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(continued)
(3)Medical surveillance.
(A) The employer shall establish and maintain an accurate record for each employee subject to medical surveillance under subsection (j).
(B) The record shall include at least the following information:
1. The name, social security number and description of the duties of the employee;
2. Written medical opinions; and
3. Any employee medical conditions related to exposure to MC.

4. The employer shall ensure that this record is maintained for the duration of employment plus thirty (30) years, in accordance with s 3204.
(4)Availability.
(A) The employer, upon written request, shall make all records required to be maintained by this section available to the Chief or NIOSH for examination and copying in accordance with s 3204. Note to subsection (m)(4)(A): All records required to be maintained by this section may be kept in the most administratively convenient form (for example, electronic or computer records would satisfy this requirement).
(B) The employer, upon request, shall make any employee exposure and objective data records required by this section available for examination and copying by affected employees, former employees, and designated representatives in accordance with s 3204.
(C) The employer, upon request, shall make employee medical records required to be kept by this section available for examination and copying by the subject employee and by anyone having the specific written consent of the subject employee in accordance with s 3204.
(5)Transfer of records.The employer shall comply with the requirements concerning transfer of records set forth in s 3204(h).
(n)Dates.
(1)Effective date. This section became effective on November 2, 1997.
(2)Start-up dates.
(A) Engineering controls required under subsection (f)(1) shall be implemented according to the following schedule:
1. For employers with fewer than 20 employees, within three (3) years after the effective date of this section.
2. For employers with fewer than 150 employees engaged in foam fabrication; for employers with fewer than 50 employees engaged in furniture refinishing, general aviation aircraft stripping, and product formulation; for employers with fewer than 50 employees using MC based adhesives for boat building and repair, recreational vehicle manufacture, van conversion, and upholstering; for employers with fewer than 50 employees using MC in construction work for restoration and preservation of buildings, painting and paint removal, cabinet making and/or floor refinishing and resurfacing, within three (3) years after the effective date of this section.
3. For employers engaged in polyurethane foam manufacturing with 20 or more employees, within thirty (30) months after the effective date of this section.
4. For employers with 150 or more employees engaged in foam fabrication; for employers with 50 or more employees engaged in furniture refinishing, general aviation aircraft stripping, and product fabrication; for employers with 50 or more employees using MC-based adhesives in boat building and repair, recreational vehicle manufacture, van conversion, and upholstering; and for employers with 50 or more employees using MC in construction work for restoration and preservation of buildings, painting and paint removal, cabinet making and/or floor refinishing and resurfacing, within two (2) years after the effective date of this section.
(B). Employers identified in subsections (n)(2)(A)2., 3., and 4. shall comply with the following requirements by the dates indicated:

1. Use of respiratory protection whenever an employee's exposure to MC exceeds or can reasonably be expected to exceed the 8-hour TWA PEL, in accordance with subsections (c)(1), (e)(3), (f)(1), and (g)(1), by the applicable dates set out in subsections (n)(2)(A)2., 3., and 4. for the installation of engineering controls.
2. Use of respiratory protection whenever an employee's exposure to MC exceeds or can reasonably be expected to exceed the STEL in accordance with subsections (e)(3), (f)(1), and (g)(1), by the applicable dates indicated in subsection (n)(2)(C).
3. Implementation of work practices (such as leak and spill detection, cleanup, and enclosure of containers) required by subsection (f)(1), by the applicable dates indicated in subsection (n)(2)(C).
4. Notification of corrective action under subsection (d)(5)(B) of this section, by no later than ninety (90) days before the compliance date applicable to such corrective action.
(C). Unless otherwise specified in subsection (n), all other requirements of this section shall be complied with.
(o) Reporting requirements. See section 5203.
(p)Appendices. The information contained in the appendices does not, by itself, create any additional obligations not otherwise imposed or detract from any existing obligation.


Note: Authority cited: Sections 142.3, 9020, 9030 and 9040, Labor Code. Reference: Sections 142.3, 9004(d), 9009, 9020, 9031 and 9040, Labor Code.







Appendix A to Section 5202 Substance Safety Data Sheet and Technical Guidelines for Methylene chloride.
I. Substance Identification

A. Substance: Methylene chloride (CH 2 Cl 2).
B. Synonyms: MC, Dichloromethane (DCM); Methylene dichloride; Methylene bichloride; Methane dichloride; CAS: 75-09-2; NCI-C50102.
C. Physical data:
1. Molecular weight: 84.9.
2. Boiling point (760 mm Hg): 39.8 deg.C (104 deg.F).
3. Specific gravity (water=1): 1.3.
4. Vapor density (air=1 at boiling point): 2.9.
5. Vapor pressure at 20 deg.C (68 deg.F): 350 mm Hg.
6. Solubility in water, g/100 g water at 20 deg. C (68 deg. F)=1.32.
7. Appearance and odor: colorless liquid with a chloroform-like odor.
D. Uses:
MC is used as a solvent, especially where high volatility is required. It is a good solvent for oils, fats, waxes, resins, bitumen, rubber and cellulose acetate and is a useful paint stripper and degreaser. It is used in paint removers, in propellant mixtures for aerosol containers, as a solvent for plastics, as a degreasing agent, as an extracting agent in the pharmaceutical industry and as a blowing agent in polyurethane foams. Its solvent property is sometimes increased by mixing with methanol, petroleum naphtha or tetrachloroethylene.
E. Appearance and odor:
MC is a clear colorless liquid with a chloroform-like odor. It is slightly soluble in water and completely miscible with most organic solvents.
F. Permissible exposure:
Exposure may not exceed 25 parts MC per million parts of air (25 ppm) as an eight-hour time-weighted average (8-hour TWA PEL) or 125 parts of MC per million parts of air (125 ppm) averaged over a 15-minute period (STEL).
II. Health Hazard Data

