General Industry
Evaluation performed by: Licensed physician (employer-selected; multiple-physician review available to employee)
Before first job assignment in a lead work area at/above the AL
- Detailed work + medical history (prior lead exposure; reproductive history; and GI, hematologic, neurologic, renal, cardiovascular, pulmonary status)
- Physical examination — emphasis on teeth/gums, hematologic, GI, renal, neurologic, cardiovascular, and pulmonary systems
- Blood pressure measurement
- Blood test measuring the amount of lead in your blood (BLL) (regulatory term: blood lead level)
- Blood test (ZPP) that flags lead's effect on red-blood-cell production (regulatory term: zinc protoporphyrin)
- Hemoglobin, hematocrit, red-cell indices, peripheral blood smear
- BUN and serum creatinine
- Routine urinalysis with microscopic examination
Interval-based while covered — NOT result-triggered
Schedule: BLL + ZPP at least every 6 months while at/above the AL. Accelerated to at least every 2 months when BLL is at or above 40 µg/100 g, continuing until two consecutive BLLs are below 40 µg/100 g; at least monthly during the removal period (29 CFR 1910.1025(j)(2)(i)).
- Blood test measuring the amount of lead in your blood (BLL) (regulatory term: blood lead level)
- Blood test (ZPP) that flags lead's effect on red-blood-cell production (regulatory term: zinc protoporphyrin)
- Annual full medical exam — required whenever any BLL during the preceding 12 months was at or above 40 µg/100 g (29 CFR 1910.1025(j)(3)(i)(A)): repeat the full baseline history, physical examination, and lab panel
As soon as possible upon employee notification of: signs or symptoms commonly associated with lead intoxication, a desire for medical advice about the effects of current or past lead exposure on the ability to procreate a healthy child, or difficulty in breathing during a respirator fitting test or during use (29 CFR 1910.1025(j)(3)(i)(C)); and as medically appropriate following medical removal or limitation (1910.1025(j)(3)(i)(D))
- Medical examination or consultation — content determined by the examining physician (29 CFR 1910.1025(j)(3)(ii))
- Pregnancy testing or laboratory evaluation of male fertility — required if requested by the employee (29 CFR 1910.1025(j)(3)(ii))
Abnormal results & exposure-event protocols
Abnormal Results & Exposure-Event Protocols
- Most recent BLL ≥40 µg/dL 1910.1025(j)(2)(i)(B): Accelerate periodic biological monitoring to BLL every 2 months; continue until two consecutive BLLs are <40 µg/dL. Tests: Blood lead level (BLL), Zinc protoporphyrin (ZPP)
- BLL ≥60 µg/dL on a single sampling 1910.1025(j)(3)(ii): Provide a follow-up (confirmatory) blood sampling within 2 weeks of the employer receiving the result. Tests: Confirmatory blood lead level (BLL)
- Single BLL ≥60 µg/dL, OR average of the last three BLLs (or all in the prior 6 months) ≥50 µg/dL — unless the last BLL is <40 1910.1025(k) — Medical Removal Protection: Remove the employee from lead exposure. Maintain wage/benefit (MRP) protection up to 18 months. Return when two consecutive BLLs ≥7 days apart are both <40 µg/dL. Tests: Periodic BLL during removal to determine return eligibility
Reporting Requirements
| Who performs the evaluation | Licensed physician |
|---|---|
| Reported to employer | Written medical opinion limited to: any detected condition that increases risk from lead exposure, recommended exposure/respirator limitations, results of the exam and tests, and a statement that the employee was informed of medical-removal results. Must NOT reveal unrelated findings. |
| Reported to / for the employee | Blood lead level: employee notified in writing within 5 working days after receipt of biological monitoring results showing a blood lead level at or above 40 µg/100 g (1910.1025(j)(2)(iv)); employer furnishes the employee a copy of the physician's written medical opinion (no specific deadline stated). |
| Time limits | Blood lead level results: employer notifies in writing within 5 working days after receipt of biological monitoring results for any employee with BLL at or above 40 µg/100 g (29 CFR 1910.1025(j)(2)(iv)). Written medical opinion: no specific deadline stated in the standard for furnishing a copy to the employee. |
| Second-opinion / multi-physician review | Multiple-physician review: employee may designate a second physician; if opinions differ, a third (jointly designated) physician resolves. |
| Recordkeeping | Medical surveillance records retained for at least 40 years, or for the duration of employment plus 20 years, whichever is longer (29 CFR 1910.1025(n)(2)(iv)). |
Medical Removal Protection
Mandatory removal at single BLL ≥60, or rolling average ≥50 (unless last <40); return at two consecutive BLLs <40; MRP wage/benefit protection up to 18 months.
