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(continued)
(l) Medical Surveillance.
(1) General.
(A) Scope.
1. Currently exposed - The employer shall institute a medical surveillance program for all employees who are or may be exposed to cadmium at or above the action level unless the employer demonstrates that the employee is not, and will not be, exposed at or above the action level on 30 or more days per year (twelve consecutive months); and,
2. Previously exposed - The employer shall also institute a medical surveillance program for all employees who prior to the effective date of this section might previously have been exposed to cadmium at or above the action level by the employer, unless the employer demonstrates that the employee did not prior to the effective date of this section work for the employer in jobs with exposure to cadmium for an aggregated total of more than 60 months.
(B) To determine an employee's fitness for using a respirator, the employer shall provide the limited medical examination specified in subsection (l)(6).
(C) The employer shall assure that all medical examinations and procedures required by this standard are performed by or under the supervision of a licensed physician, who has read and is familiar with the health effects section of Appendix A, the regulatory text of this section, the protocol for sample handling and laboratory selection in Appendix F, and the questionnaire of Appendix D. These examinations and procedures shall be provided without cost to the employee and at a time and place that is reasonable and convenient to employees.
(D) The employer shall assure that the collecting and handling of biological samples of cadmium in urine (CdU), cadmium in blood (CdB), and beta-2 microglobulin in urine (<>2-M) taken from employees under this section is done in a manner that assures their reliability and that analysis of biological samples of cadmium in urine (CdU), cadmium in blood (CdB), and beta-2 microglobulin in urine (<>2-M) taken from employees under this section is performed in laboratories with demonstrated proficiency for that particular analyte. (See Appendix F.)
(2) Initial Examination.

(A) The employer shall provide an initial (preplacement) examination to all employees covered by the medical surveillance program required in subsection (l)(1)(A). The examination shall be provided to those employees within 30 days after initial assignment to a job with exposure to cadmium or no later than 90 days after the effective date of this section, whichever date is later.
(B) The initial (preplacement) medical examination shall include:
1. A detailed medical and work history, with emphasis on: past, present, and anticipated future exposure to cadmium; any history of renal, cardiovascular, respiratory, hematopoietic, reproductive, and/or musculo-skeletal system dysfunction; current usage of medication with potential nephrotoxic side-effects; and smoking history and current status; and
2. Biological monitoring that includes the following tests:
a. Cadmium in urine (CdU), standardized to grams of creatinine (g/Cr);
b. Beta-2 microglobulin in urine (<>2-M), standardized to grams of creatinine (g/Cr), with pH specified, as described in Appendix F; and

c. Cadmium in blood (CdB), standardized to liters of whole blood (lwb).
(C) Recent Examination: An initial examination is not required to be provided if adequate records show that the employee has been examined in accordance with the requirements of subsection (l)(2)(B) within the past 12 months. In that case, such records shall be maintained as part of the employee's medical record and the prior exam shall be treated as if it were an initial examination for the purposes of subsections (l)(3) and (4).
(3) Actions Triggered by Initial Biological Monitoring:
(A) If the results of the initial biological monitoring tests show the employee's CdU level to be at or below 3<>g/g Cr,<>2-M level to be at or below 300<>g/g Cr and CdB level to be at or below 5mg/lwb, then:
1. for currently exposed employees, who are subject to medical surveillance under subsection (l)(1)(A)1., the employer shall provide the minimum level of periodic medical surveillance in accordance with the requirements in subsection (l)(4)(A); and

2. for previously exposed employees, who are subject to medical surveillance under subsection (l)(1)(A)2., the employer shall provide biological monitoring for CdU,<>2-M, and CdB one year after the initial biological monitoring and then the employer shall comply with the requirements of subsection (l)(4)(E).
(B) For all employees who are subject to medical surveillance under subsection (l)(1)(A), if the results of the initial biological monitoring tests show the level of CdU to exceed 3<>g/g Cr, the level of<>2-M to exceed 300<< mu>>g/g Cr, or the level of CdB to exceed 5mg/lwb, the employer shall:
1. within two weeks after receipt of biological monitoring results, reassess the employee's occupational exposure to cadmium as follows:
a. reassess the employee's work practices and personal hygiene;
b. reevaluate the employee's respirator use, if any, and the respirator program;
c. review the hygiene facilities;

