NC STATE Home Page NC STATE UNIVERSITY - Environmental Health and Safety 2620 Wolf Village Way Cmpus Box 8007, Raleigh NC 27695  Phone 919.515.7915 FAX 919.515.6307 NC STATE Home Page

MEDICAL SURVEILLANCE

 

Purpose

The purpose of medical surveillance is for the early identification of conditions, if any, that could present an increased risk of adverse health effects related to the task being performed.

Based on the type of work being performed, including consideration of factors such as the duration of the task, the materials being used, and the potential for exposure, medical surveillance is either recommended or required for the job.

Specific test results and other personal medical information generated by these exams will be kept confidential between the employee and the physician. The physician will determine the scope of the exam, then inform the supervisor of their recommendations based on the exam results. The supervisor will discuss these recommendations, if any, with the employee. The employee can contact the physician who performs the exam with any questions regarding the test results.

According to federal law, employees have the right to request copies of their medical or exposure records at any time by contacting their supervisor or Human Resources.

Should you have any concerns or questions regarding this procedure, please contact EH & S at 515-6860.

Objective

The primary purpose of the medical surveillance program is to identify medical conditions that could lead to an occupational disease. The secondary objective is to assure compliance with federal and state regulations which require medical monitoring when employees use certain materials.

Scope

This section pertains to medical surveillance of University employees and students related to the use of chemicals, physical agents (noise, radiation), or animal contact. Medical surveillance, as described in this section, does not include discussion of fitness for duty exams (e.g. Campus Police Officer, Emergency Responder, etc.), although these exams must be conducted through the approved NCSU medical provider.

Reference in this section to use the NCSU approved medical provider (currently Student Health Services) does not pertain to drug screening or exams conducted after work related injuries or illnesses (workers compensation cases) since these programs are currently handled under separate arrangements.

Funding

Charges for appropriate medical surveillance exams, tests and consultations, as of September 1, 2000, will be handled at the college level. Supervisors will no longer be billed directly for the employee's medical costs. However, medical cost will be billed to the individual departments, as usual, for nonacademic (Finance and Business and receipts supported) departments. For questions concerning applicability contact Gary Shaver, 515-6862.

Non-Employees and NCSU Students

It is the responsibility of the supervisor to notify the individual about his/her responsibility to comply with N.C. State’s occupational medicine program requirements. For a description of required medical exams and tests, please refer to section entitled ‘Medical Surveillance Criteria’. In addition, there is also a Medical Surveillance Chart that can be used to assist the supervisor in determining what vaccinations and medical services are recommended when handling animals. Individuals are required to submit documentation to their NCSU supervisor that they have fulfilled the medical program requirements. Upon termination of duties, the supervisor shall forward any personnel medical documentation to the Occupational Medicine Program Administrator, Student Health Center, Box 7304.

If an individual arrives without having met the appropriate occupational medicine requirement, they must receive their required tests and exams through the NCSU Occupational Medicine program by submitting an Exam Request Form and/or other applicable forms or questionnaires to the Occupational Medicine Program Administrator. All costs of exams, questionnaire reviews, vaccinations, etc. will be charged to the particular college.

If a respirator is required and not received prior to arriving at the University, respiratory protection training and fit-testing will be provided by the EHSC. Please refer to the section, Respirator Approval Exams for information concerning medical approval for respirator use. Respirator training and fit-testing may also be billed back to the college..

Special requirements may apply depending upon the individual’s status as described below:

Unsupported Individuals:

Individuals, who are not sponsored by a host institution, who receive medical services through the Occupational Medicine Program, may request copies of medical records to be provided to their own personal physician.

Unsupported individuals with special medical conditions or concerns, whose health is affected by their work or workplace, should be sent to their personal physician for work-related medical review.

Supported Individuals:

Supported individuals who receive services through the Occupational Medicine Program, should have copies of medical records sent to their host institution’s medical office. It is the responsibility of these individuals to confirm that the occupational medicine exams, tests and approvals, as well as training for respirator use, as required for NCSU employees are also in accordance with their own institutional health and safety policies.

Supported individuals in need of respiratory protection should get the necessary training, fit testing and equipment at their host institution. If respiratory protection training is to be provided by the University, permission must first be obtained from the host institution.

