California Code of Regulations, Title 8, Section 5207. Cadmium.

Subchapter 7. General Industry Safety Orders Group 16. Control of Hazardous Substances Article 110. Regulated Carcinogens

§5207. Cadmium.

(a) Scope.

This standard applies to all occupational exposures to cadmium and cadmium compounds, in all forms, and in all industries except the construction-related industries, which are covered under section 1532.

(b) Definitions.

Action level (AL) is defined as an airborne concentration of cadmium of 2.5 micrograms per cubic meter of air (2.5 <<mu>>g/m3), calculated as an 8-hour time-weighted average (TWA).

Authorized person means any person authorized by the employer and required by work duties to be present in regulated areas or any person authorized by the Chief to be in regulated areas.

Chief means the Chief of the Division of Occupational Safety and Health, or designee.

Emergency means any occurrence such as, but not limited to, equipment failure, rupture of containers, or failure of control equipment which results in an unexpected and potentially hazardous release of Cadmium.

Employee exposure and similar language referring to the air cadmium level to which an employee is exposed means the exposure to airborne cadmium that would occur if the employee were not using respiratory protective equipment.

Final medical determination is the written medical opinion of the employee's health status by the examining physician under subsections (l)(3)-(12) or, if multiple physician review under subsection (l)(13) or the alternative physician determination under subsection (l)(14) is invoked, it is the final, written medical finding, recommendation or determination that emerges from that process.

High-efficiency particulate air [HEPA] filter means a filter capable of trapping and retaining at least 99.97 percent of mono-dispersed particles of 0.3 micrometers in diameter.

NIOSH means the National Institute for Occupational Safety and Health (NIOSH), U.S. Department of Health and Human Services, or designee.

Regulated area means an area demarcated by the employer where an employee's exposure to airborne concentrations of cadmium exceeds, or can reasonably be expected to exceed the permissible exposure limit (PEL).

(c) Permissible Exposure Limit (PEL).

The employer shall assure that no employee is exposed to an airborne concentration of cadmium in excess of five micrograms per cubic meter of air (5 <<mu>>g/m3), calculated as an eight-hour time-weighted average exposure (TWA).

(d) Exposure Monitoring.

(1) General.

(A) Each employer who has a workplace or work operation covered by this section shall determine if any employee may be exposed to cadmium at or above the action level.

(B) Determinations of employee exposure shall be made from breathing zone air samples that reflect the monitored employee's regular, daily 8-hour TWA exposure to cadmium.

(C) Eight-hour TWA exposures shall be determined for each employee on the basis of one or more personal breathing zone air samples reflecting full shift exposure on each shift, for each job classification, in each work area. Where several employees perform the same job tasks, in the same job classification, on the same shift, in the same work area, and the length, duration, and level of cadmium exposures are similar, an employer may sample a representative fraction of the employees instead of all employees in order to meet this requirement. In representative sampling, the employer shall sample the employee(s) expected to have the highest cadmium exposures.

(2) Specific.

(A) Initial monitoring. Except as provided for in subsections (d)(2)(B) and (d)(2)(C), the employer shall monitor employee exposures and shall base initial determinations on the monitoring results.

(B) Where the employer has monitored after September 14, 1991, under conditions that in all important aspects closely resemble those currently prevailing and where that monitoring satisfies all other requirements, including the accuracy and confidence levels of subsection (d)(6), the employer may rely on such earlier monitoring results to satisfy the requirements of subsection (d)(2)(A).

(C) Where the employer has objective data, as defined in subsection (n)(2), demonstrating that employee exposure to cadmium will not exceed the action level under the expected conditions of processing, use, or handling, the employer may rely upon such data instead of implementing initial monitoring.

(3) Monitoring Frequency (periodic monitoring).

(A) If the initial monitoring or periodic monitoring reveals employee exposures to be at or above the action level, the employer shall monitor at a frequency and pattern needed to represent the levels of exposure of employees and where exposures are above the PEL to assure the adequacy of respiratory selection and the effectiveness of engineering and work practice controls. However, such exposure monitoring shall be performed at least every six months. The employer, at a minimum, shall continue these semi- annual measurements unless and until the conditions set out in subsection (d)(3)(B) are met.

(B) If the initial monitoring or the periodic monitoring indicates that employee exposures are below the action level and that result is confirmed by the results of another monitoring taken at least seven days later, the employer may discontinue the monitoring for those employees whose exposures are represented by such monitoring.

(4) Additional Monitoring.

The employer also shall institute the exposure monitoring required under subsections (d)(2)(A) and (d)(3) whenever there has been a change in the raw materials, equipment, personnel, work practices, or finished products that may result in additional employees being exposed to cadmium at or above the action level or in employees already exposed to cadmium at or above the action level being exposed above the PEL, or whenever the employer has any reason to suspect that any other change might result in such further exposure.

(5) Employee Notification of Monitoring Results.

(A) Within 15 working days after the receipt of the results of any monitoring performed under this section, the employer shall notify each affected employee individually in writing of the results. In addition, within the same time period the employer shall post the results of the exposure monitoring in an appropriate location that is accessible to all affected employees.

(B) Wherever monitoring results indicate that employee exposure exceeds the PEL, the employer shall include in the written notice a statement that the PEL has been exceeded and a description of the corrective action being taken by the employer to reduce employee exposure to or below the PEL.

(6) Accuracy of Measurement.

The employer shall use a method of monitoring and analysis that has an accuracy of not less than plus or minus 25 percent (+25%), with a confidence level of 95 percent, for airborne concentrations of cadmium at or above the action level, the permissible exposure limit (PEL), and the separate engineering control air limit (SECAL).

(e) Regulated Areas.

(1) Establishment.

The employer shall establish a regulated area wherever an employee's exposure to airborne concentrations of cadmium is, or can reasonably be expected to be in excess of the permissible exposure limit (PEL).

(2) Demarcation.