d. reevaluate the maintenance and effectiveness of the relevant engineering controls;
e. assess the employee's smoking history and status;
2. within 30 days after the exposure reassessment, specified in (l)(3)(B)1., take reasonable steps to correct any deficiencies found in the reassessment that may be responsible for the employee's excess exposure to cadmium; and,
3. within 90 days after receipt of biological monitoring results, provide a full medical examination to the employee in accordance with the requirements of subsection (l)(4)(B). After completing the medical examination, the examining physician shall determine in a written medical opinion whether to medically remove the employee. If the physician determines that medical removal is not necessary, then until the employee's CdU level falls to or below 3<>g/g Cr,<>2-M level falls to or below 300mg/g Cr and CdB level falls to or below 5mg/lwb, the employer shall:
a. Provide biological monitoring in accordance with subsection (l)(2)(B)2. on a semiannual basis; and

b. Provide annual medical examinations in accordance with subsection (l)(4)(B).
(C) For all employees who are subject to medical surveillance under subsection (l)(1)(A), if the results of the initial biological monitoring tests show the level of CdU to be in excess of 15<>g/g Cr, or the level of CdB to be in excess of 15mg/lwb, or the level ofb 2-M to be in excess of 1,500<>g/g Cr, the employer shall comply with the requirements of subsections (l)(3)(B)1.- 2. Within 90 days after receipt of biological monitoring results, the employer shall provide a full medical examination to the employee in accordance with the requirements of subsection (l)(4)(B). After completing the medical examination, the examining physician shall determine in a written medical opinion whether to medically remove the employee. However, if the initial biological monitoring results and the biological monitoring results obtained during the medical examination both show that: CdU exceeds 15<>g/g Cr; or CdB exceeds 15mg/lwb; or<>2-M exceeds 1500<>g/g Cr, and in addition CdU exceeds 3<>g/g Cr or CdB exceeds 5mg/liter of whole blood, then the physician shall medically remove the employee from exposure to cadmium at or above the action level. If the second set of biological monitoring results obtained during the medical examination does not show that a mandatory removal trigger level has been exceeded, then the employee is not required to be removed by the mandatory provisions of this subsection. If the employee is not required to be removed by the mandatory provisions of this subsection or by the physician's determination, then until the employee's CdU level falls to or below 3<>g/g Cr,<>2-M level falls to or below 300<>g/g Cr and CdB level falls to or below 5mg/lwb, the employer shall:
1. Periodically reassess the employee's occupational exposure to cadmium;
2. Provide biological monitoring in accordance with subsection (l)(2)(B)2. on a quarterly basis; and
3. Provide semiannual medical examinations in accordance with subsection (l)(4)(B).
(D) For all employees to whom medical surveillance is provided, beginning on January 1, 1999, and in lieu of subsections (l)(3)(A)-(C):
1. If the results of the initial biological monitoring tests show the employee's CdU level to be at or below 3<>g/g Cr,<>2-M level to be at or below 300<>g/g Cr and CdB level to be at or below 5mg/lwb, then for currently exposed employees, the employer shall comply with the requirements of subsection (l)(3)(A)1., and for previously exposed employees, the employer shall comply with the requirements of subsection (l)(3)(A)2.;
2. If the results of the initial biological monitoring tests show the level of CdU to exceed 3<>g/g Cr, the level of<>2-M to exceed 300<>g/g Cr, or the level of CdB to exceed 5mg/lwb, the employer shall comply with the requirements of subsections (l)(3)(B)1.-3.; and,
3. If the results of the initial biological monitoring tests show the level of CdU to be in excess of 7<>g/g Cr, or the level of CdB to be in excess of 10mg/lwb, or the level of<>2-M to be in excess of 750<>g/g Cr, the employer shall: comply with the requirements of subsections (l)(3)(B)1.-2.; and, within 90 days after receipt of biological monitoring results, provide a full medical examination to the employee in accordance with the requirements of subsection (l)(4)(B). After completing the medical examination, the examining physician shall determine in a written medical opinion whether to medically remove the employee. However, if the initial biological monitoring results and the biological monitoring results obtained during the medical examination both show that: CdU exceeds 7<>g/g Cr; or CdB exceeds 10mg/lwb; or<>2-M exceeds 750<>g/g Cr, and in addition CdU exceeds 3<>g/g Cr or CdB exceeds 5mg/liter of whole blood, then the physician shall medically remove the employee from exposure to cadmium at or above the action level. If the second set of biological monitoring results obtained during the medical examination does not show that a mandatory removal trigger level has been exceeded, then the employee is not required to be removed by the mandatory provisions of this subsection. If the employee is not required to be removed by the mandatory provisions of this subsection or by the physician's determination, then until the employee's CdU level falls to or below 3<>g/g Cr,<>2-M level falls to or below 300mg/g Cr and CdB level falls to or below 5mg/lwb, the employer shall: periodically reassess the employee's occupational exposure to cadmium; provide biological monitoring in accordance with subsection (l)(2)(B)2. on a quarterly basis; and provide semiannual medical examinations in accordance with subsection (l)(4)(B).
(4) Periodic Medical Surveillance.
(A) For each employee who is covered under subsection (l)(1)(A)1., the employer shall provide at least the minimum level of periodic medical surveillance, which consists of periodic medical examinations and periodic biological monitoring. A periodic medical examination shall be provided within one year after the initial examination required by subsection (l)(2) and thereafter at least biennially. Biological sampling shall be provided at least annually, either as part of a periodic medical examination or separately as periodic biological monitoring.
(B) The periodic medical examination shall include:
1. A detailed medical and work history, or update thereof, with emphasis on: past, present and anticipated future exposure to cadmium; smoking history and current status; reproductive history; current use of medications with potential nephrotoxic side-effects; any history of renal, cardiovascular, respiratory, hematopoietic, and/or musculo-skeletal system dysfunction; and as part of the medical and work history, for employees who wear respirators, questions 3-11 and 25-32 in Appendix D;
2. A complete physical examination with emphasis on: blood pressure, the respiratory system, and the urinary system;
3. A 14 inch by 17 inch, or a reasonably standard sized posterior-anterior chest X-ray (after the initial X-ray, the frequency of chest X-rays is to be determined by the examining physician);
4. Pulmonary function tests, including forced vital capacity (FVC) and forced expiratory volume at 1 second (FEV1);

