The Model for Medical Surveillance Program for Upstream Oil/Gas Producer

The Model for Medical Surveillance
Program for Caribbean Upstream
Oil/Gas Producer
Presented by:
Bernard L. Fontaine, Jr., CIH, CSP
The Windsor Consulting Group, Inc.
Copyright 2014 © The Windsor Consulting Group, Inc.

Medical Surveillance Program

Regional Control and Resources Finance and Accounting
Health, Safety, and Environmental Subsurface Reservoir Development
Facilities & Construction Control, Personnel, Contract, Resources
Maintenance, Deck, Inspection E&P Operator Asset – TSP
Production and Process Catering, Laundry, and Housekeeping
Drilling and Completion Liquefied Natural Gas Production
Construction Crew Diving Crew
General Services People and Organization
Legal Affairs Security

Task Based Risk Register (TBRA)
1 Drill Floor Crew
Vapor exposure
from descaling,
solvent, and food
condiment
No Published
Informationas
Suspect Human
Carcinogen
Health threat: URT
and eye irritation
Personal
injury (also
damage to
health)
16 3.1
Specific
sector of
activity at
global
level
High
Baseline and periodic air monitoring
personal/area exposures, identify peak and
long-term exposures, awareness training,
adequate goggles, gloves, clothing, and
respirators for elevated exposures.
Personal
injury (also
damage to
health)
7 3.1 Moderate Medium Medium
There are many individual
and organizational risk
factors that may influence
exposure. Lung function
tests for at-risk workers
exposed to prolonged or
repeated elevated
concentrations
1 Drill Operators
Vapor exposure
from descaling,
solvent, and food
condiment
No Published
Informationas
Suspect Human
Carcinogen
Health threat: URT
and eye irritation
Personal
injury (also
damage to
health)
16 3.1
Specific
sector of
activity at
global
level
High
Personal
injury (also
damage to
health)
7 3.1 Moderate Medium Medium
repeated elevated
concentrations
1 Drilling Engineer
Vapor exposure
from descaling,
solvent, and food
condiment
No Published
Informationas
Suspect Human
Carcinogen
Health threat: URT
and eye irritation
Personal
injury (also
damage to
health)
7 3.1
Specific
sector of
activity at
global
level
Moderate
Personal
injury (also
damage to
health)
3 3.1 Low Medium Medium
repeated elevated
concentrations
ID ACTIVITY AREA HAZARD THREAT CONSEQUENCE
POTENTIAL RISK
CONTROL MEASURE
RESIDUAL RISK
EVALUATION
PARAMETERS
COMMENT DUE DATE
RESPONSIBLE
PARTY
CATEGORY
CONS
LIKD
EXPOSURE
RISK
CATEGORY
CONS
LIKD
RISK
MANAG.
KNOWLD
Caribbean Regional Control and Resources
1
Regional Executive
Director
Vapor exposure
from descaling,
solvent, and food
condiment
No Published
Informationas
Suspect Human
Carcinogen
Health threat:
URT and eye
irritation
Personal
injury (also
damage to
health)
1.7 0.8
Specific
sector of
activity at
global
level
Low
Personal
injury (also
damage to
health)
1.7 0.4 Low Medium Medium
repeated elevated
concentrations

 Pre-Placement/Initial/New Hire Examinations. These exams are done
before placement in a specific job to medically assess if the worker will be
able to perform the job safely and meet the requirements for immigration
status
 Personnel Policy Enforcement Examinations. Personnel policy
enforcement examinations medically assess workers to determine if they
meet established standards and conditions of employment.
 Medical Certification Examinations. Medical certification examinations
determine if an individual meets specific medical fitness standards, such as
those promulgated for aviators and commercial drivers.
 Medical Surveillance Examinations. Medical surveillance examinations,
often referred to as occupational health examinations, provide baseline and
periodic assessments or measurements to detect abnormalities in workers
exposed to work-related health hazards.

 Return to Work or Fitness for Duty Examinations These examinations
are done for two principle reasons:
 Establish whether the individual has made adequate recovery
following the disability
 Determination why the person may not be performing up to the
standards of the position they hold or able to perform the essentials
tasks of the job
 Termination of Employment Examinations. These examinations are
designed to assess pertinent aspects of a worker’s health when the worker
leaves employment.
 Termination of Exposure Examinations These examinations are
performed when exposure to a specific hazard has ceased

 Situational Examinations This examination is conducted in response to a
specific incident for which a possible overexposure to a hazardous
substance is suspected. Biological monitoring may be performed if
validated indices are available.
 Employee Health Promotion Examinations. Employee health promotion
exams are non-occupational medical examinations given to workers as a
benefit of improving personal health through nutrition, diet and exercise,
helping reduce the risk or adverse outcomes of diabetes and high blood
pressure, heart disease and stroke, smoking, alcohol use and pregnancy,
etc.
 Emergency Treatment Provisions for emergency treatment and acute
non-emergency treatment should be made at each site. The range of
hazards include chemical, physical (such as heat and/or cold stress, falls
and trips), and biologic hazards (animal bites and plant poisoning as well
as hazardous biological wastes).

Occupational and Medical History

Occupational and Medical Questionnaire
• Make sure the worker fills out an occupational and medical history
questionnaire.
• Review the questionnaire before seeing the worker. In the examining room,
discuss the questionnaire with the worker, paying special attention to prior
occupational exposures to chemical and physical hazards.
• Review past illnesses and chronic diseases, particularly atopic diseases
such as eczema and asthma, lung diseases, and cardiovascular disease.
• Review symptoms, especially shortness of breath or labored breathing
on exertion, other chronic respiratory symptoms, chest pain, high blood
pressure, and heat intolerance.