Regulated areas shall be demarcated from the rest of the workplace in any manner that adequately establishes and alerts employees of the boundaries of the regulated area.

(3) Access.

Access to regulated areas shall be limited to authorized persons.

(4) Provision of Respirators.

Each person entering a regulated area shall be supplied with and required to use a respirator, selected in accordance with subsection (g)(2).

(5) Prohibited Activities.

The employer shall assure that employees do not eat, drink, smoke, chew tobacco or gum, or apply cosmetics in regulated areas, carry the products associated with these activities into regulated areas, or store such products in those areas.

(f) Methods of Compliance.

(1) Compliance Hierarchy.

(A) Except as specified in subsections (f)(1)(B), (C) and (D) the employer shall implement engineering and work practice controls to reduce and maintain employee exposure to cadmium at or below the PEL, except to the extent that the employer can demonstrate that such controls are not feasible.

(B) Except as specified in subsections (f)(1)(C) and (D), in industries where a separate engineering control air limit (SECAL) has been specified for particular processes (See Table 1), the employer shall implement engineering and work practice controls to reduce and maintain employee exposure at or below the SECAL, except to the extent that the employer can demonstrate that such controls are not feasible.

TABLE I
Separate Engineering Control Airborne Limits (SECALs) for Processes in Selected Industries

Industry             Process                                SECAL(<<mu>>g/m3)
Nickel Cadmium       Plate making, plate preparation        50
  Battery
                     All other processes                    15
Zinc/Cadmium         Cadmium refining, casting, melting,
  Refining*
                     oxide production, sinter plant         50
Pigment Manufacture  Calcine, crushing, milling & blending  50
                     All other processes                    15
Stabilizers*         Cadmium oxide charging, crushing,
                     drying & blending                      50
Lead Smelting*       Sinter plant, blast furnace,
                     baghouse & yard area                   50
Plating*             Mechanical plating                     15
---------

* Processes in these industries that are not specified in this table must achieve the PEL using engineering controls and work practices as required in subsection f(1)(A).

(C) The requirement to implement engineering and work practice controls to achieve the PEL or, where applicable, the SECAL does not apply where the employer demonstrates the following:

1. the employee is only intermittently exposed; and

2. the employee is not exposed above the PEL on 30 or more days per year (12 consecutive months).

(D) Wherever engineering and work practice controls are required and are not sufficient to reduce employee exposure to or below the PEL or, where applicable, the SECAL, the employer nonetheless shall implement such controls to reduce exposures to the lowest levels achievable. The employer shall supplement such controls with respiratory protection that complies with the requirements of subsection (g) and the PEL.

(E) The employer shall not use employee rotation as a method of compliance.

(2) Compliance Program.

(A) Where the PEL is exceeded, the employer shall establish and implement a written compliance program to reduce employee exposure to or below the PEL by means of engineering and work practice controls, as required by subsection (f)(1). To the extent that engineering and work practice controls cannot reduce exposures to or below the PEL, the employer shall include in the written compliance program the use of appropriate respiratory protection to achieve compliance with the PEL.

(B) Written compliance programs shall include at least the following:

1. A description of each operation in which cadmium is emitted; e.g., machinery used, material processed, controls in place, crew size, employee job responsibilities, operating procedures, and maintenance practices;

2. A description of the specific means that will be employed to achieve compliance, including engineering plans and studies used to determine methods selected for controlling exposure to cadmium, as well as, where necessary, the use of appropriate respiratory protection to achieve the PEL;

3. A report of the technology considered in meeting the PEL;

4. Air monitoring data that document the sources of cadmium emissions;

5. A detailed schedule for implementation of the program, including documentation such as copies of purchase orders for equipment, construction contracts, etc.;

6. A work practice program that includes items required under subsections (h), (i), and (j);

7. A written plan for emergency situations, as specified in subsection (h); and

8. Other relevant information.

(C) The written compliance programs shall be reviewed and updated at least annually, or more often if necessary, to reflect significant changes in the employer's compliance status.

(D) Written compliance programs shall be provided upon request for examination and copying to affected employees, designated employee representatives as well as to the Chief, and NIOSH.

(3) Mechanical Ventilation.

(A) When ventilation is used to control exposure, measurements that demonstrate the effectiveness of the system in controlling exposure, such as capture velocity, duct velocity, or static pressure shall be made as necessary to maintain its effectiveness.

(B) Measurements of the system's effectiveness in controlling exposure shall be made as necessary within five working days of any change in production, process, or control that might result in a significant increase in employee exposure to cadmium.

(C) Recirculation of air. If air from exhaust ventilation is recirculated into the workplace, the system shall have a high efficiency filter and be monitored to assure effectiveness.

(D) Procedures shall be developed and implemented to minimize employee exposure to cadmium when maintenance of ventilation systems and changing of filters is being conducted.

(g) Respiratory Protection.

(1) General.

For employees who are required to use respirators by this section, the employer must provide respirators that comply with the requirements of this subsection. Respirators must be used during:

(A) Periods necessary to install or implement feasible engineering and work practice controls when employee exposure levels exceed the PEL;

(B) Maintenance and repair activities and during those brief or intermittent operations where exposures exceed the PEL and engineering and work practice controls are not feasible or are not required;

(D) Work operations for which the employer has implemented all feasible engineering and work practice controls and such controls are not sufficient to reduce exposures to or below the PEL;

(E) Emergencies;

(F) Work operations for which an employee who is exposed to cadmium at or above the action level requests a respirator;

(G) Work operations for which an employee is exposed to cadmium above the PEL and engineering controls are not required under subsection (f)(1)(B).

(2) Respirator program.

(A) The employer must implement a respirator program in accordance with section 5144(b) through (d) (except (d)(1)(C)), and (f) through (m).

(B) No employees must use a respirator if, based upon their most recent examination, the examining physician determines that they will be unable to continue to function normally while using a respirator. If the physician determines the employee must be limited in, or removed from their current inability to use a respirator, the limitation or removal must be in accordance with subsections (l)(11) and (12).