5. Biological monitoring, as required in subsection (l)(2)(B)2.;
6. Blood analysis, in addition to the analysis required under subsection (l)(2)(B)2., including blood urea nitrogen, complete blood count, and serum creatinine;
7. Urinalysis, in addition to the analysis required under subsection (l)(2)(B)2., including the determination of albumin, glucose, and total and low molecular weight proteins;
8. For males over 40 years old, prostate palpation, or other at least as effective diagnostic test(s); and
9. Any additional tests deemed appropriate by the examining physician.
(C) Periodic biological monitoring shall be provided in accordance with subsection (l)(2)(B)2..
(D) If the results of periodic biological monitoring or the results of biological monitoring performed as part of the periodic medical examination show the level of the employee's CdU,<>2-M, or CdB to be in excess of the levels specified in subsections (l)(3)(B)-(C); or, beginning on January 1, 1999, in excess of the levels specified in subsections (l)(3)(B) or (D), the employer shall take the appropriate actions specified in subsections (l)(3)(B)- (D).
(E) For previously exposed employees under subsection (l)(1)(A)2.:
1. If the employee's levels of CdU did not exceed 3<>g/g Cr, CdB did not exceed 5mg/lwb, and <>2-M did not exceed 300<>g/g Cr in the initial biological monitoring tests, and if the results of the followup biological monitoring required by subsection (l)(3)(A)2. one year after the initial examination confirm the previous results, the employer may discontinue all periodic medical surveillance for that employee.
2. If the initial biological monitoring results for CdU, CdB, or<>2-M were in excess of the levels specified in (l)(3)(A), but subsequent biological monitoring results required by (l)(3)(B)-(D) show that the employee's CdU levels no longer exceed 3<>g/g Cr, CdB levels no longer exceed 5mg/lwb, and<>2-M levels no longer exceed 300<>g/g Cr, the employer shall provide biological monitoring for CdU, CdB, and<>2-M one year after these most recent biological monitoring results. If the results of the followup biological monitoring, specified in this subsection, confirm the previous results, the employer may discontinue all periodic medical surveillance for that employee.
3. However, if the results of the follow-up tests specified in (l)(4)(E)1. or 2. indicate that the level of the employee's CdU,b 2-M, or CdB exceeds these same levels, the employer is required to provide annual medical examinations in accordance with the provisions of subsection (l)(4)(B) until the results of biological monitoring are consistently below these levels or the examining physician determines in a written medical opinion that further medical surveillance is not required to protect the employee's health.
(F) A routine, biennial medical examination is not required to be provided in accordance with subsections (l)(3)(A) and (l)(4) if adequate medical records show that the employee has been examined in accordance with the requirements of subsection (l)(4)(B) within the past 12 months. In that case, such records shall be maintained by the employer as part of the employee's medical record, and the next routine, periodic medical examination shall be made available to the employee within two years of the previous examination.