A. MC can affect the body if it is inhaled or if the liquid comes in contact with the eyes or skin. It can also affect the body if it is swallowed.
B. Effects of overexposure:
1. Short-term Exposure:
MC is an anesthetic. Inhaling the vapor may cause mental confusion, light-headedness, nausea, vomiting, and headache. Continued exposure may cause increased light-headedness, staggering, unconsciousness, and even death. High vapor concentrations may also cause irritation of the eyes and respiratory tract. Exposure to MC may make the symptoms of angina (chest pains) worse. Skin exposure to liquid MC may cause irritation. If liquid MC remains on the skin, it may cause skin burns. Splashes of the liquid into the eyes may cause irritation.
2. Long-term (chronic) exposure:
The best evidence that MC causes cancer is from laboratory studies in which rats, mice and hamsters inhaled MC 6 hours per day, 5 days per week for 2 years. MC exposure produced lung and liver tumors in mice and mammary tumors in rats. No carcinogenic effects of MC were found in hamsters. There are also some human epidemiological studies which show an association between occupational exposure to MC and increases in biliary (bile duct) cancer and a type of brain cancer. Other epidemiological studies have not observed a relationship between MC exposure and cancer. OSHA interprets these results to mean that there is suggestive (but not absolute) evidence that MC is a human carcinogen.
C. Reporting signs and symptoms:
You should inform your employer if you develop any signs or symptoms and suspect that they are caused by exposure to MC.
D. Warning Properties:
1. Odor Threshold:
Different authors have reported varying odor thresholds for MC. Kirk-Othmer and Sax both reported 25 to 50 ppm; Summer and May both reported 150 ppm; Spector reports 320 ppm. Patty, however, states that since one can become adapted to the odor, MC should not be considered to have adequate warning properties.

2. Eye Irritation Level:
Kirk-Othmer reports that "MC vapor is seriously damaging to the eyes." Sax agrees with Kirk-Othmer's statement. The ACGIH Documentation of TLVs states that irritation of the eyes has been observed in workers exposed to concentrations up to 5000 ppm.
3. Evaluation of Warning Properties:
Since a wide range of MC odor thresholds are reported (25-320 ppm), and human adaptation to the odor occurs, MC is considered to be a material with poor warning properties.
III. Emergency First Aid Procedures

In the event of emergency, institute first aid procedures and send for first aid or medical assistance.
A. Eye and Skin Exposures:
If there is a potential for liquid MC to come in contact with eye or skin, face shields and skin protective equipment must be provided and used. If liquid MC comes in contact with the eye, get medical attention. Contact lenses should not be worn when working with this chemical.
B. Breathing:
If a person breathes in large amounts of MC, move the exposed person to fresh air at once. If breathing has stopped, perform cardiopulmonary resuscitation. Keep the affected person warm and at rest. Get medical attention as soon as possible.
C. Rescue:
Move the affected person from the hazardous exposure immediately. If the exposed person has been overcome, notify someone else and put into effect the established emergency rescue procedures. Understand the facility's emergency rescue procedures and know the locations of rescue equipment before the need arises. Do not become a casualty yourself.
IV. Respirators, Protective Clothing, and Eye Protection

A. Respirators:
Good industrial hygiene practices recommend that engineering controls be used to reduce environmental concentrations to the permissible exposure level. However, there are some exceptions where respirators may be used to control exposure. Respirators may be used when engineering and work practice controls are not feasible, when such controls are in the process of being installed, or when these controls fail and need to be supplemented. Respirators may also be used for operations which require entry into tanks or closed vessels, and in emergency situations. If the use of respirators is necessary, the only respirators permitted are those that have been approved by the Mine Safety and Health Administration (MSHA) or the National Institute for Occupational Safety and Health (NIOSH). Supplied-air respirators are required because air-purifying respirators do not provide adequate respiratory protection against MC. In addition to respirator selection, a complete written respiratory protection program should be instituted which includes regular training, maintenance, inspection, cleaning, and evaluation. If you can smell MC while wearing a respirator, proceed immediately to fresh air. If you experience difficulty in breathing while wearing a respirator, tell your employer.
B. Protective Clothing:
Employees must be provided with and required to use impervious clothing, gloves, face shields (eight-inch minimum), and other appropriate protective clothing necessary to prevent repeated or prolonged skin contact with liquid MC or contact with vessels containing liquid MC. Any clothing which becomes wet with liquid MC should be removed immediately and not reworn until the employer has ensured that the protective clothing is fit for reuse. Contaminated protective clothing should be placed in a regulated area designated by the employer for removal of MC before the clothing is laundered or disposed of. Clothing and equipment should remain in the regulated area until all of the MC contamination has evaporated; clothing and equipment should then be laundered or disposed of as appropriate.
C. Eye Protection:
Employees should be provided with and required to use splash-proof safety goggles where liquid MC may contact the eyes.
V. Housekeeping and Hygiene Facilities