Supported individuals with special medical conditions or concerns, whose health is affected by their work or workplace, should be sent to their host institution’s medical provider.

NCSU Students serving as volunteers, trainees and observers

NCSU Students will receive all occupational medicine services through SHS Occupational Medicine Program. Students may be referred to EHSC for respirator training and fit testing. Students are to complete the required Occupational Medicine forms or questionnaires and submit to SHS Occupational Medicine Administrator for review. Expenses from form review and services are billed to the college.

Responsibility

Supervisor's responsibilities:

  1. Review employee job tasks against the Medical Surveillance Criteria listed below.
  2. Contact EH&S at 515-6862 if medical surveillance is indicated for an employee. Medical surveillance is determined to be appropriate based on input from the supervisor, EH&S, and the medical provider.
  3. Use the approved NCSU medical provider. Currently, this is Student Health Services. (Nonacademic departments are to bear the cost of employee's exam.)
  4. Prior to receiving a medical screening exam, the supervisor must review the following "Medical Surveillance Statement" with the employee:

    "Based on the type of work you are performing, including considerations of factors such as the duration of your task, the materials being used, and the potential for exposure, medical surveillance is either recommended or required for this job. The purpose of this medical surveillance is for the early identification of conditions, if any, that could present an increased risk of adverse heath effects related to the task you are performing. NOTE: Information on the disclosure of private health information is described in the NCSU Notice of Privacy Practice.

    Specific test results and other personal medical information generated by those exams will be kept confidential between you and the physician. The physician will determine the scope of the exam, then inform your supervisor of their recommendations based on your exam results. Your supervisor will discuss those recommendations, if any, with you. You can contact the physician who performs your exam with any questions regarding your test results.

    According to federal law, you have the right to requests copies of your medical or exposure records at any time by contacting your supervisor or Human Resources.

    Should you have any concerns or questions regarding this procedure, please contact the Human Resources Department."

  5. The supervisor will discuss the physician's recommendations with the employee. Note: The supervisor will not receive the employee medical exam results. Rather, they will receive a "Health Recommendation Form," which contains the examining physician's recommendations based on his/her findings.
  6. Assure employees report to the physician on time for the medical exam. Continued work performance is contingent on completion of medical exams. Annual exams not completed within 3 months of the due date will require the employee to stop the task until completion of the exam.
  7. Where department employees are required to receive medical exams/tests based on specific tasks and conditions, supervisors are to ensure that students performing these same tasks under the same working conditions obtain this medical screening. All students, paid or volunteer, will have exams paid for in the same manner as full time employees. Students may be referred to EHSC for respirator training and fit testing. Students are to complete the required Occupational Medicine forms or questionnaires, including the Animal Contact Questionnaire and submit to the Occupational Medicine Program for review. Expenses from form review and services are billed to the college.
  8. Maintain any physician's reports in a confidential manner. Keep this information with the departmental records for the employee.
  9. Maintain the physician's report for the duration the employee works for you. Transfer these and other employee records to Student Health Services.
  10. Immediately contact Human Resources, Academic Personnel or Ag Extension Personnel when an employee requests access to their medical records or exposure records.
  11. Reexamine medical surveillance criteria versus job task should job duties change.
  12. It is the responsibility of the supervisor to notify visitors, trainees and other non-NCSU employees (referred to collectively as “visitors”) about their responsibility to comply with N.C. State’s occupational medicine program requirements. Individuals who fall under a requirement of the program are required to inform their NCSU supervisor that they have fulfilled N.C. State’s medical program requirements. Upon termination of duties, the supervisor shall forward any personnel medical documentation to the Occupational Medicine Program Administrator, Student Health Center, Box 7304.

    If a visitor arrives without having met the appropriate occupational medicine requirement, they must receive their required tests and exams through the NCSU Occupational Medicine program by submitting an Exam Request Form and/or other applicable forms or questionnaires to the Occupational Medicine Program Administrator. All costs of exams, questionnaire reviews, vaccinations, etc. will be charged to the particular college.