(5) Actions Triggered by Medical Examinations:
(A) If the results of a medical examination carried out in accordance with this section indicate any laboratory or clinical finding consistent with cadmium toxicity that does not require employer action under subsections (l)(2), (3) or (4), the employer, within 30 days, shall reassess the employee's occupational exposure to cadmium and take the following corrective action until the physician determines they are no longer necessary:
1. Periodically reassess: the employee's work practices and personal hygiene; the employee's respirator use, if any; the employee's smoking history and status; the respiratory protection program; the hygiene facilities; and the maintenance and effectiveness of the relevant engineering controls;
2. Within 30 days after the reassessment, take all reasonable steps to correct the deficiencies found in the reassessment that may be responsible for the employee's excess exposure to cadmium;
3. Provide semiannual medical reexaminations to evaluate the abnormal clinical sign(s) of cadmium toxicity until the results are normal or the employee is medically removed; and

4. Where the results of tests for total proteins in urine are abnormal, provide a more detailed medical evaluation of the toxic effects of cadmium on the employee's renal system.
(6) Examination for Respirator Use:
(A) To determine an employee's fitness for respirator use, the employer shall provide a medical examination that includes the elements specified in (l)(6)1.- 4.. This examination shall be provided prior to the employee's being assigned to a job that requires the use of a respirator or no later than 90 days after this section goes into effect, whichever date is later, to any employee without a medical examination within the preceding 12 months that satisfies the requirements of this subsection.
1. A detailed medical and work history, or update thereof, with emphasis on: past exposure to cadmium; smoking history and current status; any history of renal, cardiovascular, respiratory, hematopoietic, and/or musculo-skeletal system dysfunction; a description of the job for which the respirator is required; and questions 3-11 and 25-32 in Appendix D;

2. A blood pressure test;
3. Biological monitoring of the employee's levels of CdU, CdB and<>2-M in accordance with the requirements of subsection (l)(2)(B)2., unless such results already have been obtained within the previous 12 months; and
4. Any other test or procedure that the examining physician deems appropriate.
(B) After reviewing all the information obtained from the medical examination required in subsection (l)(6)(A), the physician shall determine whether the employee is fit to wear a respirator.
(C) Whenever an employee has exhibited difficulty in breathing during a respirator fit test or during use of a respirator, the employer, as soon as possible, shall provide the employee with a periodic medical examination in accordance with subsection (l)(4)(B) to determine the employee's fitness to wear a respirator.
(D) Where the results of the examination required under subsection (l)(6)(A), (B) or (C) are abnormal, medical limitation or prohibition of respirator use shall be considered. If the employee is allowed to wear a respirator, the employee's ability to continue to do so shall be periodically evaluated by a physician.
(7) Emergency Examinations:
(A) In addition to the medical surveillance required in subsections (l)(2)-(6), the employer shall provide a medical examination as soon as possible to any employee who may have been acutely exposed to cadmium because of an emergency.
(B) The examination shall include the requirements of subsection (l)(4)(B), with emphasis on the respiratory system, other organ systems considered appropriate by the examining physician, and symptoms of acute overexposure, as identified in Appendix A in subsections II2.(1)-(2) and IV.
(8) Termination of Employment Examination:
(A) At termination of employment, the employer shall provide a medical examination in accordance with subsection (l)(4)(B), including a chest X-ray, to any employee to whom at any prior time the employer was required to provide medical surveillance under subsections (l)(1)(A) or (l)(7). However, if the last examination satisfied the requirements of subsection (l)(4)(B) and was less than six months prior to the date of termination, no further examination is required unless otherwise specified in subsections (l)(3) or (l)(5);
(B) However, for employees covered by subsection(l)(1)(A)2., if the employer has discontinued all periodic medical surveillance under (l)(4)(E), no termination of employment medical examination is required.
(9) Information Provided to the Physician:
The employer shall provide the following information to the examining physician:
(A) A copy of this standard and appendices;
(B) A description of the affected employee's former, current, and anticipated duties as they relate to the employee's occupational exposure to cadmium;
(C) The employee's former, current, and anticipated future levels of occupational exposure to cadmium;
(D) A description of any personal protective equipment, including respirators, used or to be used by the employee, including when and for how long the employee has used that equipment; and
(E) relevant results of previous biological monitoring and medical examinations.
(10) Physician's Written Medical Opinion:
(A) The employer shall promptly obtain a written, signed medical opinion from the examining physician for each medical examination performed on each employee. This written opinion shall contain:
1. The physician's diagnosis for the employee;
2. The physician's opinion as to whether the employee has any detected medical condition(s) that would place the employee at increased risk of material impairment to health from further exposure to cadmium, including any indications of potential cadmium toxicity;
3. The results of any biological or other testing or related evaluations that directly assess the employee's absorption of cadmium;

