Who is covered: All employees exposed to cotton dust
Evaluation performed by: Licensed physician
🩺 Baseline / Pre-Placement
Prior to initial assignment to cotton-dust exposure
- Medical and work history
- Standardized byssinosis questionnaire (Appendix B, with Schilling byssinosis grading)
- Pulmonary function test — FVC, FEV1, and FEV1/FVC ratio (compared to NHANES III reference values)
- Across-shift spirometry: measured before the employee enters the workplace on the first day of the work week (after at least 35 hours of no cotton-dust exposure), and again no less than 4 and no more than 10 hours after the start of the work shift (captures the across-shift FEV1 change diagnostic of byssinosis)
🕒 Periodic / Routine
Interval-based by exposure level while covered — NOT result-triggered (result-triggered acceleration is in abnormal_protocols)
Schedule: At least annually for employees exposed above the action level; at least every 2 years for employees exposed at or below the action level (and for those exposed only to washed cotton or in cottonseed/waste processing).
- Medical and work history update
- Standardized byssinosis questionnaire (Appendix B)
- Pulmonary function test — FVC, FEV1, FEV1/FVC ratio
- Across-shift spirometry (pre-shift after ≥35 hours of no exposure, and 4–10 hours after shift start)
Abnormal results & exposure-event protocols
Abnormal Results & Exposure-Event Protocols
- FEV1 decrement of 5% or 200 mL on the first working day, FEV1 below the lower limit of normal, or a significant change in the questionnaire or pulmonary function results 1910.1043(h)(3)(ii) (parallel CA 5190(h)(3)(B)): Increase the periodic examination frequency to at least every 6 months. Tests: Standardized byssinosis questionnaire (Appendix B), Pulmonary function test (FVC, FEV1, FEV1/FVC) with across-shift testing
Reporting Requirements
| Who performs the evaluation | Licensed physician |
|---|---|
| Reported to employer | Written opinion limited to: the results of the pulmonary function tests (FEV1, FVC, FEV1/FVC ratio); an opinion whether the employee has any detected medical condition that would place them at increased risk from cotton-dust exposure; recommended exposure limitations; a respirator-use determination; and a statement that the employee was informed of the results. Unrelated findings must not be revealed. |
| Reported to / for the employee | Employee informed of the examination results and of any medical condition requiring further evaluation; furnished a copy of the written opinion. |
| Time limits | The standard specifies no explicit deadline for furnishing the copy of the written opinion to the employee (see unverified note). |
| Second-opinion / multi-physician review | No formal multiple-physician review mechanism specified. |
| Recordkeeping | Medical records retained for at least 20 years [1910.1043(k)(2)(iii)]. |
Medical Removal Protection
No medical removal protection scheme; abnormal-result protocol accelerates periodic testing to every 6 months. Physician's written opinion conveys PFT results and increased-risk findings.