    If a respirator is required and not received prior to arriving at the University, respiratory protection training and fit-testing will be provided by the EHSC. Please refer to the section, Respirator Approval Exams for information concerning medical approval for respirator use. Respirator training and fit-testing may also be billed back to the college.

    Of particular note, for a visitor, an Animal Contact Questionnaire is not required before handling animals. In addition to the information provided in the Medical Surveillance Criteria section, there is a Medical Surveillance Chart that can be used to assist the supervisor in determining what specific vaccinations and medical services are recommended when handling animals. For questions concerning this chart, the supervisor may contact the Occupational Medicine Program Administrator at 919-513-0277. For additional information concerning animal contact please refer to the Animal Contact Program.

    Special requirements may apply depending upon the visitor’s status as described herein. Unsupported Visitors, i.e. those who are not financially sponsored by a host institution, who receive medical services through the Occupational Medicine Program, may request copies of medical records to be provided to their own personal physician. These visitors with special medical conditions or concerns, whose health is affected by their work or workplace, should be sent to their personal physician for work-related medical review. Supported Visitors, who receive services through the Occupational Medicine Program, should have copies of medical records sent to their host institution’s medical office. It is the responsibility of these visitors to confirm that the occupational medicine exams, tests and approvals, as well as training for respirator use, as required for NCSU employees are also in accordance with their own institutional health and safety policies.

    Supported visitors in need of respiratory protection should get the necessary training, fit testing and equipment at their host institution. If respiratory protection training is to be provided by the University, permission must first be obtained from the host institution. Supported visitors with special medical conditions or concerns, whose health is affected by their work or workplace, should be sent to their host institution’s medical provider.

Human Resources, Academic Personnel, or Ag. Extension Personnel responsibilities:

Brief appropriate departmental representatives on the Departmental Responsibilities listed above.

Environmental Health and Safety Center responsibilities
  1. Coordinate medical management program for the University.
  2. Act as NCSU liaison with the medical provider, Student Health Services.
  3. Work in cooperation with contract medical provider to improve efficiency and effectiveness of medical management program.
  4. Work in cooperation with contract medical provider to determine tasks where medical surveillance is appropriate. Provide feedback to supervisors on medical surveillance inquiries.
Medical Surveillance Criteria

NCSU Environmental Health and Safety developed these criteria with the assistance from occupational health physicians. The criteria are subject to modification upon periodic review.

  1. OSHA requires medical surveillance for employees who:
    1. Have exposure to noise levels exceeding 85 dBA in an 8 hour time weighted average exposure. Refer to section 100-20, NCSU Health & Safety Manual for additional information. Refer to Hearing Conservation Requirements for additional information.
    2. Wear a respirator. Note: Refer to Guidelines for Respirator Wear for an explanation on annual medical approval.
    3. Have exposure to asbestos above the permissible limit or excursion limit for 30 days/year; perform Class 1,2, or 3 asbestos work for 30 days/year.
    4. Use any of the following 13 OSHA regulated human carcinogens as "authorized employees" and those entering "regulated" areas. Note: You must have approval from EH&S to use any of these materials.

      4-Nitrobiphenyl
      Alpha-Naphthylamine
      Methyl Chloromethyl Ether
      3,3' Dichlorobenzine (and its salt)
      Bis-Chloromethyl Ether
      Beta-Naphthylamine
      Benzidine
      4-Aminodiphenyl
      Ethyleneamine
      Beta-Propiolactone
      2-Acetylamino Fluorine
      4- Dimethylaminoazobenzine
      N-Nitrosodimethylamine

       

    5. Use Vinyl Chloride and are exposed above the action level. (The "action level" is typically one half of the permissible exposure level for the chemical.)
    6. Use Inorganic arsenic and are exposed above the action level for at least 30 days/year and based on previous exposure.
    7. Use Metallic Lead, Inorganic Lead, or Organic Lead Soaps and are exposed above the action level for greater than 30 days/year
    8. Use Benzene and are exposed above the action level for greater than 30 days/year and based on additional requirements.
    9. Have "occupational exposure" to Blood borne Pathogens, refer to NCSU model Exposure Control Plan, for information.
    10. Are exposed to Cotton Dust and are engaged in yarn manufacturing, slashing and weaving operations, or work in waste houses for textile operations
    11. Use 1,2 - Dibromo-3-Chloropropane, working in a regulated area or may be exposed in an emergency situation
    12. Are exposed to Acrylonitrile above the action level
    13. Are exposed to Ethylene Oxide at or above the action for at least 30 days/year
    14. Are exposed to Formaldehyde greater than the action level or greater than the short term exposure limit.
    15. Are exposed to Methylenedianiline greater than or equal to the action level for 30 days/year.
    16. Are exposed to Cadmium greater than or equal to the action level for 30 days/year.
  2. In addition, employees will need medical surveillance for the following jobs. Note: Medical surveillance may NOT be needed where adequate engineering controls or protective equipment are in use, or when there are no reliable medical tests.

