdB >10 µg/lwb, OR β₂-M >750 µg/g Cr — and in addition CdU >3 µg/g Cr or CdB >5 µg/liter of whole blood. Removal is also required whenever a physician so determines in a written medical opinion, and when an employee is found unfit to wear a respirator. 29 CFR 1910.1027(l)(3)(iv), (l)(11) (incorporated by 29 CFR 1915.1027) — Medical Removal Protection: Remove the employee from work where exposure to cadmium is at or above the action level (or above the PEL where removal is based on inability to wear a respirator), regardless of whether a transfer job is available. Provide follow-up biological monitoring at least every three months and follow-up medical examinations at least every six months until the physician determines in a written opinion that the employee may return to former job status or must be permanently removed. Maintain Medical Removal Protection Benefits — total normal earnings, seniority, and all other employee rights and benefits — for up to a maximum of 18 months. Tests: Follow-up biological monitoring (CdU, β₂-M, CdB) at least every three months during removal, Follow-up medical examination at least every six months during removal
- Employee medically removed because CdU, CdB, and/or β₂-M exceeded the medical removal trigger levels 29 CFR 1910.1027(l)(11)(iv)-(v), (l)(12)(iii) (incorporated by 29 CFR 1915.1027) — return to work / 18-month final determination: No return to work with cadmium exposure at or above the action level until CdU falls to or below 3 µg/g Cr, CdB falls to or below 5 µg/lwb, and β₂-M falls to or below 300 µg/g Cr. A physician may nonetheless return the employee in a written determination where continued exposure will not pose an increased risk and special circumstances make continued removal an inappropriate remedy — surveillance then continues as if the employee were still removed. Where after 18 months on removal the monitoring results have not declined enough to permit return, the employer must make available a final medical determination examination. Tests: Confirmatory biological monitoring (CdU, CdB, β₂-M) to establish return eligibility, Final medical determination examination after 18 months of unresolved removal, indicating whether the employee may return to former job status and what steps should be taken to protect the employee's health
- A medical examination indicates any laboratory or clinical finding consistent with cadmium toxicity that does not already require employer action under paragraph (l)(2), (3), or (4) 29 CFR 1910.1027(l)(5) (incorporated by 29 CFR 1915.1027) — actions triggered by medical examinations: Within 30 days, reassess the employee's occupational exposure to cadmium and take corrective action until the physician determines it is no longer necessary. Tests: Periodically reassess work practices and personal hygiene, respirator use, smoking history and status, the respiratory protection program, the hygiene facilities, and the maintenance and effectiveness of relevant engineering controls, Within 30 days after the reassessment, take all reasonable steps to correct deficiencies that may be responsible for the excess exposure, Semiannual medical reexaminations to evaluate the abnormal clinical sign(s) of cadmium toxicity until the results are normal or the employee is medically removed, Where the results of tests for total proteins in urine are abnormal, a more detailed medical evaluation of the toxic effects of cadmium on the renal system
Reporting Requirements
| Who performs the evaluation | Licensed physician familiar with App A, the regulatory text, App F, and the App D questionnaire |
|---|---|
| Reported to employer | Prompt written medical opinion for each examination containing: the physician's diagnosis; the physician's opinion as to whether the employee has any detected medical condition placing them at increased risk of material impairment to health from further cadmium exposure, including any indications of potential cadmium toxicity; the results of any biological or other testing directly assessing the employee's absorption of cadmium; any recommended removal from or limitation on duties or on use of PPE such as respirators; and a statement that the physician clearly and carefully explained the results to the employee, including all biological monitoring results, any cadmium-related conditions requiring further evaluation or treatment, and any limitation on diet or use of medications. The employer must instruct the physician not to reveal findings or diagnoses unrelated to occupational cadmium exposure. |
| Reported to / for the employee | Employer provides a copy of the physician's written medical opinion to the examined employee within two weeks after receipt thereof, and a copy of the employee's biological monitoring results with an explanation sheet within two weeks after receipt thereof (29 CFR 1910.1027(l)(15), incorporated by 29 CFR 1915.1027). Within 30 days after an employee request, the employer must also provide the information it is required to give the examining physician. |
| Time limits | Written opinion and biological monitoring results/explanation sheet furnished to the employee within 2 weeks of employer receipt; employee must inform the employer and initiate a second-physician appointment within 15 days after receipt of notice or of the initial physician's written opinion, whichever is later; physician-information package furnished on employee request within 30 days. |
| Second-opinion / multi-physician review | Multiple physician review: the employer must promptly notify the employee of the right to seek a second medical opinion after each occasion an employer-provided initial physician conducts an examination or consultation. The employee designates a second physician; if findings differ, employer and employee must assure efforts are made to resolve the disagreement, and failing quick resolution they jointly designate a third physician, with whose findings the employer must act consistently unless employer and employee agree on a resolution consistent with at least one of the other two physicians. An alternate form of physician determination may be agreed upon if expeditious and at least as protective. |
| Recordkeeping | Medical surveillance record for each covered employee — name and description of duties; the physician's written opinions and biological monitoring explanation sheets; the medical history and results of any physical examination and all required test results including biological tests, X-rays, and pulmonary function tests; cadmium-related medical symptoms; and a copy of the information provided to the physician — maintained for the duration of employment plus thirty (30) years in accordance with 29 CFR 1910.1020. Abnormal conditions or disorders caused by occupational cadmium exposure must also be reported per 29 CFR 1910.1027(l)(16). |
Medical Removal Protection
Mandatory removal on post-1999 confirmed CdU >7 µg/g Cr / CdB >10 µg/lwb / β₂-M >750 µg/g Cr with concurrent CdU >3 or CdB >5; removal from exposure at/above the AL (above the PEL where based on inability to wear a respirator); return only at CdU ≤3 AND CdB ≤5 AND β₂-M ≤300 (physician special-circumstances override available); biological monitoring at least every 3 months and medical examinations at least every 6 months during removal; MRP benefits — total normal earnings, seniority, and all other rights and benefits — for up to 18 months, then a final medical determination.