(C) If an employee exhibits breathing difficulty during a fit test or respirator use, the employer must provide the employee with a medical examination in accordance with subsection (l)(6)(B) to determine if the employee can use a respirator while performing the required duties.

(3) Respirator Selection.

(A) The employer shall select, and provide the appropriate respirators specified in Section 5144(d)(3)(A)1.

(B) The employer shall provide a powered, air-purifying respirator (PAPR) in lieu of a negative pressure respirator wherever:

1. An employee entitled to a respirator chooses to use this type of respirator; and

2. This respirator will provide adequate protection to the employee.

(D) Employers shall provide HEPA filters for powered and non-powered respirators.

(h) Emergency Situations.

The employer shall develop and implement a written plan for dealing with emergency situations involving substantial releases of airborne cadmium. The plan shall include provisions for the use of appropriate respirators and personal protective equipment. In addition, employees not essential to correcting the emergency situation shall be restricted from the area and normal operations halted in that area until the emergency is abated.

(i) Protective Work Clothing and Equipment.

(1) Provision and Use.

If an employee is exposed to airborne cadmium above the PEL or where skin or eye irritation is associated with cadmium exposure at any level, the employer shall provide at no cost to the employee, and assure that the employee uses, appropriate protective work clothing and equipment that prevents contamination of the employee and the employee's garments. Protective work clothing and equipment includes, but is not limited to:

(A) Coveralls or similar full-body work clothing;

(B) Gloves, head coverings, and boots or foot coverings; and,

(2) Removal and Storage.

(A) The employer shall assure that employees remove all protective clothing and equipment contaminated with cadmium at the completion of the work shift and do so only in change rooms provided in accordance with subsection (j)(1).

(B) The employer shall assure that no employee takes cadmium- contaminated protective clothing or equipment from the workplace, except for employees authorized to do so for purposes of laundering, cleaning, maintaining, or disposing of cadmium contaminated protective clothing and equipment at an appropriate location or facility away from the workplace.

(C) The employer shall assure that contaminated protective clothing and equipment, when removed for laundering, cleaning, maintenance, or disposal, is placed and stored in sealed, impermeable bags or other closed, impermeable containers that are designed to prevent dispersion of cadmium dust.

(D) The employer shall assure that bags or containers of contaminated protective clothing and equipment that are to be taken out of the change rooms or the workplace for laundering, cleaning, maintenance or disposal shall bear labels in accordance with subsection (m)(3).

(3) Cleaning, Replacement, and Disposal.

(A) The employer shall provide the protective clothing and equipment required by subsection (i)(1) in a clean and dry condition as often as necessary to maintain its effectiveness, but in any event at least weekly. The employer is responsible for cleaning and laundering the protective clothing and equipment required by this subsection to maintain its effectiveness and is also responsible for disposing of such clothing and equipment.

(B) The employer also is responsible for repairing or replacing required protective clothing and equipment as needed to maintain its effectiveness. When rips or tears are detected while an employee is working they shall be immediately mended, or the worksuit shall be immediately replaced.

(C) The employer shall prohibit the removal of cadmium from protective clothing and equipment by blowing, shaking, or any other means that disperses cadmium into the air.

(D) The employer shall assure that any laundering of contaminated clothing or cleaning of contaminated equipment in the workplace is done in a manner that prevents the release of airborne cadmium in excess of the permissible exposure limit prescribed in subsection (c).

(E) The employer shall inform any person who launders or cleans protective clothing or equipment contaminated with cadmium of the potentially harmful effects of exposure to cadmium and that the clothing and equipment should be laundered or cleaned in a manner to effectively prevent the release of airborne cadmium in excess of the PEL.

(j) Hygiene Areas and Practices.

(1) General.

For employees whose airborne exposure to cadmium is above the PEL, the employer shall provide clean change rooms, handwashing facilities, showers, and lunchroom facilities that comply with Article 9.

(2) Change Rooms.

The employer shall assure that change rooms are equipped with separate storage facilities for street clothes and for protective clothing and equipment, which are designed to prevent dispersion of cadmium and contamination of the employee's street clothes.

(3) Showers and Handwashing Facilities.

(A) The employer shall assure that employees who are exposed to cadmium above the PEL shower during the end of the work shift.

(B) The employer shall assure that employees whose airborne exposure to cadmium is above the PEL wash their hands and faces prior to eating, drinking, smoking, chewing tobacco or gum, or applying cosmetics.

(4) Lunchroom Facilities.

(A) The employer shall assure that the lunchroom facilities are readily accessible to employees, that tables for eating are maintained free of cadmium, and that no employee in a lunchroom facility is exposed at any time to cadmium at or above a concentration of 2.5 <<mu>>g/m3.

(B) The employer shall assure that employees do not enter lunchroom facilities with protective work clothing or equipment unless surface cadmium has been removed from the clothing and equipment by HEPA vacuuming or some other method that removes cadmium dust without dispersing it.

(k) Housekeeping.

(1) All surfaces shall be maintained as free as practicable of accumulations of cadmium.

(2) All spills and sudden releases of material containing cadmium shall be cleaned up as soon as possible.

(3) Surfaces contaminated with cadmium shall, wherever possible, be cleaned by vacuuming or other methods that minimize the likelihood of cadmium becoming airborne.

(4) HEPA-filtered vacuuming equipment or equally effective filtration methods shall be used for vacuuming. The equipment shall be used and emptied in a manner that minimizes the reentry of cadmium into the workplace.

(5) Shoveling, dry or wet sweeping, and brushing may be used only where vacuuming or other methods that minimize the likelihood of cadmium becoming airborne have been tried and found not to be effective.

(6) Compressed air shall not be used to remove cadmium from any surface unless the compressed air is used in conjunction with a ventilation system designed to capture the dust cloud created by the compressed air.