Occupational and Medical Questionnaire
• Identify individuals who are vulnerable to particular substances (e.g.,
someone with a history of severe asthmatic reaction to a specific chemical) or
who may be not immunized or vaccinated for religious or other reasons.
• Record relevant lifestyle habits (e.g., cigarette smoking, alcohol and drug
use) and hobbies.
• Neurological or psychological concerns
which impact mental health, stability,
or normal stress on the job or increase risk
violent or abnormal behavior.

Name, address, and phone number (including fax) of physician/ health center performing examination:
New Applicants ONLY:
Your Current Occupation:____
Your Current Employer:
Time in Current Position (in years/months):
Name of Department:
Examinee’s Name: Position/Job Title: SS#
Address: Work Location: Region:
Home Phone: Work Phone:
Date of Scheduled Exam: Date of Birth: Gender: Male Female
REPSOL PROGRAM MANAGER
EXAMINING PHYSICIAN (Please Note - Core Exam Must Always be Completed, Plus All Function-Specific Services
TYPE OF EXAMINATION
o Pre-placement/Baseline/Exit o Periodic o Exit
SPECIFY FUNCTION AND/OR CLEARANCES REQUESTED
(Check ALL That Apply)
Respirator User [complete Request for Respirator Clearance
form]
Health, Safety, and Environmental
Subsurface Reservoir Development
Commercial Drivers License
Facilities and Construction
Diver and Diving Team
Well Maintenance, Deck, Inspection, and Construction
Crane/Derrick/Aerial Lift Operator/Rigger
Commercial Vehicle Operator
Security
E&P Operated Asset – TSP
Laboratory/Chemical Worker
Well Drill and Oil/Gas Production
PRE-PLACEMENT/BASELINE CORE EXAM
Required Services: (Check those services completed)
Authorization for Disclosure Form
General Medical History
General Physical Examination
Chemistry Panel (including Glucose, Bilirubin (total),
Cholesterol, HDL-C, LDL-C, Triglycerides, GGTP, LDH,
SGOT, SGPT), Complete Blood Count, and Urinalysis
Urinalysis
Audiometry (including noise exposure history)
Electrocardiogram
Spirometry
Vision Screening (Corrected and Uncorrected Near and Far;
Color; Peripheral; Depth Perception)
Drug/Alcohol screen (cocaine/marijuana)
Plus other Function or Clearance-required services (see the
following page)
ANNUAL/PERIODIC/EXIT CORE EXAM
Required Services: (Check those services completed)
Authorization for Disclosure Form
General Medical History
General Physical Examination
Chemistry Panel (including Glucose, Bilirubin (total),
Cholesterol, HDL-C, LDL-C, Triglycerides, GGTP, LDH,
SGOT, SGPT), Complete Blood Count, and Urinalysis
Plus other Function or Clearance-required services (see
the following page)
Note: For Respirator User exams, the General Physical
Examination may be a brief, limited exam or a more extensive
exam, depending on the health of the examinee and the
judgment of the examiner. Also, laboratory tests (e.g.,
chemistry panel, blood count, and urinalysis) and procedures
(e.g., electrocardiograms) are intended to be at the discretion
of the examiner, rather than required services. Refer to the
Occupational Medicine Surveillance Program for further
guidance. For all Respirator User exams, completion of the
Request for Respirator Clearance form must precede this exam
and be attached to this exam form when completed.
Standard Medical History and Examination Form
The individual to be examined is to complete the shaded medical history portions of this form prior to his/her appointment.

Upstream Oil/Gas Respirator Users
Pre-Placement/Baseline Core Exam
Services, plus::
Request for Respirator Clearance form
(Limited Exam based on respirator use)
(Use above for any Respirator User exam)
Regional Control and Resources
No additional clearance specific
requirements
Finance and Accounting
No additional clearance specific
requirements
Health, Safety, and Environmental
Additional requirements applies to
offshore field personnel.
Pre-Placement/Baseline Core Exam
Services, plus:
 Vision (Cor/Uncor. Near/Far; Color;
Peripheral; Depth )
 Chest X-Ray – PA/Lat
 Blood lead and Zinc Protoporphyrin
(for firearms users)
 Mercury urine (pre-placement for
baseline)
 Cholinesterase (RBC/Plasma)
 Serum, 5cc, labeled, frozen, and stored
 Immunizations and Screening
 Audiometry (including noise exposure
history)
 Spirometry (respirator use)
Periodic Core Exam Services, plus:
Peripheral; Depth )
 Audiometry (noise exposure)
Subsurface Reservoir Development
No additional clearance specific requirements for
either the administrative and managerial staff.
Requirements apply to field geologist, petro-
physicist, geophysicist, and engineers
Pre-Placement/Baseline Core Exam Services,
plus:
Peripheral; Depth )
 Blood lead (offshore personnel)
 Mercury urine (pre-placement for baseline)
 Audiometry (including noise exposure
history)
Vision (Cor/Uncor. Near/Far; Color; Peripheral;
Depth )
 Mercury urine (prior to shift) or blood (end of
work week) for offshore personnel
 Other ACGIH BEI indicators based on
exposure risk)
Exit Core Exam Services, plus:
Audiometry
Blood lead (offshore personnel)
Mercury urine (prior to shift) or blood (end of
work week) for offshore personnel
(For age 40 and over) Multiple Risk Factor Assessment (age
lipid profile, blood pressure, diabetic screening)
 Audiogram (5 years) based on noise exposure history)
 Vision (Cor. and Uncor. Near and Far)
 Chest X-Ray (PA/Lat) (every 2 years after age 40)
 Electrocardiogram (every year after age 35)
Facilities and Construction
No additional clearance specific requirements for either the
administrative and managerial staff. Requirements apply to
field engineers and topside refurbishment workforce.
Pre-Placement/Baseline Core Exam Services, plus:
 Vision (Cor/Uncor. Near/Far; Color; Peripheral; Depth )
 Blood lead and Zinc Protoporphyrin (for firearms users)
 Mercury urine (pre-placement for baseline)
 Audiometry (including noise exposure history)
 Vision (Cor/Uncor. Near/Far; Color; Peripheral; Depth )
 Mercury urine (prior to shift) or blood (end of work week)
for offshore personnel
 Other ACGIH BEI indicators based on exposure risk
Exit Core Exam Services, plus:
Audiometry
24 hour Urine Heavy Metal Screen

