Close this search box.

Diving into Medical Surveillance in the Silica Rule

Over the last few months, we’ve covered many issues related to OSHA’s new silica rule for construction, from understanding Table 1 to addressing requirements for objective data and competent persons.

Now that enforcement has begun and the standard is in full effect, contractors are starting to ask more questions about another important aspect of the rule – medical surveillance. Here’s what all LIUNA signatory contractors should know about staying in compliance and ensuring workers are being monitored for negative health effects caused by exposure to respirable crystalline silica.

First, the purpose of medical surveillance is to:

  • Identify health effects associated with silica exposure early so employees can take appropriate action
  • Determine if an employee has any condition, such as chronic obstructive pulmonary disorder (COPD), that might make them more sensitive to silica exposure
  • Determine the employee’s fitness to continue to use respirators

    LIUNA General Secretary-Treasurer and LHSFNA Labor Co-Chairman Armand E. Sabitoni

“Medical surveillance is currently available to workers, equipping them with critical information about their health,” says LIUNA General Secretary-Treasurer and LHSFNA Labor Co-Chairman Armand E. Sabitoni. “By providing our members with the newest advancements in medical technology, Laborers who work in the field can take action to protect their health by limiting future silica exposure, voluntarily wearing a respirator for extra protection and making personal lifestyle or health choices such as quitting smoking.”

Construction employers are required to make initial or periodic medical exams available to all employees who will wear a respirator for 30 or more days over the next year due to silica exposure. The standard also requires medical surveillance to be:

  • Available at no cost to employees
  • Available at a reasonable time and place
  • Performed by a physician or other licensed health care professional (PLHCP)
  • Offered at least every three years following the initial exam, unless recommended more often by a PLHCP

Now let’s look beyond the general requirements and answer some of the common questions that LIUNA District Councils, Local Unions, Training Fund representatives, signatory contractors and members may have about medical surveillance requirements in the standard.

How is 30 days calculated? What if I switch employers during the year or only wear a respirator for a few minutes a day?

Any amount of respirator use on a given day, even just a few minutes, counts as a full day toward the 30 day limit over the next 365 days. However, days of respirator use with another employer don’t count toward this 30 day threshold. Contractors only have to track when they put employees in respirators, not when a different employer required it.

If a worker gets an exam and then switches jobs, do they have to get another exam after 30 days of respirator use with the new employer?

No. Workers who are cleared after an initial baseline test can go three years without being offered another exam. After an exam, workers will receive a written medical opinion that includes any recommended limitations on their exposure to silica and serves as proof that medical surveillance requirements under the silica standard have been met for the next three years.

What does the exam actually include?

Exams include a review of the patient’s medical and work history, a physical exam with special emphasis on the respiratory system and a pulmonary function test. Unlike medical fit testing that workers undergo as part of OSHA’s respiratory protection standard, medical surveillance under the silica rule calls for two additional tests – a chest X-ray interpreted by a NIOSH-certified B Reader and a test for latent tuberculosis.

Employers must also provide information to the physician or PLHCP prior to the exam, including:

  • The silica rule’s exposure standards
  • Description of former, current and anticipated duties related to the employee’s occupational exposure to silica dust
  • Details of any personal protective equipment (PPE) used by the employee, including time and duration. This information must also be provided for anticipated future use.
  • Any applicable employment-related medical exams currently held by the employer

Do the employer and the employee get the same information after an exam?

Mostly, but not entirely. The employer and employee both receive a written medical opinion with the date of the exam, a statement that the exam checked for silica exposure and any recommended limitations on the employee’s futures exposures. The employee may also receive additional medical information, but that information is private and not shared with the employer unless the employee gives written authorization. The goal of this requirement is to enhance employee privacy and encourage employees to participate in medical surveillance by minimizing fears about retaliation or discrimination based on medical findings.

What is the cost of an exam?

Like most costs related to health care, the cost of an exam is likely to vary depending on your geographic location. Estimates place the cost of each exam at around $420. This calculation includes the cost of the exam itself and the fact that employees must be paid for the time spent taking the exam.

LHSFNA Resources

The LHSFNA’s What Your Doctor Needs to Know About Silica pamphlet provides additional information about the health risks of occupational silica exposure. The Fund’s Silica Rule Compliance Flowchart and Silica and Table 1: A Field Guide to Compliance publications can help LIUNA signatory contractors reduce worker exposures while assisting with compliance. To order these or other silica-related materials, visit and click on Publications.

[Nick Fox]

Recent Lifelines