(7) Waste, scrap, debris, bags, containers, personal protective equipment, and clothing contaminated with cadmium and consigned for disposal shall be collected and disposed of in sealed impermeable bags or other closed, impermeable containers. These bags and containers shall be labeled in accordance with subsection (m)(3).

(l) Medical Surveillance.

(1) General.

(A) Scope.

1. Currently exposed - The employer shall institute a medical surveillance program for all employees who are or may be exposed to cadmium at or above the action level unless the employer demonstrates that the employee is not, and will not be, exposed at or above the action level on 30 or more days per year (twelve consecutive months); and,

2. Previously exposed - The employer shall also institute a medical surveillance program for all employees who prior to the effective date of this section might previously have been exposed to cadmium at or above the action level by the employer, unless the employer demonstrates that the employee did not prior to the effective date of this section work for the employer in jobs with exposure to cadmium for an aggregated total of more than 60 months.

(B) To determine an employee's fitness for using a respirator, the employer shall provide the limited medical examination specified in subsection (l)(6).

(C) The employer shall assure that all medical examinations and procedures required by this standard are performed by or under the supervision of a licensed physician, who has read and is familiar with the health effects section of Appendix A, the regulatory text of this section, the protocol for sample handling and laboratory selection in Appendix F, and the questionnaire of Appendix D. These examinations and procedures shall be provided without cost to the employee and at a time and place that is reasonable and convenient to employees.

(D) The employer shall assure that the collecting and handling of biological samples of cadmium in urine (CdU), cadmium in blood (CdB), and beta-2 microglobulin in urine (<<beta>>2 -M) taken from employees under this section is done in a manner that assures their reliability and that analysis of biological samples of cadmium in urine (CdU), cadmium in blood (CdB), and beta-2 microglobulin in urine (-M) taken from employees under this section is done in a manner that assures their reliability and that analysis of biological samples of cadmium in urine (CdU), cadmium in blood (CdB), and beta-2 microglobulin in urine (<<beta>>2 -M) taken from employees under this section is performed in laboratories with demonstrated proficiency for that particular analyte. (See Appendix F.)-M) taken from employees under this section is performed in laboratories with demonstrated proficiency for that particular analyte. (See Appendix F.)

(2) Initial Examination.

(A) The employer shall provide an initial (preplacement) examination to all employees covered by the medical surveillance program required in subsection (l)(1)(A). The examination shall be provided to those employees within 30 days after initial assignment to a job with exposure to cadmium or no later than 90 days after the effective date of this section, whichever date is later.

(B) The initial (preplacement) medical examination shall include:

1. A detailed medical and work history, with emphasis on: past, present, and anticipated future exposure to cadmium; any history of renal, cardiovascular, respiratory, hematopoietic, reproductive, and/or musculo-skeletal system dysfunction; current usage of medication with potential nephrotoxic side-effects; and smoking history and current status; and

2. Biological monitoring that includes the following tests:

a. Cadmium in urine (CdU), standardized to grams of creatinine (g/Cr);

b. Beta-2 microglobulin in urine (<<beta>>2 -M), standardized to grams of creatinine (g/Cr), with pH specified, as described in Appendix F; and-M), standardized to grams of creatinine (g/Cr), with pH specified, as described in Appendix F; and

c. Cadmium in blood (CdB), standardized to liters of whole blood (lwb).

(C) Recent Examination: An initial examination is not required to be provided if adequate records show that the employee has been examined in accordance with the requirements of subsection (l)(2)(B) within the past 12 months. In that case, such records shall be maintained as part of the employee's medical record and the prior exam shall be treated as if it were an initial examination for the purposes of subsections (l)(3) and (4).

(3) Actions Triggered by Initial Biological Monitoring:

(A) If the results of the initial biological monitoring tests show the employee's CdU level to be at or below 3 <<mu>>g/g Cr, <<beta>>2 -M level to be at or below 300-M level to be at or below 300 <<mu>>g/g Cr and CdB level to be at or below 5 <<mu>>g/lwb, then:

1. for currently exposed employees, who are subject to medical surveillance under subsection (l)(1)(A)1., the employer shall provide the minimum level of periodic medical surveillance in accordance with the requirements in subsection (l)(4)(A); and

2. for previously exposed employees, who are subject to medical surveillance under subsection (l)(1)(A)2., the employer shall provide biological monitoring for CdU, <<beta>>2 -M, and CdB one year after the initial biological monitoring and then the employer shall comply with the requirements of subsection (-M, and CdB one year after the initial biological monitoring and then the employer shall comply with the requirements of subsection (l)(4)(E).

(B) For all employees who are subject to medical surveillance under subsection (l)(1)(A), if the results of the initial biological monitoring tests show the level of CdU to exceed 3 <<mu>>g/g Cr, the level of <<beta>>2 -M to exceed 300 <<mu>>g/g Cr, or the level of CdB to exceed 5 <<mu>>g/lwb, the employer shall:

1. within two weeks after receipt of biological monitoring results, reassess the employee's occupational exposure to cadmium as follows:

a. reassess the employee's work practices and personal hygiene;

b. reevaluate the employee's respirator use, if any, and the respirator program;

c. review the hygiene facilities;

d. reevaluate the maintenance and effectiveness of the relevant engineering controls;

e. assess the employee's smoking history and status;

2. within 30 days after the exposure reassessment, specified in (l)(3)(B)1., take reasonable steps to correct any deficiencies found in the reassessment that may be responsible for the employee's excess exposure to cadmium; and,

3. within 90 days after receipt of biological monitoring results, provide a full medical examination to the employee in accordance with the requirements of subsection (l)(4)(B). After completing the medical examination, the examining physician shall determine in a written medical opinion whether to medically remove the employee. If the physician determines that medical removal is not necessary, then until the employee's CdU level falls to or below 3 <<mu>>g/g Cr, <<beta>>2 -M level falls to or below 300 <<mu>>g/g Cr and CdB level falls to or below 5 <<mu>>g/lwb, the employer shall:

a. Provide biological monitoring in accordance with subsection (l)(2)(B)2. on a semiannual basis; and

b. Provide annual medical examinations in accordance with subsection (l)(4)(B).