For purposes of complying with the sanitation requirements of Article 9, the following items should be emphasized:
A. The workplace should be kept clean, orderly, and in a sanitary condition. The employer should institute a leak and spill detection program for operations involving liquid MC in order to detect sources of fugitive MC emissions.
B. Emergency drench showers and eyewash facilities are recommended. These should be maintained in a sanitary condition. Suitable cleansing agents should also be provided to assure the effective removal of MC from the skin.
C. Because of the hazardous nature of MC, contaminated protective clothing should be placed in a regulated area designated by the employer for removal of MC before the clothing is laundered or disposed of.
VI. Precautions for Safe Use, Handling, and Storage

A. Fire and Explosion Hazards:
MC has no flash point in a conventional closed tester, but it forms flammable vapor-air mixtures at approximately 100 deg.C (212 deg.F), or higher. It has a lower explosion limit of 12%, and an upper explosion limit of 19% in air. It has an autoignition temperature of 556.1 deg.C (1033 deg.F), and a boiling point of 39.8 deg.C (104 deg.F). It is heavier than water with a specific gravity of 1.3. It is slightly soluble in water.
B. Reactivity Hazards:
Conditions contributing to the instability of MC are heat and moisture. Contact with strong oxidizers, caustics, and chemically active metals such as aluminum or magnesium powder, sodium and potassium may cause fires and explosions. Special precautions: Liquid MC will attack some forms of plastics, rubber, and coatings.
C. Toxicity:
Liquid MC is painful and irritating if splashed in the eyes or if confined on the skin by gloves, clothing, or shoes. Vapors in high concentrations may cause narcosis and death. Prolonged exposure to vapors may cause cancer or exacerbate cardiac disease.
D. Storage:
Protect against physical damage. Because of its corrosive properties, and its high vapor pressure, MC should be stored in plain, galvanized or lead lined, mild steel containers in a cool, dry, well ventilated area away from direct sunlight, heat source and acute fire hazards.
E. Piping Material:
All piping and valves at the loading or unloading station should be of material that is resistant to MC and should be carefully inspected prior to connection to the transport vehicle and periodically during the operation.
F. Usual Shipping Containers:
Glass bottles, 5- and 55-gallon steel drums, tank cars, and tank trucks. Note: This section addresses MC exposure in marine terminal and longshore employment only where leaking or broken packages allow MC exposure that is not addressed through compliance with Article 14.
G. Electrical Equipment:
Electrical installations in Class I hazardous locations as defined in Article 500 of the National Electrical Code, should be installed according to Article 501 of the code; and electrical equipment should be suitable for use in atmospheres containing MC vapors. See Flammable and Combustible Liquids Code (NFPA No. 325M), Chemical Safety Data Sheet SD-86 (Manufacturing Chemists' Association, Inc.).
H. Fire Fighting:
When involved in fire, MC emits highly toxic and irritating fumes such as phosgene, hydrogen chloride and carbon monoxide. Wear breathing apparatus and use water spray to keep fire- exposed containers cool. Water spray may be used to flush spills away from exposures. Extinguishing media are dry chemical, carbon dioxide, foam. For purposes of compliance with the Electrical Safety Orders, locations classified as hazardous due to the presence of MC shall be Class I.
I. Spills and Leaks:
Persons not wearing protective equipment and clothing should be restricted from areas of spills or leaks until cleanup has been completed. If MC has spilled or leaked, the following steps should be taken:
1. Remove all ignition sources.
2. Ventilate area of spill or leak.
3. Collect for reclamation or absorb in vermiculite, dry sand, earth, or a similar material.
J. Methods of Waste Disposal:
Small spills should be absorbed onto sand and taken to a safe area for atmospheric evaporation. Incineration is the preferred method for disposal of large quantities by mixing with a combustible solvent and spraying into an incinerator equipped with acid scrubbers to remove hydrogen chloride gases formed. Complete combustion will convert carbon monoxide to carbon dioxide. Care should be taken for the presence of phosgene.
K. You should not keep food, beverage, or smoking materials, or eat or smoke in regulated areas where MC concentrations are above the permissible exposure limits.
L. Portable heating units should not be used in confined areas where MC is used.
M. Ask your supervisor where MC is used in your work area and for any additional plant safety and health rules.
VII. Medical Requirements

Your employer is required to offer you the opportunity to participate in a medical surveillance program if you are exposed to MC at concentrations at or above the action level (12.5 ppm 8- hour TWA) for more than 30 days a year or at concentrations exceeding the PELs (25 ppm 8- hour TWA or 125 ppm 15-minute STEL) for more than 10 days a year. If you are exposed to MC at concentrations over either of the PELs, your employer will also be required to have a physician or other licensed health care professional ensure that you are able to wear the respirator that you are assigned. Your employer must provide all medical examinations relating to your MC exposure at a reasonable time and place and at no cost to you.
VIII. Monitoring and Measurement Procedures