4. Any recommended removal from, or limitation on the activities or duties of the employee or on the employee's use of personal protective equipment, such as respirators;
5. A statement that the physician has clearly and carefully explained to the employee the results of the medical examination, including all biological monitoring results and any medical conditions related to cadmium exposure that require further evaluation or treatment, and any limitation on the employee's diet or use of medications.
(B) The employer promptly shall obtain a copy of the results of any biological monitoring provided by an employer to an employee independently of a medical examination under subsections (l)(2) and (l)(4), and, in lieu of a written medical opinion, an explanation sheet explaining those results.
(C) The employer shall instruct the physician not to reveal orally or in the written medical opinion given to the employer specific findings or diagnoses unrelated to occupational exposure to cadmium.
(11) Medical Removal Protection (MRP):

(A) General.
1. The employer shall temporarily remove an employee from work where there is excess exposure to cadmium on each occasion that medical removal is required under subsections (l)(3), (l)(4), or (l)(6) and on each occasion that a physician determines in a written medical opinion that the employee should be removed from such exposure. The physician's determination may be based on biological monitoring results, inability to wear a respirator, evidence of illness, other signs or symptoms of cadmium-related dysfunction or disease, or any other reason deemed medically sufficient by the physician.
2. The employer shall medically remove an employee in accordance with subsection (l)(11) regardless of whether at the time of removal a job is available into which the removed employee may be transferred.
3. Whenever an employee is medically removed under subsection (l)(11), the employer shall transfer the removed employee to a job where the exposure to cadmium is within the permissible levels specified in that subsection as soon as one becomes available.

4. For any employee who is medically removed under the provisions of subsection (l)(11)(A), the employer shall provide follow-up biological monitoring in accordance with (l)(2)(B)2. at least every three months and follow-up medical examinations semi-annually at least every six months until in a written medical opinion the examining physician determines that either the employee may be returned to his/her former job status as specified under (l)(11)(D)-(E) or the employee must be permanently removed from excess cadmium exposure.
5. The employer may not return an employee who has been medically removed for any reason to his/her former job status until a physician determines in a written medical opinion that continued medical removal is no longer necessary to protect the employee's health.
(B) Where an employee is found unfit to wear a respirator under subsection (l)(6)(B), the employer shall remove the employee from work where exposure to cadmium is above the PEL.
(C) Where removal is based on any reason other than the employee's inability to wear a respirator, the employer shall remove the employee from work where exposure to cadmium is at or above the action level.