(C) For all employees who are subject to medical surveillance under subsection (l)(1)(A), if the results of the initial biological monitoring tests show the level of CdU to be in excess of 15 <<mu>>g/g Cr, or the level of CdB to be in excess of 15 <<mu>>g/lwb, or the level of <<beta>>2 -M to be in excess of 1,500 <<mu>>g/g Cr, the employer shall comply with the requirements of subsections (l)(3)(B)1.-2. Within 90 days after receipt of biological monitoring results, the employer shall provide a full medical examination to the employee in accordance with the requirements of subsection (l)(4)(B). After completing the medical examination, the examining physician shall determine in a written medical opinion whether to medically remove the employee. However, if the initial biological monitoring results and the biological monitoring results obtained during the medical examination both show that: CdU exceeds 15 <<mu>> g/g Cr; or CdB exceeds 15 <<mu>>g/lwb; or <<beta>>2 -M exceeds 1500 <<mu>>g/g Cr, and in addition CdU exceeds 3 <<mu>>g/g Cr or CdB exceeds 5 <<mu>>g/liter of whole blood, then the physician shall medically remove the employee from exposure to cadmium at or above the action level. If the second set of biological monitoring results obtained during the medical examination does not show that a mandatory removal trigger level has been exceeded, then the employee is not required to be removed by the mandatory provisions of this subsection. If the employee is not required to be removed by the mandatory provisions of this subsection or by the physician's determination, then until the employee's CdU level falls to or below 3 <<mu>>g/g Cr, <<beta>>2 -M level falls to or below 300 <<mu>>g/g Cr and CdB level falls to or below 5 <<mu>> g/lwb, the employer shall:

1. Periodically reassess the employee's occupational exposure to cadmium;

2. Provide biological monitoring in accordance with subsection (l)(2)(B)2. on a quarterly basis; and

3. Provide semiannual medical examinations in accordance with subsection (l)(4)(B).

(D) For all employees to whom medical surveillance is provided, beginning on January 1, 1999, and in lieu of subsections (l)(3)(A)-(C):

1. If the results of the initial biological monitoring tests show the employee's CdU level to be at or below 3 <<mu>>g/g Cr, <<beta>>2 -M level to be at or below 300 <<mu>>g/g Cr and CdB level to be at or below 5 <<mu>>g/lwb, then for currently exposed employees, the employer shall comply with the requirements of subsection (l)(3)(A)1., and for previously exposed employees, the employer shall comply with the requirements of subsection (l)(3)(A)2.;

2. If the results of the initial biological monitoring tests show the level of CdU to exceed 3 <<mu>>g/g Cr, the level of <<beta>>2 -M to exceed 300 <<mu>> g/g Cr, or the level of CdB to exceed 5 <<mu>>g/lwb, the employer shall comply with the requirements of subsections (l)(3)(B)1.-3.; and,

3. If the results of the initial biological monitoring tests show the level of CdU to be in excess of 7 <<mu>>g/g Cr, or the level of CdB to be in excess of 10 <<mu>>g/lwb, or the level of <<beta>>2 -M to be in excess of 750 <<mu>>g/g Cr, the employer shall: comply with the requirements of subsections (l)(3)(B)1.-2.; and, within 90 days after receipt of biological monitoring results, provide a full medical examination to the employee in accordance with the requirements of subsection (l)(4)(B). After completing the medical examination, the examining physician shall determine in a written medical opinion whether to medically remove the employee. However, if the initial biological monitoring results and the biological monitoring results obtained during the medical examination both show that: CdU exceeds 7 <<mu>>g/g Cr; or CdB exceeds 10 <<mu>>g/lwb; or <<beta>>2 -M exceeds 750 <<mu>>g/g Cr, and in addition CdU exceeds 3 <<mu>>g/g Cr or CdB exceeds 5 <<mu>>g/liter of whole blood, then the physician shall medically remove the employee from exposure to cadmium at or above the action level. If the second set of biological monitoring results obtained during the medical examination does not show that a mandatory removal trigger level has been exceeded, then the employee is not required to be removed by the mandatory provisions of this subsection. If the employee is not required to be removed by the mandatory provisions of this subsection or by the physician's determination, then until the employee's CdU level falls to or below 3 <<mu>>g/g Cr, <<beta>> 2 -M level falls to or below 300 <<mu>>g/g Cr and CdB level falls to or below 5 <<mu>>g/lwb, the employer shall: periodically reassess the employee's occupational exposure to cadmium; provide biological monitoring in accordance with subsection (l)(2)(B)2. on a quarterly basis; and provide semiannual medical examinations in accordance with subsection (l)(4)(B).

(4) Periodic Medical Surveillance.

(A) For each employee who is covered under subsection (l)(1)(A)1., the employer shall provide at least the minimum level of periodic medical surveillance, which consists of periodic medical examinations and periodic biological monitoring. A periodic medical examination shall be provided within one year after the initial examination required by subsection (l)(2) and thereafter at least biennially. Biological sampling shall be provided at least annually, either as part of a periodic medical examination or separately as periodic biological monitoring.