    a) All employees having a potential for significant exposure to cholinesterase inhibiting organophosphate chemicals should participate in periodic monitoring of cholinesterase levels. Refer to Pesticide Exposure Prevention for additional information on exposure reduction, and Cholinesterase Biomonitoring Program for Cholinesterase activity determination.

    b) Maintenance operations that creates airborne particles of lead, cadmium, arsenic, or other systemic toxins where local exhaust is not used.

    c) Significant and prolonged use of mercury, chlorinated solvents, heavy metals, or other solids and liquids with chronic toxicity and:

    - enclosure and local exhaust ventilation are not available or ineffective or

    - prolonged glove contact is necessary and material is capable of rapid absorption through the skin or;

    - oral uptake is possible from contaminated surfaces and the material used is a systemic poison.

    d) Use of radioactive material under specific conditions described in NCSU Radiation Protection

    e) Use of Class 3b and 4 lasers - ophthalmology exam required prior to use

    f) As specified by department or committee requirements

    Note: Various advisory groups (e.g. Biosafety Committee) or colleges (e.g. CVM) may recommend/require medical exams, biological monitoring, immunizations, or titers based on the nature of the work activity. Refer to Animal Contact for information concerning vertebrate animal exposure.

Environmental Health & Safety Center personnel will assist supervisors in determining whether medical monitoring is necessary or appropriate for their employees. Call 515-6860 or 515-6862-for information.

Access to Medical Surveillance Services and Consultation

In order to contact Student Health Services for advice or to make an appointment to receive a medical service, you will need to complete the following steps:

For medical appointments:

For Respirator Approval Exams, complete and send the following forms in a sealed envelope to: Occupational Medicine Coordinator, Student Health Services, Box 7304

    1. Exam Request Form
    2. Confidential Medical Evaluation & Workplace Exposure Questionnaire

Be sure to check on the exam request form what medical service you are requesting; fill out the form completely, use space on form to explain your answers. Respirator exams for using SCBA equipment for emergency response activities will be scheduled by Student Health. Employees requesting an annual SCBA medical for emergency response should fill out only an Exam Request form and send to Student Health. Please refer to Respiratory Protection Program for program guidelines.

For Vaccinations please complete and send the following forms in a sealed envelope to: Occupational Medicine Coordinator, Student Health Services, Box 7304

    1. Exam Request Form

For audiograms please complete and send the following forms in a sealed envelope to: Occupational Medicine Coordinator, Student Health Services, Box 7304. Please refer to Hearing Conservation Requirements for program information.

    1. Exam Request Form
    2. Hearing Log

For Animal Handler questionnaire review and Animal Handler Physicals please complete and send the following form in a sealed envelope to: Occupational Medicine Coordinator, Student Health Services, Box 7304 Please refer to Animal Contact for program guidelines.

    1. Animal Contact Form

For All Other Exams, such as blood lead determinations and cholinesterase inhibitor checks please complete and send the Exam Request Form in a sealed envelope to: Occupational Medicine Coordinator, Student Health Services, Box 7304. Please refer to Pesticide Exposure Prevention for program guidelines.

Once the form is received by Student Health, the Occupational Medicine Coordinator will e-mail you appointment information. Please allow for a period of two weeks to schedule an appointment.

Contact Points

  • Medical Advice: 513-2380
  • Billing and appointment scheduling: 513-0277
  • Non-medical advice (e.g. program requirements, chemical exposure monitoring): 515-6862
  • NCSU Notice of Privacy Practice: 513-3267