A. Exposure above the Permissible Exposure Limit:
1. Eight-hour exposure evaluation: Measurements taken for the purpose of determining employee exposure under this section are best taken with consecutive samples covering the full shift. Air samples must be taken in the employee's breathing zone.
2. Monitoring techniques: The sampling and analysis under this section may be performed by collection of the MC vapor on two charcoal adsorption tubes in series or other composition adsorption tubes, with subsequent chemical analysis. Sampling and analysis may also be performed by instruments such as real-time continuous monitoring systems, portable direct reading instruments, or passive dosimeters as long as measurements taken using these methods accurately evaluate the concentration of MC in employees' breathing zones. OSHA method 80 is an example of a validated method of sampling and analysis of MC. Copies of this method are available from OSHA or can be downloaded from the Internet at http://www.osha.gov. The employer has the obligation of selecting a monitoring method which meets the accuracy and precision requirements of the standard under his or her unique field conditions. The standard requires that the method of monitoring must be accurate, to a 95 percent confidence level, to plus or minus 25 percent for concentrations of MC at or above 25 ppm, and to plus or minus 35 percent for concentrations at or below 25 ppm. In addition to OSHA method 80, there are numerous other methods available for monitoring for MC in the workplace.
B. Since many of the duties relating to employee exposure are dependent on the results of measurement procedures, employers must assure that the evaluation of employee exposure is performed by a technically qualified person.
IX. Observation of Monitoring

Your employer is required to perform measurements that are representative of your exposure to MC and you or your designated representative are entitled to observe the monitoring procedure. You are entitled to observe the steps taken in the measurement procedure, and to record the results obtained. When the monitoring procedure is taking place in an area where respirators or personal protective clothing and equipment are required to be worn, you or your representative must also be provided with, and must wear, protective clothing and equipment.
X. Access To Information

A. Your employer is required to inform you of the information contained in this Appendix. In addition, your employer must instruct you in the proper work practices for using MC, emergency procedures, and the correct use of protective equipment.
B. Your employer is required to determine whether you are being exposed to MC. You or your representative has the right to observe employee measurements and to record the results obtained. Your employer is required to inform you of your exposure. If your employer determines that you are being over exposed, he or she is required to inform you of the actions which are being taken to reduce your exposure to within permissible exposure limits.
C. Your employer is required to keep records of your exposures and medical examinations. These records must be kept by the employer for at least thirty (30) years.
D. Your employer is required to release your exposure and medical records to you or your representative upon your request.
E. Your employer is required to provide labels and material safety data sheets (MSDS) for all materials, mixtures or solutions composed of greater than 0.1 percent MC. An example of a label that would satisfy these requirements would be:
D anger Contains Methylene Chloride Potential Cancer Hazard
May worsen heart disease because methylene chloride is converted to carbon monoxide in the body.
May cause dizziness, headache, irritation of the throat and lungs, loss of consciousness and death at high concentrations (for example, if used in a poorly ventilated room).
Avoid Skin Contact. Contact with liquid causes skin and eye irritation.
XI. Common Operations and Controls

The following list includes some common operations in which exposure to MC may occur and control methods which may be effective in each case:

Operations Controls
Use as solvent in paint and varnish General dilution ventilation; local
removers; manufacture of aerosols; cold exhaust ventilation; personal
cleaning and ultrasonic cleaning; and as protective equipment; substitution.
a solvent in furniture stripping.
Use as solvent in vapor degreasing. Process enclosure; local exhaust
ventilation; chilling coils;
substitution.
Use as a secondary refrigerant in General dilution ventilation;
air conditioning and scientific testing. local exhaust ventilation;
personal protective equipment.




Note: Authority cited: Sections 142.3, 9020, 9030 and 9040, Labor Code. Reference: Sections 142.3, 9004(d), 9009, 9020, 9031 and 9040, Labor Code.







Appendix B to Section 5202 Medical Surveillance for Methylene chloride.
I. Primary Route of Entry