(B) The periodic medical examination shall include:

1. A detailed medical and work history, or update thereof, with emphasis on: past, present and anticipated future exposure to cadmium; smoking history and current status; reproductive history; current use of medications with potential nephrotoxic side-effects; any history of renal, cardiovascular, respiratory, hematopoietic, and/or musculo-skeletal system dysfunction; and as part of the medical and work history, for employees who wear respirators, questions 3-11 and 25-32 in Appendix D;

2. A complete physical examination with emphasis on: blood pressure, the respiratory system, and the urinary system;

3. A 14 inch by 17 inch, or a reasonably standard sized posterior-anterior chest X-ray (after the initial X-ray, the frequency of chest X-rays is to be determined by the examining physician);

4. Pulmonary function tests, including forced vital capacity (FVC) and forced expiratory volume at 1 second (FEV1);

5. Biological monitoring, as required in subsection (l)(2)(B)2.;

6. Blood analysis, in addition to the analysis required under subsection (l)(2)(B)2., including blood urea nitrogen, complete blood count, and serum creatinine;

7. Urinalysis, in addition to the analysis required under subsection (l)(2)(B)2., including the determination of albumin, glucose, and total and low molecular weight proteins;

8. For males over 40 years old, prostate palpation, or other at least as effective diagnostic test(s); and

9. Any additional tests deemed appropriate by the examining physician.

(D) If the results of periodic biological monitoring or the results of biological monitoring performed as part of the periodic medical examination show the level of the employee's CdU, <<beta>>2 -M, or CdB to be in excess of the levels specified in subsections (-M, or CdB to be in excess of the levels specified in subsections (l)(3)(B)-(C); or, beginning on January 1, 1999, in excess of the levels specified in subsections (l)(3)(B) or (D), the employer shall take the appropriate actions specified in subsections (l)(3)(B)-(D).

(E) For previously exposed employees under subsection (l)(1)(A)2.:

1. If the employee's levels of CdU did not exceed 3 <<mu>>g/g Cr, CdB did not exceed 5 <<mu>>g/lwb, and <<beta>>2 -M did not exceed 300 <<mu>>g/g Cr in the initial biological monitoring tests, and if the results of the followup biological monitoring required by subsection (l)(3)(A)2. one year after the initial examination confirm the previous results, the employer may discontinue all periodic medical surveillance for that employee.

2. If the initial biological monitoring results for CdU, CdB, or <<beta>>2 -M were in excess of the levels specified in (-M were in excess of the levels specified in (l)(3)(A), but subsequent biological monitoring results required by (l)(3)(B)-(D) show that the employee's CdU levels no longer exceed 3 <<mu>> g/g Cr, CdB levels no longer exceed 5 <<mu>>g/lwb, and <<beta>>2 -M levels no longer exceed 300 <<mu>>g/g Cr, the employer shall provide biological monitoring for CdU, CdB, and <<beta>>2 -M one year after these most recent biological monitoring results. If the results of the followup biological monitoring, specified in this subsection, confirm the previous results, the employer may discontinue all periodic medical surveillance for that employee.-M one year after these most recent biological monitoring results. If the results of the followup biological monitoring, specified in this subsection, confirm the previous results, the employer may discontinue all periodic medical surveillance for that employee.

3. However, if the results of the follow-up tests specified in (l)(4)(E)1. or 2. indicate that the level of the employee's CdU, <<beta>>2 -M, or CdB exceeds these same levels, the employer is required to provide annual medical examinations in accordance with the provisions of subsection (-M, or CdB exceeds these same levels, the employer is required to provide annual medical examinations in accordance with the provisions of subsection (l)(4)(B) until the results of biological monitoring are consistently below these levels or the examining physician determines in a written medical opinion that further medical surveillance is not required to protect the employee's health.

(F) A routine, biennial medical examination is not required to be provided in accordance with subsections (l)(3)(A) and (l)(4) if adequate medical records show that the employee has been examined in accordance with the requirements of subsection (l)(4)(B) within the past 12 months. In that case, such records shall be maintained by the employer as part of the employee's medical record, and the next routine, periodic medical examination shall be made available to the employee within two years of the previous examination.

(5) Actions Triggered by Medical Examinations:

(A) If the results of a medical examination carried out in accordance with this section indicate any laboratory or clinical finding consistent with cadmium toxicity that does not require employer action under subsections (l)(2), (3) or (4), the employer, within 30 days, shall reassess the employee's occupational exposure to cadmium and take the following corrective action until the physician determines they are no longer necessary:

1. Periodically reassess: the employee's work practices and personal hygiene; the employee's respirator use, if any; the employee's smoking history and status; the respiratory protection program; the hygiene facilities; and the maintenance and effectiveness of the relevant engineering controls;

2. Within 30 days after the reassessment, take all reasonable steps to correct the deficiencies found in the reassessment that may be responsible for the employee's excess exposure to cadmium;

3. Provide semiannual medical reexaminations to evaluate the abnormal clinical sign(s) of cadmium toxicity until the results are normal or the employee is medically removed; and

4. Where the results of tests for total proteins in urine are abnormal, provide a more detailed medical evaluation of the toxic effects of cadmium on the employee's renal system.

(6) Examination for Respirator Use:

(A) To determine an employee's fitness for respirator use, the employer shall provide a medical examination that includes the elements specified in (l)(6)1.- 4.. This examination shall be provided prior to the employee's being assigned to a job that requires the use of a respirator or no later than 90 days after this section goes into effect, whichever date is later, to any employee without a medical examination within the preceding 12 months that satisfies the requirements of this subsection.

1. A detailed medical and work history, or update thereof, with emphasis on: past exposure to cadmium; smoking history and current status; any history of renal, cardiovascular, respiratory, hematopoietic, and/or musculo-skeletal system dysfunction; a description of the job for which the respirator is required; and questions 3-11 and 25-32 in Appendix D;

2. A blood pressure test;

3. Biological monitoring of the employee's levels of CdU, CdB and <<beta>>2 - M in accordance with the requirements of subsection (-M in accordance with the requirements of subsection (l)(2)(B)2., unless such results already have been obtained within the previous 12 months; and

4. Any other test or procedure that the examining physician deems appropriate.

(B) After reviewing all the information obtained from the medical examination required in subsection (l)(6)(A), the physician shall determine whether the employee is fit to wear a respirator.

(C) Whenever an employee has exhibited difficulty in breathing during a respirator fit test or during use of a respirator, the employer, as soon as possible, shall provide the employee with a periodic medical examination in accordance with subsection (l)(4)(B) to determine the employee's fitness to wear a respirator.

