General Industry
Who is covered: Each employee occupationally exposed at/above the action level for 30+ days/year [1910.1053(i)(1)(i)]
Evaluation performed by: PLHCP (physician or other licensed health care professional); specialist (pulmonologist/B-Reader) on referral
🩺 Baseline / Pre-Placement
Within 30 days of initial assignment, unless a qualifying exam was provided within the prior 3 years
- Medical and work history — current/past silica exposure, respiratory symptoms (shortness of breath, cough, wheezing), history of tuberculosis, and smoking status
- Physical examination with special emphasis on the respiratory system
- Chest X-ray (single PA radiograph) classified per the ILO International Classification by a NIOSH-certified B Reader
- Pulmonary function test — FVC, FEV1, and FEV1/FVC ratio, administered by a technician with a current NIOSH-approved spirometry course certificate
- Testing for latent tuberculosis infection [29 CFR 1910.1053(i)(2)(v)] — satisfied by a TB skin test (Mantoux tuberculin skin test/TST, historically PPD) or an interferon-gamma release assay (IGRA) blood test: QuantiFERON-TB Gold Plus (QFT-Plus) or T-SPOT.TB
- Any other tests deemed appropriate by the PLHCP
🕒 Periodic / Routine
Interval-based while covered — NOT result-triggered
Schedule: At least every 3 years (or more frequently if recommended by the PLHCP).
- Medical and work history (past/current silica exposure, respiratory symptoms, TB history, smoking status)
- Physical examination with emphasis on the respiratory system
- Chest X-ray — single posteroanterior radiographic projection, interpreted and classified per ILO International Classification by a NIOSH-certified B Reader
- Pulmonary function test — FVC, FEV1, and FEV1/FVC ratio by a spirometry technician with current NIOSH-approved certification
- Any other tests deemed appropriate by the PLHCP
- Note: latent TB testing is NOT required at periodic exams (excluded per 1910.1053(i)(3))
Abnormal results & exposure-event protocols
Abnormal Results & Exposure-Event Protocols
- Chest X-ray classified as 1/0 or higher by the B Reader, OR referral otherwise deemed appropriate by the PLHCP 1910.1053(i)(7) (parallel CA provisions): Refer the employee to a specialist (e.g., a pulmonary specialist / B-Reader specialist). The specialist examination must be made available within 30 days after the PLHCP's written opinion. (A low-dose CT is NOT a codified requirement; it may be ordered at the specialist's discretion.) Tests: Specialist examination, Specialist may order additional studies at their discretion
Reporting Requirements
| Who performs the evaluation | PLHCP (physician or other licensed health care professional); specialist referral on abnormal X-ray |
|---|---|
| Reported to employer | Written medical opinion within 30 days of the examination, limited to: the date of the exam; a statement that the exam met the requirements of the section; and any recommended respirator-use limitations. Exposure limitations and the specialist-referral statement are included ONLY with the employee's written authorization. |
| Reported to / for the employee | PLHCP's written medical report furnished to the employee within 30 days of each examination, including: exam results and any condition placing the employee at increased risk; recommended respirator-use and exposure limitations; and a statement (if applicable) that the employee should be examined by a specialist because the chest X-ray was classified 1/0 or higher. |
| Time limits | Written medical report to employee within 30 days of each examination [1910.1053(i)(5)]; written medical opinion to employer within 30 days of each examination [1910.1053(i)(6)]; specialist examination must be made available within 30 days of receiving the PLHCP's written opinion recommending specialist referral [1910.1053(i)(7)]. |
| Second-opinion / multi-physician review | No formal multiple-physician dispute mechanism; abnormal-result specialist referral is the codified escalation. |
| Recordkeeping | Medical surveillance records retained for the duration of employment plus 30 years (per 29 CFR 1910.1020). |
Medical Removal Protection
No medical removal protection scheme. Escalation is a specialist referral when the chest X-ray is classified 1/0 or higher.
Construction
Who is covered: Each employee required to use a respirator for 30+ days/year (respirator-based trigger, NOT action-level based — differs from general industry) [1926.1153(h)(1)(i)]
Evaluation performed by: PLHCP (physician or other licensed health care professional); specialist (pulmonologist/B-Reader) on referral
🩺 Baseline / Pre-Placement
Within 30 days of initial assignment, unless a qualifying exam was provided within the prior 3 years
- Medical and work history — current/past silica exposure, respiratory symptoms (shortness of breath, cough, wheezing), history of tuberculosis, and smoking status
- Physical examination with special emphasis on the respiratory system
- Chest X-ray (single PA radiograph) classified per the ILO International Classification by a NIOSH-certified B Reader
- Pulmonary function test — FVC, FEV1, and FEV1/FVC ratio, administered by a technician with a current NIOSH-approved spirometry course certificate
- Testing for latent tuberculosis infection [29 CFR 1926.1153(h)(2)(v)] — satisfied by a TB skin test (Mantoux tuberculin skin test/TST, historically PPD) or an interferon-gamma release assay (IGRA) blood test: QuantiFERON-TB Gold Plus (QFT-Plus) or T-SPOT.TB
- Any other tests deemed appropriate by the PLHCP
🕒 Periodic / Routine
Interval-based while covered — NOT result-triggered
Schedule: At least every 3 years (or more frequently if recommended by the PLHCP).
- Medical and work history (respiratory symptoms, smoking status)
- Physical examination with emphasis on the respiratory system
- Chest X-ray classified per ILO by a NIOSH-certified B Reader
- Pulmonary function test — FVC, FEV1, FEV1/FVC ratio by a certified spirometry technician
- Any other tests deemed appropriate by the PLHCP
Abnormal results & exposure-event protocols
Abnormal Results & Exposure-Event Protocols
- Chest X-ray classified as 1/0 or higher by the B Reader, OR referral otherwise deemed appropriate by the PLHCP 1926.1153(h)(7) [mirrors 1910.1053(i)(7)]: Refer the employee to a specialist (e.g., a pulmonary specialist / B-Reader specialist). The specialist examination must be made available within 30 days after the PLHCP's written opinion. (A low-dose CT is NOT a codified requirement; it may be ordered at the specialist's discretion.) Tests: Specialist examination, Specialist may order additional studies at their discretion
Reporting Requirements
| Who performs the evaluation | PLHCP (physician or other licensed health care professional); specialist referral on abnormal X-ray |
|---|---|
| Reported to employer | Written medical opinion within 30 days of the examination, limited to: the date of the exam; a statement that the exam met the requirements of the section; and any recommended respirator-use limitations. Exposure limitations and the specialist-referral statement are included ONLY with the employee's written authorization. |
| Reported to / for the employee | PLHCP's written medical report furnished to the employee within 30 days of each examination, including: exam results and any condition placing the employee at increased risk; recommended respirator-use and exposure limitations; and a statement (if applicable) that the employee should be examined by a specialist because the chest X-ray was classified 1/0 or higher. |
| Time limits | Written report to employee within 30 days of each exam [(i)(5)]; written opinion to employer within 30 days of the exam [(i)(6)]; specialist exam available within 30 days after the PLHCP's written opinion [(i)(7)]. |
| Second-opinion / multi-physician review | No formal multiple-physician dispute mechanism; abnormal-result specialist referral is the codified escalation. |
| Recordkeeping | Medical surveillance records retained for the duration of employment plus 30 years (per 29 CFR 1910.1020). |
Medical Removal Protection
No medical removal protection scheme. Escalation is a specialist referral when the chest X-ray is classified 1/0 or higher.