(D) Except as specified in subsection (l)(11)(E), no employee who was removed because his/her level of CdU, CdB and/or<>2-M exceeded the medical removal trigger levels in subsections (l)(3) or (l)(4) may be returned to work with exposure to cadmium at or above the action level until the employee's levels of CdU fall to or below 3<>g/g Cr, CdB falls to or below 5mg/lwb, and<>2-M falls to or below 300<>g/g Cr.
(E) However, when in the examining physician's opinion continued exposure to cadmium will not pose an increased risk to the employee's health and there are special circumstances that make continued medical removal an inappropriate remedy, the physician shall fully discuss these matters with the employee, and then in a written determination may return a worker to his/her former job status despite what would otherwise be unacceptably high biological monitoring results. Thereafter, the returned employee shall continue to be provided with medical surveillance as if he/she were still on medical removal until the employee's levels of CdU fall to or below 3<>g/g Cr, CdB falls to or below 5mg/lwb, and<>2-M falls to or below 300<>g/g Cr.
(F) Where an employer, although not required by(l)(11)(A)-(C) to do so, removes an employee from exposure to cadmium or otherwise places limitations on an employee due to the effects of cadmium exposure on the employee's medical condition, the employer shall provide the same medical removal protection benefits to that employee under subsection (l)(12) as would have been provided had the removal been required under subsection (l)(11)(A)-(C).
(12) Medical Removal Protection Benefits (MRPB).
(A) The employer shall provide MRPB for up to a maximum of 18 months to an employee each time and while the employee is temporarily medically removed under subsection (l)(11).
(B) For purposes of this section, the requirement that the employer provide MRPB means that the employer shall maintain the total normal earnings, seniority, and all other employee rights and benefits of the removed employee, including the employee's right to his/her former job status, as if the employee had not been removed from the employee's job or otherwise medically limited.
(C) Where, after 18 months on medical removal because of elevated biological monitoring results, the employee's monitoring results have not declined to a low enough level to permit the employee to be returned to his/her former job status:

1. the employer shall make available to the employee a medical examination pursuant to this section in order to obtain a final medical determination as to whether the employee may be returned to his/her former job status or must be permanently removed from excess cadmium exposure; and
2. the employer shall assure that the final medical determination indicates whether the employee may be returned to his/her former job status and what steps, if any, should be taken to protect the employee's health.
(D) The employer may condition the provision of MRPB upon the employee's participation in medical surveillance provided in accordance with this section.
(13) Multiple Physician Review.
(A) If the employer selects the initial physician to conduct any medical examination or consultation provided to an employee under this section, the employee may designate a second physician to:
1. Review any findings, determinations, or recommendations of the initial physician; and

2. Conduct such examinations, consultations, and laboratory tests as the second physician deems necessary to facilitate this review.
(B) The employer shall promptly notify an employee of the right to seek a second medical opinion after each occasion that an initial physician provided by the employer conducts a medical examination or consultation pursuant to this section. The employer may condition its participation in, and payment for, multiple physician review upon the employee doing the following within fifteen (15) days after receipt of this notice, or receipt of the initial physician's written opinion, whichever is later:
1. Informing the employer that he or she intends to seek a medical opinion; and
2. Initiating steps to make an appointment with a second physician.
(C) If the findings, determinations, or recommendations of the second physician differ from those of the initial physician, then the employer and the employee shall assure that efforts are made for the two physicians to resolve any disagreement.

(D) If the two physicians have been unable to quickly resolve their disagreement, then the employer and the employee, through their respective physicians, shall designate a third physician to:
1. Review any findings, determinations, or recommendations of the other two physicians; and
2. Conduct such examinations, consultations, laboratory tests, and discussions with the other two physicians as the third physician deems necessary to resolve the disagreement among them.
(E) The employer shall act consistently with the findings, determinations, and recommendations of the third physician, unless the employer and the employee reach an agreement that is consistent with the recommendations of at least one of the other two physicians.
(14) Alternate Physician Determination.
The employer and an employee or designated employee representative may agree upon the use of any alternate form of physician determination in lieu of the multiple physician review provided by subsection (l)(13), so long as the alternative is expeditious and at least as protective of the employee.
(15) Information the Employer Must Provide the Employee.
(A) The employer shall provide a copy of the physician's written medical opinion to the examined employee within two weeks after receipt thereof.
(B) The employer shall provide the employee with a copy of the employee's biological monitoring results and an explanation sheet explaining the results within two weeks after receipt thereof.
(C) Within 30 days after a request by an employee, the employer shall provide the employee with the information the employer is required to provide the examining physician under subsection (l)(9).
(16) Reporting.
In addition to other medical events that are required to be reported on the Cal/OSHA Form No. 200, the employer shall report any abnormal condition or disorder caused by occupational exposure to cadmium associated with employment as specified in Title 8, Section 14301.
(m) Communication of Cadmium Hazards to Employees.
(1) General.
In communications concerning cadmium hazards, employers shall comply with the requirements of the Hazard Communication Standard, section 5194, including but not limited to the requirements concerning warning signs and labels, material safety data sheets (MSDS), and employee information and training. In addition, employers shall comply with the following requirements:
(2) Warning Signs.
(A) Warning signs shall be provided and displayed in regulated areas. In addition, warning signs shall be posted at all approaches to regulated areas so that an employee may read the signs and take necessary protective steps before entering the area.
(B) Warning signs required by subsection (m)(2)(A) shall bear the following information:
DANGER CADMIUM CANCER HAZARD CAN CAUSE LUNG AND KIDNEY DISEASE AUTHORIZED
PERSONNEL ONLY RESPIRATORS REQUIRED IN THIS AREA