Construction
Evaluation performed by: Licensed physician (employer-selected; multiple-physician review available to employee)
Before or at the start of a job with exposure at/above the AL
- Detailed work + medical history (prior lead exposure; reproductive history; GI, hematologic, neurologic, renal, cardiovascular, pulmonary status)
- Physical examination — emphasis on teeth/gums, hematologic, GI, renal, neurologic, cardiovascular, pulmonary systems
- Blood pressure measurement
- Blood test measuring the amount of lead in your blood (BLL) (regulatory term: blood lead level)
- Blood test (ZPP) that flags lead's effect on red-blood-cell production (regulatory term: zinc protoporphyrin)
- Hemoglobin, hematocrit, red-cell indices, peripheral blood smear
- BUN and serum creatinine
- Routine urinalysis with microscopic examination
Interval-based while covered — NOT result-triggered
Schedule: For employees in the full program (exposed >30 days/12 months): BLL + ZPP at least every 2 months for the first 6 months of the program, then at least every 6 months thereafter. Accelerated to at least every 2 months whenever any BLL is at or above 40 µg/dl, continuing until two consecutive BLLs are below 40 µg/dl. At least monthly during the removal period (29 CFR 1926.62(j)(2)(i)(A)-(C)).
- Blood test measuring the amount of lead in your blood (BLL) (regulatory term: blood lead level)
- Blood test (ZPP) that flags lead's effect on red-blood-cell production (regulatory term: zinc protoporphyrin)
- Annual full medical exam — required whenever any BLL during the preceding 12 months was at or above 40 µg/dl (29 CFR 1926.62(j)(3)(i)(A)): repeat the full baseline history, physical examination, and lab panel
As soon as possible upon employee notification of: signs or symptoms commonly associated with lead intoxication, a desire for medical advice about the effects of current or past lead exposure on the ability to procreate a healthy child, pregnancy, or difficulty in breathing during a respirator fitting test or during use (29 CFR 1926.62(j)(3)(i)(B)); and as medically appropriate following medical removal or limitation (1926.62(j)(3)(i)(C))
- Medical examination or consultation — content determined by the examining physician (29 CFR 1926.62(j)(3)(ii))
- Pregnancy testing or laboratory evaluation of male fertility — required if requested by the employee (29 CFR 1926.62(j)(3)(ii))
Abnormal results & exposure-event protocols
Abnormal Results & Exposure-Event Protocols
- Most recent BLL ≥40 µg/dL 1926.62(j)(2)(iii): Accelerate periodic biological monitoring to BLL every 2 months; continue until two consecutive BLLs are <40 µg/dL. Tests: Blood lead level (BLL), Zinc protoporphyrin (ZPP)
- Single BLL ≥50 µg/dL (confirmed by a second sampling within 2 weeks) 1926.62(k) — Medical Removal Protection: Remove the employee from lead exposure (construction has no GI rolling-average trigger). Maintain wage/benefit (MRP) protection up to 18 months. Return when two consecutive BLLs are both <40 µg/dL. Tests: Confirmatory BLL within 2 weeks, Periodic BLL during removal to determine return eligibility
Reporting Requirements
| Who performs the evaluation | Licensed physician |
|---|---|
| Reported to employer | Written medical opinion limited to: condition increasing risk from lead, recommended limitations, exam/test results, and a statement that the employee was informed of removal results. Must NOT reveal unrelated findings. |
| Reported to / for the employee | Employer provides a copy of the written opinion to the employee; employee informed of any condition needing further evaluation. |
| Time limits | Blood lead level results: employer notifies each employee in writing within 5 working days after receipt of biological (blood-lead) monitoring results, regardless of level (29 CFR 1926.62(j)(2)(iv)(A)); employees with a blood lead level at or above 40 µg/dl are additionally notified that the standard requires temporary medical removal with Medical Removal Protection benefits (1926.62(j)(2)(iv)(B)). Written medical opinion: no specific deadline stated in 1926.62(j)(3)(v)(A) for furnishing a copy to the employee. (The separate 5-working-day air-monitoring notice under 1926.62(d)(8)(i) is exposure monitoring, not medical surveillance.) |
| Second-opinion / multi-physician review | Multiple-physician review available to the employee (second and, if needed, jointly-designated third physician). |
| Recordkeeping | Medical surveillance records maintained in accordance with 29 CFR 1910.33 as referenced in 1926.62(n)(2)(iv). The construction lead standard does not specify its own numeric retention period. |
Medical Removal Protection
Mandatory removal at single BLL ≥50 (confirmed within 2 weeks); return at two consecutive BLLs <40; up to 18 months MRP benefits. Construction lacks the GI rolling-average trigger.