Physical Exam
• Physical exam of all body organs, focusing on the pulmonary,
cardiovascular, dermatology, and musculoskeletal systems.
• Note conditions that could increase susceptibility to heat stroke, such as
obesity and lack of physical exercise.
• Note any cardiovascular, metabolic, or pulmonary disease, or two or more
major cardiovascular disease risk factors that restricts offshore exercise
physical activity
• Note conditions that could affect respirator use, such as missing or arthritic
fingers, facial scars, dentures, poor eyesight, or perforated ear drums.
• Ability to work while wearing protective equipment

Physical Exam
• Disqualify individuals who are clearly unable to perform based on the
medical history and physical exam (e.g., those with severe lung disease,
heart disease, neurological, psychological, or orthopedic problems)
.
• Note limitations concerning the worker's ability to use protective
equipment (e.g., individuals who must wear contact lenses cannot wear full-
face piece respirators).
• Provide additional testing (e.g., chest X-ray, pulmonary function testing,
electro-cardiogram) for ability to wear protective equipment where necessary.
• Base the determination on the individual worker's profile (e.g., medical
history and physical exam, age, previous exposures and testing).

Physical Exam
• Implement pre-activity screening tools (e.g., physical activity readiness
survey, health risk appraisal, or health history questionnaire) to provide a
means for a prospective user of health fitness equipment to clearly determine
their level of risk (e.g., low, moderate and high) before engaging in a program
of physical activity.
• Make a written assessment of the worker's capacity to perform while
wearing a respirator, if wearing a respirator is a job requirement.
Note: No employee should be assigned to a task that requires the use of a
respirator unless it has been determined that the person is physically able to
perform under such conditions.

Traditional Examination Tests
 Pulmonary function tests should be administered if the individual uses
a respirator, has been or may be exposed to irritating or toxic
substances, or if the individual has breathing difficulties, especially when
wearing a respirator.
 Audiometric tests. Annual retests are required for personnel subject to
high noise exposures (an 8-hour, time-weighted average of 85 dBA or
more), those required to wear hearing protection, or as otherwise
indicated by reports of a temporary or permanent shift in hearing.
 Vision tests. Annual retests are recommended to check for vision
degradation.
 Blood and urine tests when indicated.

Traditional Biological Tests
Function Test Example
Liver:
General,
Obstruction,
and Cell injury
Blood tests
Enzyme test
Enzyme tests
 Total protein, albumin, globulin, total bilirubin (direct
bilirubin if total is elevated).
 Alkaline phosphatase.
 Gamma glutamyl transpeptidase (GGTP),
 Lactic dehydrogenase (LDH),
 Serum glutamic-oxaloacetic transaminase (SGOT),
 Serum glutamic-pyruvic transaminase (SGPT).
Kidney: General Blood tests
 Blood urea nitrogen (BUN),
 Creatinine,
 Uric acid.
Multiple Systems
and Organs
Urinalysis  Including color; appearance; specific gravity; pH;
qualitative glucose, protein, bile, and acetone; occult
blood; microscopic examination of centrifuged sediment.
Blood-Forming
Function
Blood tests  Complete blood count (CBC) with differential and platelet
evaluation, including white cell count (WBC), red blood
count (RBC), hemoglobin (HGB), hematocrit or packed
cell volume (HCT), and desired erythrocyte indices.
Reticulocyte count may be appropriate if there is a
likelihood of exposure to hemolytic chemicals.

Observed Effects
Type of Exposure
Lowered Number of
Sperm
Abnormal Sperm
Shape
Altered Sperm Shape
Altered Hormones/Sexual
Performance
Inorganic Lead X X X X
Dibromochloropropane X
Carbaryl (Sevin ) X
Toluenediamine and Dinitrotoluene X
Ethylene Dibromide X X X
Styrene and Acetone) X
Ethylene Glycol Monoethyl Ether X
Welding X X
Perchloroethylene X
Mercury Vapor X
Heat X X
Microwaves from Radar X
Kepone** X
Bromine Vapor** X X X
Radiation** (Chernobyl) X X X X
Carbon Disulfide X
2,4-Dichlorophenoxy Acetic Acid (2,4-D) X X
Male Reproductive Hazards