Inhalation.
II. Toxicology

Methylene chloride (MC) is primarily an inhalation hazard. The principal acute hazardous effects are the depressant action on the central nervous system, possible cardiac toxicity and possible liver toxicity. The range of CNS effects are from decreased eye/hand coordination and decreased performance in vigilance tasks to narcosis and even death of individuals exposed at very high doses. Cardiac toxicity is due to the metabolism of MC to carbon monoxide, and the effects of carbon monoxide on heart tissue. Carbon monoxide displaces oxygen in the blood, decreases the oxygen available to heart tissue, increasing the risk of damage to the heart, which may result in heart attacks in susceptible individuals. Susceptible individuals include persons with heart disease and those with risk factors for heart disease. Elevated liver enzymes and irritation to the respiratory passages and eyes have also been reported for both humans and experimental animals exposed to MC vapors. MC is metabolized to carbon monoxide and carbon dioxide via two separate pathways. Through the first pathway, MC is metabolized to carbon monoxide as an end-product via the P-450 mixed function oxidase pathway located in the microsomal fraction of the cell. This biotransformation of MC to carbon monoxide occurs through the process of microsomal oxidative dechlorination which takes place primarily in the liver. The amount of conversion to carbon monoxide is significant as measured by the concentration of carboxyhemoglobin, up to 12% measured in the blood following occupational exposure of up to 610 ppm. Through the second pathway, MC is metabolized to carbon dioxide as an end product (with formaldehyde and formic acid as metabolic intermediates) via the glutathione dependent enzyme found in the cytosolic fraction of the liver cell. Metabolites along this pathway are believed to be associated with the carcinogenic activity of MC.
MC has been tested for carcinogenicity in several laboratory rodents. These rodent studies indicate that there is clear evidence that MC is carcinogenic to male and female mice and female rats. Based on epidemiologic studies, OSHA has concluded that there is suggestive evidence of increased cancer risk in MC-related worker populations. The epidemiological evidence is consistent with the finding of excess cancer in the experimental animal studies. NIOSH regards MC as a potential occupational carcinogen and the International Agency for Research Cancer (IARC) classifies MC as an animal carcinogen. OSHA considers MC as a suspected human carcinogen.
III. Medical Signs and Symptoms of Acute Exposure

Skin exposure to liquid MC may cause irritation or skin burns. Liquid MC can also be irritating to the eyes. MC is also absorbed through the skin and may contribute to the MC exposure by inhalation.
At high concentrations in air, MC may cause nausea, vomiting, light-headedness, numbness of the extremities, changes in blood enzyme levels, and breathing problems, leading to bronchitis and pulmonary edema, unconsciousness and even death.
At lower concentrations in air, MC may cause irritation to the skin, eye, and respiratory tract and occasionally headache and nausea. Perhaps the greatest problem from exposure to low concentrations of MC is the CNS effects on coordination and alertness that may cause unsafe operations of machinery and equipment, leading to self-injury or accidents.
Low levels and short duration exposures do not seem to produce permanent disability, but chronic exposures to MC have been demonstrated to produce liver toxicity in animals, and therefore, the evidence is suggestive for liver toxicity in humans after chronic exposure. Chronic exposure to MC may also cause cancer.
IV. Surveillance and Preventive Considerations

As discussed above, MC is classified as a suspect or potential human carcinogen. It is a central nervous system (CNS) depressant and a skin, eye and respiratory tract irritant. At extremely high concentrations, MC has caused liver damage in animals. MC principally affects the CNS, where it acts as a narcotic. The observation of the symptoms characteristic of CNS depression, along with a physical examination, provides the best detection of early neurological disorders. Since exposure to MC also increases the carboxyhemoglobin level in the blood, ambient carbon monoxide levels would have an additive effect on that carboxyhemoglobin level. Based on such information, a periodic post-shift carboxyhemoglobin test as an index of the presence of carbon monoxide in the blood is recommended, but not required, for medical surveillance.
Based on the animal evidence and three epidemiologic studies previously mentioned, OSHA concludes that MC is a suspect human carcinogen. The medical surveillance program is designed to observe exposed workers on a regular basis. While the medical surveillance program cannot detect MC-induced cancer at a preneoplastic stage, OSHA anticipates that, as in the past, early detection and treatments of cancers leading to enhanced survival rates will continue to evolve.
A. Medical and Occupational History:
The medical and occupational work history plays an important role in the initial evaluation of workers exposed to MC. It is therefore extremely important for the examining physician or other licensed health care professional to evaluate the MC-exposed worker carefully and completely and to focus the examination on MC's potentially associated health hazards. The medical evaluation must include an annual detailed work and medical history with special emphasis on cardiac history and neurological symptoms.
An important goal of the medical history is to elicit information from the worker regarding potential signs or symptoms associated with increased levels of carboxyhemoglobin due to the presence of carbon monoxide in the blood. Physicians or other licensed health care professionals should ensure that the smoking history of all MC exposed employees is known. Exposure to MC may cause a significant increase in carboxyhemoglobin level in all exposed persons. However, smokers as well as workers with anemia or heart disease and those concurrently exposed to carbon monoxide are at especially high risk of toxic effects because of an already reduced oxygen carrying capacity of the blood.
A comprehensive or interim medical and work history should also include occurrence of headache, dizziness, fatigue, chest pain, shortness of breath, pain in the limbs, and irritation of the skin and eyes.
In addition, it is important for the physician or other licensed health care professional to become familiar with the operating conditions in which exposure to MC is likely to occur. The physician or other licensed health care professional also must become familiar with the signs and symptoms that may indicate that a worker is receiving otherwise unrecognized and exceptionally high exposure levels of MC.
An example of a medical and work history that would satisfy the requirement for a comprehensive or interim work history is represented by the following:
The following is a list of recommended questions and issues for the self-administered questionnaire for methylene chloride exposure.
Questionnaire For Methylene chloride Exposure
I. Demographic Information
1. Name
2. Social Security Number
3. Date
4. Date of Birth

5. Age
6. Present occupation
7. Sex
8. Race
II. Occupational History
1. Have you ever worked with Methylene chloride, Dichloromethane, Methylene dichloride, or CH 2 Cl 2 (all are different names for the same chemical)? Please list which on the occupational history form if you have not already.
2. If you have worked in any of the following industries and have not listed them on the occupational history form, please do so.
Furniture stripping
Polyurethane foam manufacturing

