Subpart Z
Occupational asbestos exposure is linked to lung cancer, pleural and peritoneal mesothelioma, gastrointestinal cancer, and asbestosis. The appendix also notes associations with increased rates of esophageal, kidney, laryngeal, pharyngeal, and buccal cavity cancers.
Asbestos-related diseases are typically long-latency and often appear many years after first exposure—commonly about 20 years for most diseases. Mesothelioma has an even longer average latency (about 40 years), while lung cancer often appears after roughly 15–20 years.
No — the appendix states there are no known acute effects associated with asbestos exposure; the health effects are generally chronic and appear many years later.
Smoking greatly increases the risk of lung cancer for workers exposed to asbestos, and quitting smoking will reduce that risk but not down to the level of someone who was never exposed to asbestos.
Shortness of breath, chest pain, abdominal pain (for mesothelioma), persistent cough, unexplained fatigue, and findings on chest X-ray such as pleural plaques, pleural calcification, pleural fibrosis, or small irregular parenchymal opacities should prompt further medical evaluation.
Asbestosis is a fibrotic lung disease caused by asbestos fiber accumulation in the lungs; diagnosis is based on an asbestos exposure history, characteristic radiologic abnormalities, end-inspiratory crackles (rales), and other clinical features of pulmonary fibrosis.
The employer must provide a medical surveillance program for all employees who are or will be exposed to asbestos at or above the permissible exposure limit of 0.1 fiber per cubic centimeter of air.
All examinations and procedures must be performed by or under the supervision of a licensed physician and must be provided at a reasonable time and place at no cost to the employee.
Routine exams must include: (i) medical and work histories with emphasis on respiratory, cardiovascular and digestive symptoms; (ii) completion of the respiratory disease questionnaire in Appendix D of the standard; (iii) a physical exam including a chest X‑ray and pulmonary function test measuring FVC and FEV1; and (iv) any other laboratory or tests the physician deems necessary.
Employers must make the prescribed medical tests available at least annually, more often if the examining physician recommends it, and upon termination of employment.
The employer must give the physician a copy of the asbestos standard and its appendices, a description of the employee’s duties related to asbestos exposure, the employee’s representative exposure level, a description of personal protective and respiratory equipment used, and relevant prior medical examination information not otherwise available to the physician.
The written opinion must state the results of the examination, whether the employee has any medical conditions that increase risk of exposure-related disease, any recommended work limitations or PPE limitations, and that the employee has been informed of the exam results and any asbestos-related conditions needing follow-up. It must not reveal specific findings or diagnoses unrelated to asbestos exposure. A copy must be provided to the employee.
If a physician identifies overexposure, the employer should take measures to eliminate or mitigate further exposure so as to lower the risk of serious long-term consequences for the employee.
Yes — chest X‑rays and pulmonary function tests may indicate that an employee has been overexposed to asbestos and has increased risk of developing asbestos-related chronic disease, even though there are no adequate screening tests to reliably predict cancers caused by asbestos.
Yes — asbestos remediation activities involving asbestos-containing building materials performed during property remediation or restoration are covered by OSHA’s construction asbestos standard, 29 CFR 1926.1101, not the general industry asbestos standard.
Yes — OSHA gives the examining physician broad latitude to prescribe additional laboratory or other tests that the physician deems necessary according to sound medical practice.
Yes — examinations and procedures must be performed at a reasonable time and place and must be provided at no cost to the employee.
Yes — if the examining physician recommends more frequent testing than annual, the employer is required to make those tests available as recommended.
Exposure levels influence both the need for medical surveillance (employer must provide surveillance at or above the PEL of 0.1 f/cc) and the level of respiratory protection required; for certain Class I asbestos tasks, higher measured exposures (for example, exceeding 1 f/cc as an 8‑hour TWA) trigger mandatory use of supplied‑air respirators with auxiliary SCBA, while lower exposures require different respirator options or negative exposure assessments.
The physician should become familiar with the workplace operating conditions where asbestos exposure can occur because that information is important for evaluating medical and work histories and conducting appropriate physical examinations.
Yes — the employer must provide a copy of the physician’s written opinion to the affected employee.