Observed Effects
Type of Exposure Agent Observed Effects Potentially Exposed Workers
Cancer treatment drugs (e.g.,
Methotrexate)
Infertility, miscarriage, birth defects, low birth
weight
Health care workers,
pharmacists
Certain ethylene glycol ethers such as 2-
ethoxyethanol (2EE) and 2-
methoxyethanol (2ME)
Miscarriages
Electronic and semiconductor workers
Carbon disulfide (CS2) Menstrual cycle changes Viscose rayon workers
Inorganic Lead
Infertility, miscarriage, low birth weight,
developmental disorders
Battery makers, solderers, welders,
radiator repairers, bridge painters,
firing range workers, home remodelers
Ionizing radiation (e.g., X-rays and
gamma rays)
Infertility, miscarriage, birth defects, low birth
weight, developmental disorders, childhood
cancers
Health care workers, dental personnel,
atomic workers
Strenuous physical labor (e.g., prolonged
standing, heavy lifting)
Miscarriage late in
pregnancy, premature delivery
Many types of workers
Cytomegalovirus (CMV) Birth defects, low birth weight,
Developmental disorders
Health care workers, workers in contact with infants and
children
Hepatitis B virus Low birth weight Health care workers
Human immunodeficiency virus (HIV)
Low birth weight, childhood
cancer
Health care workers
Human parvovirus B19
Miscarriage
children
Rubella (German measles)
Birth defects, low birth weight
children
Toxoplasmosis
Miscarriage, birth defects, developmental
disorders
Animal care workers, veterinarians
Varicella zoster virus(chicken pox) Birth defects, low birth weight
children
Female Reproductive Hazards

Dura- Uncertainty Cover CAS
Route tion MRL Factors Endpoint Status Date Number
Oral Int. 0.6 mg/kg/day 300 Hepatic Final 08/95 83-32-9
NAME ROUTE
DURATION OF
EXPOSURE
MRL
UNCERTAINTY
FACTOR
ENDPOINT STATUS COVER DATE CAS NUMBER
ACETONE
Inh. Acute 26 ppm 9 Neurol. Final 05/94 67-64-1
Int. 13 ppm 100 Neurol.
Chr. 13 ppm 100 Neurol.
Oral Int. 2 mg/kg/day 100 Hemato.
ACROLEIN
Inh. Acute 0.003 ppm 100 Resp. Final 08/07
107-02-8
Int. 0.00004 ppm 300 Resp.
Oral Int. 0.004 mg/kg/day 100 Gastro.
ACRYLAMIDE
Oral Acute 0.01 mg/kg/day 30 Repro. Final 12/12
79-06-1
Int. 0.001 mg/kg/day 30 Neurol.
Chr. 0.001 mg/kg/day 30 Neurol.
ACRYLONITRILE Inh. Acute 0.1 ppm 10 Neurol. Final 12/90 107-13-1
Oral Acute 0.1 mg/kg/day 100 Develop.
Int. 0.01 mg/kg/day 1000 Repro.
Chr. 0.04 mg/kg/day 100 Hemato.
ALDRIN Oral Acute 0.002 mg/kg/day 1000 Develop. Final 09/02 309-00-2
Chr. 0.00003 mg/kg/day 1000 Hepatic
ALUMINUM Oral Int. 1.0 mg/kg/day 30 Neurol. Final 09/08 7429-90-5
Chr. 1.0 mg/kg/day 90 Neurol.
AMERICIUM Rad. Acute 4 mSv 3 Develop. Final 10/04 7440-35-9
Chr. 1 mSv/yr 3 Other
AMMONIA Inh. Acute 1.7 ppm 30 Resp. Final 10/04 7664-41-7
Chr. 0.1 ppm 30 Resp.
ANTHRACENE Oral Int. 10 mg/kg/day 100 Hepatic Final 08/95 120-12-7
ASTDR Minimum Risk Levels (MRLs)

Mental Health History

Severity of Psychosocial Stressors in Adulthood
Severity Acute Events Enduring Circumstances
None None None
Mild
Broke up with boyfriend/girlfriend Family arguments
Started or graduated from school Job dissatisfaction
Child left home Residence in high-crime region
Moderate
Marriage Marital discord
Marital separation Serious financial problems
Loss of job Trouble with boss
Miscarriage Being a single parent
Severe
Divorce Unemployment
Birth of first child Poverty
Extreme
Death of spouse Serious chronic illness
Serious physical illness diagnosed Ongoing physical or sexual abuse
Victim of rape
Catastrophic
Death of child Captivity as hostage
Suicide of spouse Concentration camp experience
Devastating natural disaster
Nakao BioPsychoSocial Medicine 2010 4:4 doi:10.1186/1751-0759-4-4