Chemical manufacturing or formulation
Pharmaceutical manufacturing
Any industry in which you used solvents to clean and degrease equipment or parts
Construction, especially painting and refinishing
Aerosol manufacturing
Any industry in which you used aerosol adhesives
3. If you have not listed hobbies or household projects on the occupational history form, especially furniture refinishing, spray painting, or paint stripping, please do so.
III. Medical History
A. General

1. Do you consider yourself to be in good health? If no, state reason(s).
2. Do you or have you ever had:
a. Persistent thirst
b. Frequent urination (three times or more at night)
c. Dermatitis or irritated skin
d. Non-healing wounds
3. What prescription or non-prescription medications do you take, and for what reasons?
4. Are you allergic to any medications, and what type of reaction do you have?
B. Respiratory
1. Do you have or have you ever had any chest illnesses or diseases? Explain.

2. Do you have or have you ever had any of the following:
a. Asthma
b. Wheezing
c. Shortness of breath
3. Have you ever had an abnormal chest X-ray? If so, when, where, and what were the findings?
4. Have you ever had difficulty using a respirator or breathing apparatus? Explain.
5. Do any chest or lung diseases run in your family? Explain.
6. Have you ever smoked cigarettes, cigars, or a pipe? Age started:
7. Do you now smoke?
8. If you have stopped smoking completely, how old were you when you stopped?

9. On the average of the entire time you smoked, how many packs of cigarettes, cigars, or bowls of tobacco did you smoke per day?
C. Cardiovascular
1. Have you ever been diagnosed with any of the following: Which of the following apply to you now or did apply to you at some time in the past, even if the problem is controlled by medication? Please explain any yes answers (i.e., when problem was diagnosed, length of time on medication).
a. High cholesterol or triglyceride level
b. Hypertension (high blood pressure)
c. Diabetes
d. Family history of heart attack, stroke, or blocked arteries
2. Have you ever had chest pain? If so, answer the next five questions.

a. What was the quality of the pain (i.e., crushing, stabbing, squeezing)?
b. Did the pain go anywhere (i.e., into jaw, left arm)?
c. What brought the pain out?
d. How long did it last?
e. What made the pain go away?
3. Have you ever had heart disease, a heart attack, stroke, aneurysm, or blocked arteries anywhere in you body? Explain (when, treatment).
4. Have you ever had bypass surgery for blocked arteries in your heart or anywhere else? Explain.
5. Have you ever had any other procedures done to open up a blocked artery (balloon angioplasty, carotid endarterectomy, clot-dissolving drug)?
6. Do you have or have you ever had (explain each):

a. Heart murmur
b. Irregular heartbeat
c. Shortness of breath while lying flat
d. Congestive heart failure
e. Ankle swelling
f. Recurrent pain anywhere below the waist while walking
7. Have you ever had an electrocardiogram (EKG)? When?
8. Have you ever had an abnormal EKG? If so, when, where, and what were the findings?
9. Do any heart diseases, high blood pressure, diabetes, high cholesterol, or high triglycerides run in your family? Explain.
D. Hepatobiliary and Pancreas

1. Do you now or have you ever drunk alcoholic beverages? Age started: ________ Age stopped: ________.
2. Average numbers per week:
a. Beers: ________, ounces in usual container:
b. Glasses of wine: ________, ounces per glass:
c. Drinks: ________, ounces in usual container:
3. Do you have or have you ever had (explain each):
a. Hepatitis (infectious, autoimmune, drug-induced, or chemical)
b. Jaundice
c. Elevated liver enzymes or elevated bilirubin
d. Liver disease or cancer
E. Central Nervous System
1. Do you or have you ever had (explain each):
a. Headache
b. Dizziness
c. Fainting
d. Loss of consciousness
e. Garbled speech
f. Lack of balance
g. Mental/psychiatric illness
h. Forgetfulness
F. Hematologic
1. Do you have, or have you ever had (explain each):
a. Anemia
b. Sickle cell disease or trait
c. Glucose-6-phosphate dehydrogenase deficiency
d. Bleeding tendency disorder
2. If not already mentioned previously, have you ever had a reaction to sulfa drugs or to drugs used to prevent or treat malaria? What was the drug? Describe the reaction.
B. Physical Examination
The complete physical examination, when coupled with the medical and occupational history, assists the physician or other licensed health care professional in detecting pre-existing conditions that might place the employee at increased risk, and establishes a baseline for future health monitoring. These examinations should include:
1. Clinical impressions of the nervous system, cardiovascular function and pulmonary function, with additional tests conducted where indicated or determined by the examining physician or other licensed health care professional to be necessary.
2. An evaluation of the advisability of the worker using a respirator, because the use of certain respirators places an additional burden on the cardiopulmonary system. It is necessary for the attending physician or other licensed health care professional to evaluate the cardiopulmonary function of these workers, in order to inform the employer in a written medical opinion of the worker's ability or fitness to work in an area requiring the use of certain types of respiratory protective equipment. The presence of facial hair or scars that might interfere with the worker's ability to wear certain types of respirators should also be noted during the examination and in the written medical opinion.
Because of the importance of lung function to workers required to wear certain types of respirators to protect themselves from MC exposure, these workers must receive an assessment of pulmonary function before they begin to wear a negative pressure respirator and at least annually thereafter. The recommended pulmonary function tests include measurement of the employee's forced vital capacity (FVC), forced expiratory volume at one second (FEV1), as well as calculation of the ratios of FEV1 to FVC, and the ratios of measured FVC and measured FEV1 to expected respective values corrected for variation due to age, sex, race, and height. Pulmonary function evaluation must be conducted by a physician or other licensed health care professional experienced in pulmonary function tests.
The following is a summary of the elements of a physical exam which would fulfill the requirements under the MC standard:
Physical Exam
I. Skin and appendages
1. Irritated or broken skin
2. Jaundice