(D) Where the results of the examination required under subsection (l)(6)(A), (B) or (C) are abnormal, medical limitation or prohibition of respirator use shall be considered. If the employee is allowed to wear a respirator, the employee's ability to continue to do so shall be periodically evaluated by a physician.

(7) Emergency Examinations:

(A) In addition to the medical surveillance required in subsections (l)(2)-(6), the employer shall provide a medical examination as soon as possible to any employee who may have been acutely exposed to cadmium because of an emergency.

(B) The examination shall include the requirements of subsection (l)(4)(B), with emphasis on the respiratory system, other organ systems considered appropriate by the examining physician, and symptoms of acute overexposure, as identified in Appendix A in subsections II2.(1)-(2) and IV.

(8) Termination of Employment Examination:

(A) At termination of employment, the employer shall provide a medical examination in accordance with subsection (l)(4)(B), including a chest X-ray, to any employee to whom at any prior time the employer was required to provide medical surveillance under subsections (l)(1)(A) or (l)(7). However, if the last examination satisfied the requirements of subsection (l)(4)(B) and was less than six months prior to the date of termination, no further examination is required unless otherwise specified in subsections (l)(3) or (l)(5);

(B) However, for employees covered by subsection(l)(1)(A)2., if the employer has discontinued all periodic medical surveillance under (l)(4)(E), no termination of employment medical examination is required.

(9) Information Provided to the Physician:

The employer shall provide the following information to the examining physician:

(A) A copy of this standard and appendices;

(B) A description of the affected employee's former, current, and anticipated duties as they relate to the employee's occupational exposure to cadmium;

(D) A description of any personal protective equipment, including respirators, used or to be used by the employee, including when and for how long the employee has used that equipment; and

(E) relevant results of previous biological monitoring and medical examinations.

(10) Physician's Written Medical Opinion:

(A) The employer shall promptly obtain a written, signed medical opinion from the examining physician for each medical examination performed on each employee. This written opinion shall contain:

1. The physician's diagnosis for the employee;

2. The physician's opinion as to whether the employee has any detected medical condition(s) that would place the employee at increased risk of material impairment to health from further exposure to cadmium, including any indications of potential cadmium toxicity;

3. The results of any biological or other testing or related evaluations that directly assess the employee's absorption of cadmium;

4. Any recommended removal from, or limitation on the activities or duties of the employee or on the employee's use of personal protective equipment, such as respirators;

5. A statement that the physician has clearly and carefully explained to the employee the results of the medical examination, including all biological monitoring results and any medical conditions related to cadmium exposure that require further evaluation or treatment, and any limitation on the employee's diet or use of medications.

(B) The employer promptly shall obtain a copy of the results of any biological monitoring provided by an employer to an employee independently of a medical examination under subsections (l)(2) and (l)(4), and, in lieu of a written medical opinion, an explanation sheet explaining those results.

(C) The employer shall instruct the physician not to reveal orally or in the written medical opinion given to the employer specific findings or diagnoses unrelated to occupational exposure to cadmium.

(11) Medical Removal Protection (MRP):

(A) General.

1. The employer shall temporarily remove an employee from work where there is excess exposure to cadmium on each occasion that medical removal is required under subsections (l)(3), (l)(4), or (l)(6) and on each occasion that a physician determines in a written medical opinion that the employee should be removed from such exposure. The physician's determination may be based on biological monitoring results, inability to wear a respirator, evidence of illness, other signs or symptoms of cadmium-related dysfunction or disease, or any other reason deemed medically sufficient by the physician.

2. The employer shall medically remove an employee in accordance with subsection (l)(11) regardless of whether at the time of removal a job is available into which the removed employee may be transferred.

3. Whenever an employee is medically removed under subsection (l)(11), the employer shall transfer the removed employee to a job where the exposure to cadmium is within the permissible levels specified in that subsection as soon as one becomes available.

4. For any employee who is medically removed under the provisions of subsection (l)(11)(A), the employer shall provide follow-up biological monitoring in accordance with (l)(2)(B)2. at least every three months and follow-up medical examinations semi-annually at least every six months until in a written medical opinion the examining physician determines that either the employee may be returned to his/her former job status as specified under (l)(11)(D)-(E) or the employee must be permanently removed from excess cadmium exposure.

5. The employer may not return an employee who has been medically removed for any reason to his/her former job status until a physician determines in a written medical opinion that continued medical removal is no longer necessary to protect the employee's health.

(B) Where an employee is found unfit to wear a respirator under subsection (l)(6)(B), the employer shall remove the employee from work where exposure to cadmium is above the PEL.

(C) Where removal is based on any reason other than the employee's inability to wear a respirator, the employer shall remove the employee from work where exposure to cadmium is at or above the action level.

(D) Except as specified in subsection (l)(11)(E), no employee who was removed because his/her level of CdU, CdB and/or <<beta>>2 -M exceeded the medical removal trigger levels in subsections (-M exceeded the medical removal trigger levels in subsections (l)(3) or (l)(4) may be returned to work with exposure to cadmium at or above the action level until the employee's levels of CdU fall to or below 3 <<mu>>g/g Cr, CdB falls to or below 5 <<mu>>g/lwb, and <<beta>>2 - M falls to or below 300 <<mu>>g/g Cr.

(E) However, when in the examining physician's opinion continued exposure to cadmium will not pose an increased risk to the employee's health and there are special circumstances that make continued medical removal an inappropriate remedy, the physician shall fully discuss these matters with the employee, and then in a written determination may return a worker to his/her former job status despite what would otherwise be unacceptably high biological monitoring results. Thereafter, the returned employee shall continue to be provided with medical surveillance as if he/she were still on medical removal until the employee's levels of CdU fall to or below 3 <<mu>>g/g Cr, CdB falls to or below 5 <<mu>>g/lwb, and <<beta>>2 -M falls to or below 300 <<mu>>g/g Cr.