Process Step Sub-Step Description Responsibility
Step 1: Industrial Hygienist (IH) or Health,
Safety, and Environmental (HSE) staff
performs workplace assessment to
characterize major chemical, biological,
radiological, human factors/ergonomic,
and/or physical agent exposure(s) as part of
industrial hygiene/exposure monitoring
survey to validate TBRAs.
1. Using Control Banding - define Similar Exposure Groups (SEG): The IH/HSE staff will group workers having the
same general exposure profile by control banding based on:
a. Similarity, duration, and frequency of the tasks they perform
b. Materials, operation, and processes with which they work
c. Similarity of the way they perform the work tasks based on performance using Standard Operating Procedures
(SOPs)
Medical Director and
Regional HSE Manager
2. Define Task-Based Risk Assessment Profiles for each SEG: The IH/HSE will use quantitative and qualitative
data, including exposure monitoring to determine:
a. The degree of personnel exposure
b. Estimates of the actual exposure levels for the SEG
c. Specialized biological monitoring to evaluate exposure indices
3. Make Judgments on Acceptability of the Exposure Profile for each SEG- The IH/HSE shall judge the SEG
exposure profile as acceptable, uncertain, or unacceptable. The IH/HSE shall
a. Determine and document the rationale for each judgment
b. Evaluate and determine the adequacy of existing controls
4. Make Control Strategy Recommendations - The IH/HSE makes appropriate recommendations regarding the
workplace, workforce and environmental agents based on the results of the exposure assessments by using
accepted industrial hygiene practices, which also comply with appropriate regulatory requirements.
a. Include hazard-based medical surveillance recommendations for SEGs determined to have moderate to high
exposure profiles
5. Communication -IH/HSE communicates applicable medical surveillance recommendations to the surveyed
activity (HSE Manager, P&O Manager, HSE Officer, and Medical Director (when applicable)) via the industrial
hygiene survey.
a. IH/HSE explains how every section of the IH survey helps contribute to the overall Occupational Safety and
Health program effectiveness for their group
b. IH/HSE explains hazard-based recommendations and also informs regional leadership about additional
requirements to certify exams for their personnel
6. Record Keeping – IH/HSE documents exposure data in the Occupational Health Data Management System
Step 2: Department Head, Regional P&O
Manager, and/or HSE Manager reviews
outcome of most current industrial hygiene
survey and TBRA results with Supervisors
1. Department Head, Regional P&O Manager, and/or HSE Manager works with supervisors to identify each
specific worker (by name) recommended for hazard based surveillance, including new check-ins during check-in
process from TBRA.
Department Head, Regional
P&O Manager, or Regional
HSE Manager
2. Department Head, Regional P&O Manager, and/or HSE Manager places each worker into the company’s
manual or automated tracker system
3. Schedule required medical surveillance examinations for workers with sufficient lead time to complete
examinations and maintain qualifications based on the company's operational schedule

Step 3: Worker or Supervisor contacts Regional HSE Manager,
P&O Manager or Medical Director’s office (when applicable) to
schedule initial baseline, annual, or termination exam
1. Communicate worker’s required exams to Occupational Health staff and
verify any paperwork that worker needs to bring to exam
Individual Supervisor,
Regional HSE Manager,
P&O Manager and/or
Company Medical
Director
2. The Medical Director may perform several Occupational Health Medical
Surveillance examinations. If performed by an affiliated Company MDR, the
MDR should document the exam appropriately.
3. Supervisor accommodates exam in worker’s schedule
Step 4: Occupational Health clinic utilizes TBRA Matrix to
consolidate all required exam elements into one (if possible)
exam visit
N/A Medical Director
Step 5: Worker reports to Company Medical Department for
physical exam (when applicable) at appointed exam date/time
N/A Individual Supervisor,
P&O Manager Medical
Director and Individual
Worker
Step 6: Medical Director (when applicable) performs physical
exam, collect appropriate specimens/samples and documents
exam completion and disposition based on all of the
observations and findings
1. Place hardcopy of exam completion in medical record (when applicable) Medical Director
2. Enter exam completion into electronic medical record
3. Notify P&O Manager and Supervisor of exam completion and disposition
- Qualified
- Not Qualified
- Qualified with Work Restrictions
4. Results indicating overexposure to a health stressor should be forwarded
to the worker’s Supervisor, P&O Manager, and HSE Manager
5. Complete a Medical Surveillance Exam Completion and Disposition form
Step 7: Worker returns to work with exam completion
documentation
1. Medical Director or other Company MDR provides objective documentation
of exam completion and disposition to worker
- Qualified
- Not Qualified
- Qualified with Work Restrictions
Medical Director
2. Examining physician completes a Physician's/Provider's Written Opinion
form

Step 8: Supervisor concurs or non-concurs with exam
completion and updates by Regional HSE Manager or Medical
Director
1. Worker provides copy of objective documentation to Supervisor, Regional P&O
Manager and/or HSE Manager
Supervisor, Regional HSE
Manager, P&O Manager,
and/or Medical Director2.HSE Manager or Medical Director updates occupational health tracking system
Step 9: Regional HSE Manager or Medical Director updates
tracker system with exam date and next exam due date
1. Occupational health tracker can take any form
a. Automated system
b. Manual system (Excel, Access, etc.)
P&O Manager, and/or
Medical Director
Step 10: Regional HSE Manager and/or Medical Director
checks tracker system for scheduling periodically (monthly but
not longer than quarterly recommended)
1. Regional HSE Manager or Medical Director notifies Supervisors of personnel coming
due for medical surveillance exam within 45 (recommended) days
P&O Manager, and/or
Medical Director2. Supervisor alerts worker of exam due
3. Supervisor or worker contact by Regional HSE Manager, P&O Manager, and/or Medical
Director for exam scheduling/appointment (Return to Process Step 3)
4. Supervisors should inform Regional HSE Manager, P&O Manager or Medical Director if
worker changes job duties and may no longer need to be enrolled in program. Regional
HSE Manager or P&O Manager should consult with Medical Director regarding Termination
Exam prior to official disenrollment from program.
Step 11: Regional HSE Manager or P&O Manager calculates
and reports exam/BEI completion rates for medical
surveillance program based on occupational health tracker
data
1. Calculate the overall exam completion rate using the following formula:
Occupational Medical Exam Completion Rate (%) = # of personnel receiving required
medical exams x 100 divided by the # of personnel requiring medical exams for
occupational exposures
P&O Manager, and/or
Medical Director
2. Calculate the overall audiogram completion rate using the following formula:
Occupational Audiogram Completion Rate (%) = # of personnel receiving required
audiograms x 100 divided by the # of personnel requiring audiograms
3. Calculate the overall BEI completion rate using the following formula:
Occupational BEI Completion Rate (%) = # of personnel receiving required BEIs as part of
their medical exam x 100 divided by the # of personnel requiring medical exams for
occupational exposure
4. Calculate the overall occupational health performance using the following formula:
Overall Qualified Workforce Rate (%) = # of personal considered “qualified or qualified with
restriction x 100 divided by total number of examinations
5. Report the overall Occupational Medical Exam Completion Rates to higher corporate
manager via the annual HSE self-assessment process
Step 12 (if applicable): Medical Director notifies Supervisor via
Regional P&O Manager, HSE Manager, if exam indicates
“Qualified” or “Qualified With Restrictions
1. Notification should be addressed to the Supervisor, Regional HSE Manager and P&O
Manager
P&O Manager, and/or
Medical Director

