Lead Medical Surveillance

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

No termination examination is required. 29 CFR 1910.1025 was checked in full and imposes no exit, separation, or end-of-employment examination requirement — 1910.1025(j)(3)(i) sets out the complete schedule on which medical examinations must be made available, and separation from employment is not among its triggers.

• No termination or end-of-employment examination is required — the four triggers enumerated at 29 CFR 1910.1025(j)(3)(i)(A)–(D) are: annually where a test in the preceding 12 months showed a level at or above 40 µg/100 g; prior to first assignment to an area at or above the action level; upon employee notification of lead-intoxication symptoms, a desire for advice on the ability to procreate a healthy child, or breathing difficulty during respirator fitting or use; and as medically appropriate following medical removal or limitation
• Medical surveillance under this standard is structured around interval-based biological monitoring and exposure- and symptom-driven examinations rather than a fixed end-of-employment examination (29 CFR 1910.1025(j)(2)–(j)(3))
• Records retention is the only surviving obligation once an employee leaves — medical surveillance records are kept for at least 40 years, or for the duration of employment plus 20 years, whichever is longer (29 CFR 1910.1025(n)(2)(iv))

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 — the standard deliberately assigns the content of these examinations to the examining physician rather than prescribing it. The concluding undesignated (flush) sentence of 29 CFR 1910.1025(j)(3)(ii), which follows element (F) and carries no letter of its own, provides that the content of examinations made available under the (j)(3)(i)(C) and (j)(3)(i)(D) triggers "shall be determined by an examining physician." This is an allocation of judgment, not a gap: the introductory sentence of (j)(3)(ii) expressly limits the standard's fixed element list to examinations made available under triggers (j)(3)(i)(A) through (B) — the annual exam and the prior-to-assignment (preplacement) exam — so no fixed element list attaches to the triggers covered by this block.
• Pregnancy testing or laboratory evaluation of male fertility — the sole content element the standard itself mandates for these triggers, and only upon employee request; same concluding undesignated sentence of 29 CFR 1910.1025(j)(3)(ii).

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

None — 29 CFR 1926.62 imposes no termination or exit examination requirement. 1926.62(j)(3)(i) sets out the complete schedule on which the employer must make medical examinations and consultations available, and separation from employment is not among the listed triggers.

• No termination examination is required by 29 CFR 1926.62 — this is a verified absence in the standard, not an omission from this page
• Examination triggers under 29 CFR 1926.62(j)(3)(i) are exhaustive and consist only of: at least annually where a blood sampling test in the preceding 12 months showed a BLL at or above 40 µg/dl (j)(3)(i)(A); 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 lead exposure on the ability to procreate a healthy child, pregnancy, or difficulty breathing during a respirator fitting test or during use (j)(3)(i)(B); and as medically appropriate following removal from lead exposure or other limitation under a final medical determination (j)(3)(i)(C)
• Construction lead surveillance is built around blood-lead biological monitoring under 29 CFR 1926.62(j)(2) rather than a separation-triggered examination — biological monitoring obligations end when the employee is no longer covered under 1926.62(j)(1)
• Checked and confirmed absent from 29 CFR 1926.62(j) (medical surveillance), 1926.62(k) (medical removal protection), and Appendices A through C — no provision conditions an examination on termination of employment; the only termination-related provision in the standard concerns transfer of medical records, not an examination

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 — 29 CFR 1926.62(j)(3)(ii) assigns the content of examinations made available under (j)(3)(i)(B)-(C) to the examining physician: it "shall be determined by an examining physician." The scope is open by regulatory design, sized by the physician to the notification that triggered the visit — it is not an item left unspecified on this page
• Pregnancy testing or laboratory evaluation of male fertility — the single element 29 CFR 1926.62(j)(3)(ii) fixes for these examinations, and it attaches only on the employee's request
• Scope boundary — the fixed element list at 29 CFR 1926.62(j)(3)(ii)(A)-(F) governs only examinations made available under (j)(3)(i)(A), the at-least-annual examination owed where a blood sampling test in the preceding 12 months indicated a BLL at or above 40 µg/dl. The same provision of (j)(3)(ii) that hands (B)-(C) content to the physician reserves that list for (A) examinations, so it does not attach to the (j)(3)(i)(B)-(C) examinations described here. Those (A) examinations appear in this section's periodic schedule, not here

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

None — no termination-of-employment or exit examination is required. 29 CFR 1915.1025 makes the shipyard requirements identical to 29 CFR 1910.1025, and 1910.1025(j)(3)(i) triggers examinations only prior to first assignment, at least annually where a BLL was at or above 40 µg/100 g in the preceding 12 months, on employee notification under (j)(3)(i)(C), and as medically appropriate after medical removal or limitation — separation from employment is not among them

• No exit or termination examination required — 29 CFR 1915.1025 provides that shipyard requirements are identical to 29 CFR 1910.1025, and no provision of 29 CFR 1910.1025 imposes an examination triggered by termination of employment, transfer out of lead work, or the end of a job assignment
• Surveillance is tied to exposure and to BLL rather than to a separation date — biological monitoring continues on the 29 CFR 1910.1025(j)(2) schedule for as long as the employee remains covered, and the annual full examination is driven by a BLL at or above 40 µg/100 g during the preceding 12 months (29 CFR 1910.1025(j)(3)(i)(A))
• Employer obligations that do survive separation are records obligations, not examination obligations — medical surveillance records are 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))

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 — the standard deliberately assigns the content of these examinations to the examining physician rather than prescribing it. Under 29 CFR 1910.1025(j)(3)(ii), as incorporated verbatim by 29 CFR 1915.1025, the concluding undesignated (flush) sentence — which follows element (F) and carries no letter of its own — provides that the content of examinations made available under the (j)(3)(i)(C) and (j)(3)(i)(D) triggers "shall be determined by an examining physician." This is an allocation of judgment, not a gap: the introductory sentence of (j)(3)(ii) expressly limits the standard's fixed element list to examinations made available under triggers (j)(3)(i)(A) through (B) — the annual exam and the prior-to-assignment (preplacement) exam — so no fixed element list attaches to the triggers covered by this block.
• Pregnancy testing or laboratory evaluation of male fertility — the sole content element the standard itself mandates for these triggers, and only upon employee request; same concluding undesignated sentence of 29 CFR 1910.1025(j)(3)(ii).
• Employer must furnish the examining physician, for any examination or consultation under this section, a copy of the lead standard including all appendices; a description of the employee's duties as they relate to exposure; the employee's exposure or anticipated exposure level to lead and any other toxic substance; a description of any personal protective equipment used; prior blood lead determinations; and all prior written medical opinions in the employer's possession or control (29 CFR 1910.1025(j)(3)(iv)(A))