3. Clubbing cyanosis, edema
4. Capillary refill time
5. Pallor
II. Head
1. Facial deformities
2. Scars
3. Hair growth
III. Eyes
1. Scleral icterus
2. Corneal arcus
3. Pupillary size and response

4. Fundoscopic exam
IV. Chest
1. Standard exam
V. Heart
1. Standard exam
2. Jugular vein distention
3. Peripheral pulses
VI. Abdomen
1. Liver span
VII. Nervous System

1. Complete standard neuralgic exam
VIII. Laboratory
1. Hemoglobin and hematocrit
2. Alanine aminotransferase (ALT, SGPT)
3. Post-shift carboxyhemoglobin
IX. Studies
1. Pulmonary function testing
2. Electrocardiogram
An evaluation of the oxygen carrying capacity of the blood of employees (for example by measured red blood cell volume) is considered useful, especially for workers acutely exposed to MC.
It is also recommended, but not required, that end of shift carboxyhemoglobin levels be determined periodically, and any level above 3% for non-smokers and above 10% for smokers should prompt an investigation of the worker and his workplace. This test is recommended because MC is metabolized to CO, which combines strongly with hemoglobin, resulting in a reduced capacity of the blood to transport oxygen in the body. This is of particular concern for cigarette smokers because they already have a diminished hemoglobin capacity due to the presence of CO in cigarette smoke.
C. Additional Examinations and Referrals
1. Examination by a Specialist
When a worker examination reveals unexplained symptoms or signs (i.e. in the physical examination or in the laboratory tests), follow-up medical examinations are necessary to assure that MC exposure is not adversely affecting the worker's health. When the examining physician or other licensed health care professional finds it necessary, additional tests should be included to determine the nature of the medical problem and the underlying cause. Where relevant, the worker should be sent to a specialist for further testing and treatment as deemed necessary.

The final rule requires additional investigations to be covered and it also permits physicians or other licensed health care professionals to add appropriate or necessary tests to improve the diagnosis of disease should such tests become available in the future.
2. Emergencies
The examination of workers exposed to MC in an emergency should be directed at the organ systems most likely to be affected. If the worker has received a severe acute exposure, hospitalization may be required to assure proper medical intervention. It is not possible to precisely define "severe," but the physician or other licensed health care professional's judgment should not merely rest on hospitalization. If the worker has suffered significant conjunctival, oral, or nasal irritation, respiratory distress, or discomfort, the physician or other licensed health care professional should instigate appropriate follow-up procedures. These include attention to the eyes, lungs and the neurological system. The frequency of follow-up examinations should be determined by the attending physician or other licensed health care professional. This testing permits the early identification essential to proper medical management of such workers.
D. Employer Obligations
The employer is required to provide the responsible physician or other licensed health care professional and any specialists involved in a diagnosis with the following information: a copy of the MC standard including relevant appendices, a description of the affected employee's duties as they relate to his or her exposure to MC; an estimate of the employee's exposure including duration (e.g., 15hr/wk, three 8-hour shifts/wk, full time); a description of any personal protective equipment used by the employee, including respirators; and the results of any previous medical determinations for the affected employee related to MC exposure to the extent that this information is within the employer's control.
E. Physicians' or Other Licensed Health Care Professionals' Obligations
The standard requires the employer to ensure that the physician or other licensed health care professional provides a written statement to the employee and the employer. This statement should contain the physician's or licensed health care professional's opinion as to whether the employee has any medical condition placing him or her at increased risk of impaired health from exposure to MC or use of respirators, as appropriate. The physician or other licensed health care professional should also state his or her opinion regarding any restrictions that should be placed on the employee's exposure to MC or upon the use of protective clothing or equipment such as respirators. If the employee wears a respirator as a result of his or her exposure to MC, the physician or other licensed health care professional's opinion should also contain a statement regarding the suitability of the employee to wear the type of respirator assigned. Furthermore, the employee should be informed by the physician or other licensed health care professional about the cancer risk of MC and about risk factors for heart disease, and the potential for exacerbation of underlying heart disease by exposure to MC through its metabolism to carbon monoxide. Finally, the physician or other licensed health care professional should inform the employer that the employee has been told the results of the medical examination and of any medical conditions which require further explanation or treatment. This written opinion must not contain any information on specific findings or diagnosis unrelated to employee's occupational exposures.
The purpose in requiring the examining physician or other licensed health care professional to supply the employer with a written opinion is to provide the employer with a medical basis to assist the employer in placing employees initially, in assuring that their health is not being impaired by exposure to MC, and to assess the employee's ability to use any required protective equipment.