Step 13 (if applicable): If worker is deemed medically “Not
Qualified”, or “Qualified with Restrictions” the Regional HSE
Manager, P&O Manager, and/or Medical Director consults with
Supervisor regarding findings
1. Quantitatively characterize exposure(s) Regional HSE Manager,
P&O Manager, and/or
Medical Director
2. Consider possible control measures
3. Re-evaluate individual work exposure, working/operating conditions, and
the selection and use of personal protective equipment
4. Determine follow-up exam recommendations and further testing for
confirmation
Step 14 (if applicable): Medical Director notifies Regional HSE
and P&O Manager of reportable illness or injury from
occupational exposure or mishaps
1. Utilize absenteeism, accident, injury and illness statistics, reports, email, or
other notification method to ensure Regional HSE Manager, P&O Manager,
Medical Director, and Supervisor are aware of all reportable occupational
related illnesses and injuries
P&O Manager,
Step 15 (if applicable):Regional HSE Manager reports loss time
or restricted workdays related to occupational illness and
injuries to Corporate HSE Manager
1. Report recordable occupational illness and injury statistics to the Corporate
HSE Manager
Regional HSE Manager
2. Report near-miss occupational illness and injury statistics to the Corporate
HSE Manager
3. Compare regional occupational injury and illness statistics with corporate
performance metrics and benchmarks
Step 16 (if applicable): Contract workers with possible
occupationally-related health issues or injuries contact Regional
HSE Manager, P&O Manager, and Contracts Department Head
1. If abnormality in lab results or medical examination is perceived to be work
related based on contractor physical provided to their personnel, information
should be shared and provided to Regional HSE Manage
P&O Manager,
Contracts Department
Head, and Contractor
Management
2. Using control banding with SEGs, HSE staff should determine if company
personnel may be at risk for similar adverse outcomes from occupational
exposure
Step 17: Regional HSE Manager and/or Medical Director
periodically assesses the tracker to ensure proper updating and
compliance status
1. Regional HSE Manager or Medical Director must frequently communicate
with P&O Manager and Supervisors in order to maximize likelihood of proper
personnel identification, enrollment, tracking, and exam completion.
and/or Medical Director
2. Update tracking system as needed.
Step 18: Corporate HSE provide oversight of regional medical
surveillance program implementation, assessment, and quality
control/assurance
Corporate HSE periodically assess regional HSE programs during annual
health and safety self-assessment rollup or during required triennial
Occupational Safety and Health Management Evaluations
Corporate and Regional
HSE Managers, and/or
Medical Director

Component Recommended Optional
Executive Physical
Examination
 Medical history review on reported physical/mental ailment
 Comprehensive physical
 Laboratory tests:
o CBC (Complete Blood Count) with differential
o Urinalysis
o Chemistry profile including lipid profile/cholesterol screening, blood
sugar, liver and kidney profile
o Thyroid function tests
o C reactive protein, homocysteine
 Colorectal cancer screening
 EKG (Electrocardiogram)
 Body composition analysis
 Spirometry, as needed
 Audiometry, as needed
 Visual acuity, as needed
 Immunizations: MMR (measles, mumps,
 rubella) if born after 1956, tetanus every 10 years and hepatitis, as needed
 Pap smear (women)
 PSA (prostate specific antigen): Annual testing typically begins at age 45
(men)
Additional exam components are provided when recommended:
 Baseline mammogram at age 38 (women)
 Audiology evaluation
 Eye examination with glaucoma screening
 Dermatology evaluation
 Nutrition consult
 Chest X-ray
 Cardiac stress test (non-imaging): Baseline at age 45 repeat every 2 years
 Bone densitometry: recommended at menopause and then every two years
or upon physician recommendation
 Colonoscopy at age 50 and then every 5 to 7 years.

Staff Pre-Placement
Screening
 Medical history review on reported physical/ mental ailment
 Occupational history.
 Physical examination.
 Determination of fitness to work and wearing protective clothing,
respirator, and equipment.
 Audiometry testing, as needed
o Urinalysis
o Chemistry profile including lipid profile/cholesterol screening,
blood sugar, liver and kidney profile
o Specific biological indices
 Immunizations: MMR (measles, mumps, rubella) if born after 1956,
tetanus every 10 years and hepatitis, as needed
 Pap smear (women)
 PSA (prostate specific antigen): Annual testing typically begins at age
45 (men)
 Chest X-ray, as needed
 Colonoscopy at age 50 and then every 5 to 7 years.
 Pulmonary function test (PFT) – Spirometry from respirator use.
 Eye examination
 Baseline mammogram at age 38 (women)
 Dermatology, as needed
 EKG (Electrocardiogram)
 Freezing pre-
employment serum
specimen for later testing
(limited to specific
situations,

