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 lead level (BLL)
- Zinc protoporphyrin (ZPP)
- 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 (at least every 2 months during the first 6 months of exposure). Full medical examination at least annually if any BLL ≥40 µg/dL was recorded in the preceding 12 months; otherwise on request.
- Blood lead level (BLL)
- Zinc protoporphyrin (ZPP)
- Annual full medical exam (when triggered): repeat the full baseline history, physical examination, and lab panel
At termination of employment in lead work
- Termination medical examination — required if a periodic exam was not completed within the 6 months prior to job end
- Blood lead level (BLL)
Acute overexposure, signs/symptoms of lead intoxication, employee report of pregnancy, or difficulty breathing during respirator fit-test/use
- Medical consultation and examination as indicated
- Blood lead level (BLL)
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 | Employee notified in writing within 5 working days of any finding indicating a medical condition; employer furnishes a copy of the written opinion to the employee. |
| Time limits | Written opinion furnished to the employee within 5 working days of the employer receiving it. |
| 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 the duration of employment plus 30 years (29 CFR 1910.1020). |
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 lead level (BLL)
- Zinc protoporphyrin (ZPP)
- 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 (at least every 2 months during the first 6 months for employees in the full program). Full medical examination at least annually if any BLL ≥40 µg/dL was recorded in the preceding 12 months.
- Blood lead level (BLL)
- Zinc protoporphyrin (ZPP)
- Annual full medical exam (when triggered): repeat the full baseline history, physical examination, and lab panel
At termination of employment in lead work
- Termination medical examination — required if a periodic exam was not completed within the 6 months prior to job end
- Blood lead level (BLL)
Signs/symptoms of lead intoxication, reproductive counseling request, employee report of pregnancy, or respirator breathing difficulty
- Medical consultation and examination as indicated
- Blood lead level (BLL)
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 | Written opinion furnished to the employee within 5 working days of the employer receiving it. |
| Second-opinion / multi-physician review | Multiple-physician review available to the employee (second and, if needed, jointly-designated third physician). |
| Recordkeeping | Medical surveillance records retained for the duration of employment plus 30 years (29 CFR 1910.1020). |
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.