Note: Authority cited: Sections 142.3, 9020, 9030 and 9040, Labor Code. Reference: Sections 142.3, 9004(d), 9009, 9020, 9031 and 9040, Labor Code.






s 5203. Carcinogen Report of Use Requirements.
(a) Scope. All employers who use a regulated carcinogen shall report that use in writing to the Chief as required by this section. Note : Asbestos has additional report of use and asbestos-related work registration requirements in sections 1529, 5208, and 8358.
(b) Definitions.
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 a regulated carcinogen.
Regulated carcinogen means a recognized cancer causing substance, compound, mixture, or product regulated by sections 1529, 1532, 1535, 8358, or Article 110 sections 5200-5220.
Use means any use by an employer that could potentially result in employee exposure to a regulated carcinogen. Use includes but is not limited to: manufacturing, sale, transfer, storage, disposal, handling, research utilization, and transportation of a regulated carcinogen.
(c) Use that requires reporting.
(1) Regulated area. For all regulated carcinogens that specify a requirement for the employer to establish a regulated area, use of a regulated carcinogen within such a regulated area shall be reported.
(2) Other use. For regulated carcinogens that do not have a regulated area requirement, reporting is required for any use of a concentration greater than or equal to 0.1% by weight or volume and which results in exposure or potential exposure to employees.
(d) Report of use.
(1) Initial use of a regulated carcinogen shall be reported in writing to the Chief within 15 calendar days of that initial use.
(2) Any changes in the reported information shall be similarly reported in writing within 15 calendar days of such change.
(3) All written reports shall be mailed to:
OCCUPATIONAL CARCINOGEN CONTROL UNIT
DIVISION OF OCCUPATIONAL SAFETY AND HEALTH

POST OFFICE BOX 420603
SAN FRANCISCO, CALIFORNIA 94142
(4) The report shall include:
(A) The name of the employer and address of each workplace where a regulated carcinogen is in use;
(B) An identifying description of where the use of a regulated carcinogen is located in the workplace;
(C) A brief description of each process or operation which creates employee exposure to the regulated carcinogen, including the estimated number of employees engaged in each process or operation; and
(D) The names and addresses of any collective bargaining units or other representatives of the affected employees.
(e) Temporary worksite notification. Employers with temporary worksites need only provide an initial report and changes as specified in subsection (c) for the employer's permanent workplace location. Such employers shall also provide notification of the time and date of commencement of work, the approximate duration of the work, the location, the type of business, and the kind of work for each temporary worksite at least 24 hours prior to the commencement of each job when feasible, to the nearest district office of the Division of Occupational Safety and Health.
(f) Emergency. Any emergency, as defined in subsection (b), shall be reported as follows:
(1) A report of the occurrence of an emergency and the facts obtainable at that time shall be made within 24 hours to the nearest district office of the Division of Occupational Safety and Health.
(2) A written report shall be filed with the Chief within 15 calendar days after the occurrence of an emergency. The written report shall include:
(A) A description of the operation or process involved including its location, the amount of regulated carcinogen released, and the duration of the emergency.
(B) A statement of the known or estimated extent of employee exposure to the regulated carcinogen and area of contamination.
(C) An analysis of the circumstance that led up to the emergency.
(D) A description of the measures taken or to be taken, with specific dates, to prevent further similar emergencies from reoccurring.
(g) Posting. A copy of the applicable written report of use, temporary worksite notification, and emergency report shall be posted where the regulated carcinogen is in use or other appropriate location where the posting is conspicuous to affected employees. The reports shall be posted until the use no longer takes place at the worksite with the exception of emergency reports which shall be posted for at least 30 days after the written report was filed with the Chief.


Note: Authority cited: Sections 142.3, 9020 and 9030, Labor Code. Reference: Sections 142.3, 9004, 9009, 9020, 9030 and 9031, Labor Code.






s 5204. Hydrogen Peroxide.


Note: Authority cited: Section 142.3, Labor Code. Reference: Section 142.3, Labor Code.







s 5205. Perchloric Acid and Oxonium Perchlorate.


Note: Authority cited: Section 142.3, Labor Code. Reference: Section 142.3, Labor Code.







s 5206. Chromium (VI).
(a) Scope.
(1) This standard applies to occupational exposures to chromium (VI) in all forms and compounds in general industry, except:
(2) Exposures that occur in the application of pesticides regulated by the California Department of Pesticide Regulation, the U.S. Environmental Protection Agency or another Federal government agency (e.g., the treatment of wood with preservatives);
(3) Exposures to portland cement; or
(4) Wherethe employer has objective data demonstrating that a material containing chromium or a specific process, operation, or activity involving chromium cannot release dusts, fumes, or mists of chromium (VI) in concentrations at or above 0.5 mg/m 3 as an 8-hour time-weighted average (TWA) under any expected conditions of use. (continued)