Shipyard / Maritime
Evaluation performed by: Licensed physician (employer-selected; multiple-physician review available to employee)
Before first job assignment in a lead work area at/above the AL
- Detailed work + medical history (prior lead exposure; reproductive history; and GI, hematologic, neurologic, renal, cardiovascular, pulmonary status)
- Physical examination — emphasis on teeth/gums, hematologic, GI, renal, neurologic, cardiovascular, and pulmonary systems
- Blood pressure measurement
- Blood test measuring the amount of lead in your blood (BLL) (regulatory term: blood lead level)
- Blood test (ZPP) that flags lead's effect on red-blood-cell production (regulatory term: zinc protoporphyrin)
- Hemoglobin, hematocrit, red-cell indices, peripheral blood smear
- BUN and serum creatinine
- Routine urinalysis with microscopic examination
Interval-based while covered — NOT result-triggered
Schedule: BLL + ZPP at least every 6 months while at/above the AL. Accelerated to at least every 2 months when BLL is at or above 40 µg/100 g, continuing until two consecutive BLLs are below 40 µg/100 g; at least monthly during the removal period (29 CFR 1910.1025(j)(2)(i)).
- Blood test measuring the amount of lead in your blood (BLL) (regulatory term: blood lead level)
- Blood test (ZPP) that flags lead's effect on red-blood-cell production (regulatory term: zinc protoporphyrin)
- Annual full medical exam — required whenever any BLL during the preceding 12 months was at or above 40 µg/100 g (29 CFR 1910.1025(j)(3)(i)(A)): repeat the full baseline history, physical examination, and lab panel
As soon as possible upon employee notification of: signs or symptoms commonly associated with lead intoxication, a desire for medical advice about the effects of current or past lead exposure on the ability to procreate a healthy child, or difficulty in breathing during a respirator fitting test or during use (29 CFR 1910.1025(j)(3)(i)(C)); and as medically appropriate following medical removal or limitation (1910.1025(j)(3)(i)(D))
- Medical examination or consultation — content determined by the examining physician (29 CFR 1910.1025(j)(3)(ii))
- Pregnancy testing or laboratory evaluation of male fertility — required if requested by the employee (29 CFR 1910.1025(j)(3)(ii))
Abnormal results & exposure-event protocols
Abnormal Results & Exposure-Event Protocols
- Most recent BLL ≥40 µg/dL 1910.1025(j)(2)(i)(B): Accelerate periodic biological monitoring to BLL every 2 months; continue until two consecutive BLLs are <40 µg/dL. Tests: Blood lead level (BLL), Zinc protoporphyrin (ZPP)
- BLL ≥60 µg/dL on a single sampling 1910.1025(j)(3)(ii): Provide a follow-up (confirmatory) blood sampling within 2 weeks of the employer receiving the result. Tests: Confirmatory blood lead level (BLL)
- Single BLL ≥60 µg/dL, OR average of the last three BLLs (or all in the prior 6 months) ≥50 µg/dL — unless the last BLL is <40 1910.1025(k) — Medical Removal Protection: Remove the employee from lead exposure. Maintain wage/benefit (MRP) protection up to 18 months. Return when two consecutive BLLs ≥7 days apart are both <40 µg/dL. Tests: Periodic BLL during removal to determine return eligibility
Reporting Requirements
| Who performs the evaluation | Licensed physician |
|---|---|
| Reported to employer | Written medical opinion limited to: any detected condition that increases risk from lead exposure, recommended exposure/respirator limitations, results of the exam and tests, and a statement that the employee was informed of medical-removal results. Must NOT reveal unrelated findings. |
| Reported to / for the employee | Blood lead level: employee notified in writing within 5 working days after receipt of biological monitoring results showing a blood lead level at or above 40 µg/100 g (1910.1025(j)(2)(iv)); employer furnishes the employee a copy of the physician's written medical opinion (no specific deadline stated). |
| Time limits | Blood lead level results: employer notifies in writing within 5 working days after receipt of biological monitoring results for any employee with BLL at or above 40 µg/100 g (29 CFR 1910.1025(j)(2)(iv)). Written medical opinion: no specific deadline stated in the standard for furnishing a copy to the employee. |
| Second-opinion / multi-physician review | Multiple-physician review: employee may designate a second physician; if opinions differ, a third (jointly designated) physician resolves. |
| Recordkeeping | Medical surveillance records retained for at least 40 years, or for the duration of employment plus 20 years, whichever is longer (29 CFR 1910.1025(n)(2)(iv)). |
Medical Removal Protection
Mandatory removal at single BLL ≥60, or rolling average ≥50 (unless last <40); return at two consecutive BLLs <40; MRP wage/benefit protection up to 18 months.