The Initial Worker Surveillance Exam

The initial OSHA silica standard medical surveillance exam must include:

  1. A medical and work history that focuses on the employee’s past, present, and projected future exposure to respirable crystalline silica, dust, or other agents affecting the respiratory system, a history of their respiratory problems, including signs and symptoms of respiratory diseases (for example, shortness of breath, wheezing, or cough), a history of tuberculosis, and their smoking status and smoking history.
  2. A physical exam by the health care provider that focuses in-depth on the respiratory system.
  3. A chest x-ray (which is to be interpreted according to the International Labour Office International Classification of Radiographs of Pneumoconioses by a National Institute for Occupational Health & Safety – certified B Reader; this involves a certified physician reading the x-ray according to certain procedures to determine if the x-ray shows signs of disease such as silicosis).
  4. A pulmonary function test, also known as a spirometry test, that is administered by a NIOSH spirometry trained technician.  The pulmonary function test must include the forced vital capacity (the total amount of air that is forcibly blown out after taking in a full breath), forced expiratory volume in one second (the amount of air forcibly blown out in the first second of the forced vital capacity), and the FEV1/FVC ratio (the speed of the air that is forcibly blown out).
  5. Testing for latent tuberculosis infection.
  6. Respiratory protection fit testing.
  7. Any other test that the health care provider deems appropriate and/or medically necessary.

How Often Are These Exams Required?

  • Periodic exams are typically done every 3 years, and include each of the tests above with exception of testing for latent tuberculosis; that test is only required with the initial examination.

Additional Information

The complete OSHA guidelines may be found in the following documents:

OSHA Small Entity Compliance Guide for Construction

Small Entity Compliance Guide for the Respirable Crystalline Silica Standard for General Industry & Maritime