Staff Periodic/Annual
Medical Exam
 Yearly update of medical and occupational history; yearly
physical examination; testing based on
(1) Initial/periodic exam results
(2) Exposures, and
(3) Job class and task
(4) Risk rank based on hazard
 More frequent testing based on specific health condition or
risk of exposures.
 Specific monitoring requirements of OSHA health standards
 ACGIH Biological Exposure Indices (BEIs) based on chemical
exposure
 Audiometric exam (if applicable)
 Pulmonary function test (if needed based on respirator use)
o Urinalysis
o Chemistry profile including lipid profile/cholesterol
screening, blood sugar, liver and kidney profile
 Yearly testing with routine
medical tests, as needed
Staff Termination
Medical Exam
 Update of medical and occupational history; final physical
examination; and lab testing based on:
(1) Examination results,
(2) Exposure monitoring, and
(3) Job class and task
(4) Risk rank based on hazard
 Medical tests, as needed

Emergency Treatment
 Emergency first aid on site.
 Liaison with local hospital and medical specialists.
 Decontamination of victims.
 Telemedicine where needed
 Arrange for transport of victims.
 Transfer medical records; give details of incident and medical
history to next care provider.
 Lab tests based on hazard
 Medical follow-up based on exposure potential and exam
outcome
 Freezing serum specimen
for later testing (limited to
specific situations,
 Reporting medical
outcome to HSE, P&O,
and leadership
Non-emergency Treatment
 Develop mechanism for non-emergency health care.
 Construct total body health, nutrition, diet, exercise, and
wellness program
 Counseling for physical and mental health
 Progress and follow-up,
as needed
Return Back to Work or
Fitness for Duty Exams
 Physical or mental exam based on written policy to;
o Determine adequate recovery,
o Validate reason not performing up to the standards of the job,
o Confirm diagnosis or extent of related limitations or
restriction
o Prognosis or anticipated length of physical/mental disability
o Reasonable accommodations process to aid the impairment
which may make achievement difficult or limits the capacity
for work
o Review and confirm/rebut opinion to treating healthcare
provider
 Align return back to work
and fit for duty policy with
family and medical leave

Recordkeeping and
Review
 Maintain and provide access to medical records in
accordance with internal standard.
 Report and record occupational injuries and illnesses.
 Review risk assessment for work task regularly to determine
if additional testing is needed.
 Align recordkeeping with data from exposure monitoring
 Evaluate exposure monitoring data with adverse outcomes
to evaluate effectiveness of control measures to reduce risk
 Review and audit program periodically.
 Focus on current site hazards, exposures, risk and industrial
hygiene standards/guidelines
 Annual report of
occupational related
injuries and illness
 Annual report of medical
intervention based on
hazard
 Annual report on trending
medical cost for
examinations, treatment,
and rehabilitation therapy
for return personnel back
to work

Target
Organs
Medical
Surveillance
Criteria
Required
Exam
Required
Medical
History
Physical Exam
Elements
Required
Special
Procedures
Other
Required
Elements
Peripheral
nervous system
Central nervous
system
Eyes
Mucous
membranes
Respiratory
Liver and kidneys
Employees who are or
may be exposed
:
- At or above 0,012
mg.m3 AL 8-hour TWA
for more than 30 days
per year
- At or above 0,025
mg.m3 PEL 8-hour
TWA for more than 10
days per year
- At or above 0,025
mg.m3 for 30 days or a
maximum ceiling value
of 0.1 mg.m3 for more
than 10 days a year
- At or above BEI
criterion
Note: Adjust AL or PEL
8-hour TWA exposure
values for extended 12-
hour workshift (i.e.,
multiply each value by
0.67 to get correct
guidance on exposure
levels
Initial (baseline)
Annual
Reassignment or
termination of
Emergency exposure
collect blood/urine
sample prior to for
urinary mercury or at
the end of the shift for
blood mercury levels.
Medical removal from
work exposure when
requested by
nephrologist
Detailed work
exposure history
(provided by
employer)
Medical history
including:
- Past exposure via
inhalation or skin
absorption to
elemental or organic
mercury compounds
- Renal disease
- Liver disease
- Medication history
- Exposure from dietary
sources
- Personal or family
history of mercury
exposure
Examinations
conducted by or under
the direct supervision of
a
licensed physician
Initial complete
physical exam
Detailed medical and
occupational History
initially,
brief update annually
Complete physical
examination with focus
on the
blood, skin from
absorption, CNS, and
liver and kidney function
Respirator medical
exam if required
Annual: Brief history
regarding any new
exposures, changes in
CNS, PNS, liver and
kidney function
Complete blood count
(CBC), urinalysis,
voluntary pregnancy
test, and urine/blood
mercury (results
reviewed by examining
physician)
Other tests deemed
appropriate by the
physician PFT (every 3
years if required to use
a
respirator >30 days a
year)
Emergency exposure:
Annual exam
requirements plus
urinary/blood mercury
test
BEI: >35 ug total
inorganic mercury/g
creatinine prior to work
shift and/or >15 ug/l
total inorganic mercury
in blood end of the work
shift at end of workweek
Physician’s written
opinion to employer:
- Results of medical
examination and
testing
- Opinion whether
exposure places
worker at increased
risk for health
impairment
- Recommended work
limitations
- Statement that
employee has been
informed of exam
results and conditions
that may require further
evaluation
Employer shall provide
copy of written opinion
to affected employee
Medical Surveillance Program for Exposure to Inorganic Mercury