(F) Where an employer, although not required by(l)(11)(A)-(C) to do so, removes an employee from exposure to cadmium or otherwise places limitations on an employee due to the effects of cadmium exposure on the employee's medical condition, the employer shall provide the same medical removal protection benefits to that employee under subsection (l)(12) as would have been provided had the removal been required under subsection (l)(11)(A)-(C).

(12) Medical Removal Protection Benefits (MRPB).

(A) The employer shall provide MRPB for up to a maximum of 18 months to an employee each time and while the employee is temporarily medically removed under subsection (l)(11).

(B) For purposes of this section, the requirement that the employer provide MRPB means that the employer shall maintain the total normal earnings, seniority, and all other employee rights and benefits of the removed employee, including the employee's right to his/her former job status, as if the employee had not been removed from the employee's job or otherwise medically limited.

(C) Where, after 18 months on medical removal because of elevated biological monitoring results, the employee's monitoring results have not declined to a low enough level to permit the employee to be returned to his/her former job status:

1. the employer shall make available to the employee a medical examination pursuant to this section in order to obtain a final medical determination as to whether the employee may be returned to his/her former job status or must be permanently removed from excess cadmium exposure; and

2. the employer shall assure that the final medical determination indicates whether the employee may be returned to his/her former job status and what steps, if any, should be taken to protect the employee's health.

(D) The employer may condition the provision of MRPB upon the employee's participation in medical surveillance provided in accordance with this section.

(13) Multiple Physician Review.

(A) If the employer selects the initial physician to conduct any medical examination or consultation provided to an employee under this section, the employee may designate a second physician to:

1. Review any findings, determinations, or recommendations of the initial physician; and

2. Conduct such examinations, consultations, and laboratory tests as the second physician deems necessary to facilitate this review.

(B) The employer shall promptly notify an employee of the right to seek a second medical opinion after each occasion that an initial physician provided by the employer conducts a medical examination or consultation pursuant to this section. The employer may condition its participation in, and payment for, multiple physician review upon the employee doing the following within fifteen (15) days after receipt of this notice, or receipt of the initial physician's written opinion, whichever is later:

1. Informing the employer that he or she intends to seek a medical opinion; and

2. Initiating steps to make an appointment with a second physician.

(C) If the findings, determinations, or recommendations of the second physician differ from those of the initial physician, then the employer and the employee shall assure that efforts are made for the two physicians to resolve any disagreement.

(D) If the two physicians have been unable to quickly resolve their disagreement, then the employer and the employee, through their respective physicians, shall designate a third physician to:

1. Review any findings, determinations, or recommendations of the other two physicians; and

2. Conduct such examinations, consultations, laboratory tests, and discussions with the other two physicians as the third physician deems necessary to resolve the disagreement among them.

(E) The employer shall act consistently with the findings, determinations, and recommendations of the third physician, unless the employer and the employee reach an agreement that is consistent with the recommendations of at least one of the other two physicians.

(14) Alternate Physician Determination.

The employer and an employee or designated employee representative may agree upon the use of any alternate form of physician determination in lieu of the multiple physician review provided by subsection (l)(13), so long as the alternative is expeditious and at least as protective of the employee.

(15) Information the Employer Must Provide the Employee.

(A) The employer shall provide a copy of the physician's written medical opinion to the examined employee within two weeks after receipt thereof.

(B) The employer shall provide the employee with a copy of the employee's biological monitoring results and an explanation sheet explaining the results within two weeks after receipt thereof.

(C) Within 30 days after a request by an employee, the employer shall provide the employee with the information the employer is required to provide the examining physician under subsection (l)(9).

(16) Reporting.

In addition to other medical events that are required to be reported on the Cal/OSHA Form No. 200, the employer shall report any abnormal condition or disorder caused by occupational exposure to cadmium associated with employment as specified in Title 8, Section 14301.

(m) Communication of Cadmium Hazards to Employees.

(1) General.

In communications concerning cadmium hazards, employers shall comply with the requirements of the Hazard Communication Standard, section 5194, including but not limited to the requirements concerning warning signs and labels, material safety data sheets (MSDS), and employee information and training. In addition, employers shall comply with the following requirements:

(2) Warning Signs.

(A) Warning signs shall be provided and displayed in regulated areas. In addition, warning signs shall be posted at all approaches to regulated areas so that an employee may read the signs and take necessary protective steps before entering the area.

(B) Warning signs required by subsection (m)(2)(A) shall bear the following information:

DANGER
CADMIUM
CANCER HAZARD
CAN CAUSE LUNG AND KIDNEY DISEASE
AUTHORIZED PERSONNEL ONLY
RESPIRATORS REQUIRED IN THIS AREA

(C) The employer shall assure that signs required by this subsection are illuminated, cleaned, and maintained as necessary so that the legend is readily visible.

(3) Warning Labels.

(A) Shipping and storage containers containing cadmium, cadmium compounds, or cadmium contaminated clothing, equipment, waste, scrap, or debris shall bear appropriate warning labels, as specified in subsection (m)(3)(B).

(B) The warning labels shall include at least the following information:

DANGER
CONTAINS CADMIUM
CANCER HAZARD
AVOID CREATING DUST
CAN CAUSE LUNG AND KIDNEY DISEASE

(4) Employee Information and Training.

(A) The employer shall institute a training program for all employees who are potentially exposed to cadmium, assure employee participation in the program, and maintain a record of the contents of such program.

(B) Training shall be provided prior to or at the time of initial assignment to a job involving potential exposure to cadmium and at least annually thereafter.

(C) The employer shall make the training program understandable to the employee and shall assure that each employee is informed of the following:

1. The health hazards associated with cadmium exposure, with special attention to the information incorporated in Appendix A;

2. The quantity, location, manner of use, release, and storage of cadmium in the workplace and the specific nature of operations that could result in exposure to cadmium, especially exposures above the PEL;

3. The engineering controls and work practices associated with the employee's