Target
Organs
Medical
Surveillance
Criteria
Required
Exam
Required
Medical
History
Physical Exam
Elements
Required
Special
Procedures
Other
Required
Elements
Blood/bone
marrow
Central nervous
system
Eyes
Respiratory
Skin
Kidneys
Employees who are or
may be exposed
:
- At or above 0.25 ppm
8-hour AL TWA more
than 30
days per year
- At or above 0.5 ppm
PEL 8-hour TWA or
peaks of 2.5 ppm for
15-min STEL for more
than 10 days a year
- At or above BEI
criterion
- At or above 1 part per
million (ppm) 30 days
per year prior to 1987
- Exposure to >0.1%
benzene solvent or
exposure from oil/gas
products
Note: Adjust A or PEL
8-hour TWA exposure
values for extended 12-
hour workshift (i.e.,
multiply each value by
0.67 to get correct
levels
Initial (baseline)
Annual
Reassignment or
termination of
Emergency exposure
collect urine sample at
the end of shift for
urinary phenol test
within 72 hours and
urine specific gravity
corrected to 1.024.
If urinary phenol test is
equal to or greater than
75 mg phenol/L of
urine, repeat CBC
monthly for three (3)
months.
Medical removal from
work exposure when
requested by
hematologist/internist
Detailed work
exposure history
(provided by
employer)
Medical history
including:
- Past exposure to
benzene or other
blood/bone marrow
toxins
- Renal disease
- Liver disease
- Medication history
- Exposure to ionizing
radiation
- Exposure to bone
marrow toxins
outside the work
environment
- Personal or family
history of blood
dyscrasias including
blood/bone marrow
neoplasms, genetic
hemoglobin
abnormalities,
bleeding disorders, or
abnormal function of
formed blood
elements
Examinations
conducted by or under
the direct supervision
of a
licensed physician
Initial complete
physical exam
Detailed medical and
occupational History
initially,
brief update annually
Complete physical
examination with focus
on the
blood, skin from
absorption, CNS, and
liver and kidney
function
Respirator medical
exam if required
Annual: Brief history
regarding any new
exposures, changes in
any drug use, and
appearance of physical
signs
relating to blood
disorders
Complete blood count
(CBC) (results
reviewed by examining
physician)
Other tests deemed
appropriate by the
physician PFT (every 3
years if required to use
a
respirator >30 days a
year)
Emergency exposure:
Annual exam
requirements plus end
of-shift urinary phenol
test
BEI: >25 ug/l S-
phenylmercapturic acid
in urine at end of
workshift or > 500 mg
t,t-merconic acid/g
creatinine in urine at
end of workshift
Refer to full standard
for guidance on further
evaluation/ordering of
laboratory tests
Physician’s written
opinion to employer:
- Results of medical
examination and
testing
- Opinion whether
exposure places
worker at increased
risk for health
impairment
- Recommended work
limitations
- Statement that
employee has been
informed of exam
results and conditions that
may require further
evaluation
Employer shall provide copy
of written opinion
to affected employee
Medical Surveillance Program for Exposure to Benzene

Target
Organs
Medical
Surveillance
Criteria
Required
Exam
Required
Medical
History
Physical Exam
Elements
Required
Special
Procedures
Other
Required
Elements
Blood/bone
Marrow
Central and
peripheral
nervous systems
Gastrointestinal
System
Gums
Kidneys
Reproductive
System
Cardiovascular
system
Employees who are or may
be exposed:
-At or above the 0.025
mg/m3 AL TWA for more
than30 days a year
-At or above the 0.05
mg/m3 PEL TWA for more
than 10 days a year
Examinations must be
conducted by or under the
supervision of a
licensed physician
A multiple-physician
review may be
required for discrepancies
in medical opinion or
diagnosis.
Note: Adjust AL and PEL 8-
hour TWA exposure values
for extended 12-hour
workshift (i.e., multiply each
value by 0.67 to get correct
levels
Pre-placement
(baseline)
Annual (at least
annually for any
employee with a blood lead
level (BLL) at or
above 40 μg/100g in
preceding 12 months)
Emergency exposure
When medically
appropriate for each
employee either
removed from or
otherwise limited with
regard to lead exposure
Upon request of
employee for medical
advice regarding lead
exposure and
reproductive health
As required for
respirator clearance
Reassignment or
termination of occupational
exposure
Detailed medical and work
history with emphasis on:
- Past lead exposure
- Occupational
- Non-occupational
- Personal habits
- Smoking
- Hygiene
- Past problems
- Gastrointestinal
- Renal
- Reproductive
- Neurological
- Hematologic
Examinations
conducted by or under the
direct supervision of a
licensed physician
Complete physical
exam with particular
attention to:
- Teeth
- Gums
- Hematologic system
- Gastrointestinal tract
- Kidneys
- Heart
- Blood vessels
- Blood pressure
- Neurologic system
- Lungs (if respirator
will be required)
Blood lead (at least
every 6 months)
CBC with indices and
peripheral smear
morphology
Zinc protoporphyrin
(ZPP) (required each time a
BLL is
measured)
BUN
Cr
Urinalysis (UA) with
microscopic
Medical evaluation if
respirator required
For biological
Monitoring
BEI: >30 ug lead/100 ml
blood.
Use control banding to
evaluate similar exposures
for different work tasks.
Employee may request
additional physician
evaluation (up to three
physicians total)
Other tests deemed
appropriate by
examining physician
Physician’s
written opinion that
includes:
- Whether employee
has a medical
condition placing the
employee at
increased risk from
lead exposure
- Any recommended
protective measures
or limitations for
employee
- Any recommendation
regarding limited use of
respirators
- Results of blood lead
determinations
- Statement that
employee has been
informed of exam
results
Medical Surveillance Program for Exposure to Inorganic Lead

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