(C) The employer shall assure that signs required by this subsection are illuminated, cleaned, and maintained as necessary so that the legend is readily visible.
(3) Warning Labels.
(A) Shipping and storage containers containing cadmium, cadmium compounds, or cadmium contaminated clothing, equipment, waste, scrap, or debris shall bear appropriate warning labels, as specified in subsection (m)(3)(B).
(B) The warning labels shall include at least the following information:
DANGER CONTAINS CADMIUM CANCER HAZARD AVOID CREATING DUST CAN CAUSE LUNG AND
KIDNEY DISEASE

(C) Where feasible, installed cadmium products shall have a visible label or other indication that cadmium is present.

(4) Employee Information and Training.
(A) The employer shall institute a training program for all employees who are potentially exposed to cadmium, assure employee participation in the program, and maintain a record of the contents of such program.
(B) Training shall be provided prior to or at the time of initial assignment to a job involving potential exposure to cadmium and at least annually thereafter.
(C) The employer shall make the training program understandable to the employee and shall assure that each employee is informed of the following:
1. The health hazards associated with cadmium exposure, with special attention to the information incorporated in Appendix A;
2. The quantity, location, manner of use, release, and storage of cadmium in the workplace and the specific nature of operations that could result in exposure to cadmium, especially exposures above the PEL;
3. The engineering controls and work practices associated with the employee's job assignment;

4. The measures employees can take to protect themselves from exposure to cadmium, including modification of such habits as smoking and personal hygiene, and specific procedures the employer has implemented to protect employees from exposure to cadmium such as appropriate work practices, emergency procedures, and the provision of personal protective equipment;
5. The purpose, proper selection, fitting, proper use, and limitations of respirators and protective clothing;
6. The purpose and a description of the medical surveillance program required by subsection (l);
7. The contents of this section and its appendices, and,
8. The employee's rights of access to records under section 3204(e) and (g).
(D) Additional access to information and training program and materials.
1. The employer shall make a copy of this section and its appendices readily available without cost to all affected employees and shall provide a copy if requested.
2. The employer shall provide to the Chief or NIOSH, upon request, all materials relating to the employee information and the training program.
(n) Recordkeeping.
(1) Exposure Monitoring.
(A) The employer shall establish and keep an accurate record of all air monitoring for cadmium in the workplace.
(B) This record shall include at least the following information:
1. The monitoring date, duration, and results in terms of an 8-hour TWA of each sample taken;
2. The name, social security number, and job classification of the employees monitored and of all other employees whose exposures the monitoring is intended to represent;

3. A description of the sampling and analytical methods used and evidence of their accuracy;
4. The type of respiratory protective device, if any, worn by the monitored employee;
5. A notation of any other conditions that might have affected the monitoring results.
(C) The employer shall maintain this record for at least thirty (30) years, in accordance with section 3204.
(2) Objective Data for Exemption from Requirement for Initial Monitoring.
(A) For purposes of this section, objective data are information demonstrating that a particular product or material containing cadmium or a specific process, operation, or activity involving cadmium cannot release dust or fumes in concentrations at or above the action level even under the worst-case release conditions. Objective data can be obtained from an industry-wide study or from laboratory product test results from manufacturers of cadmium-containing products or materials. The data the employer uses from an industry-wide survey must be obtained under workplace conditions closely resembling the processes, types of material, control methods, work practices and environmental conditions in the employer's current operations.
(B) The employer shall establish and maintain a record of the objective data for at least 30 years.
(3) Medical Surveillance.
(A) The employer shall establish and maintain an accurate record for each employee covered by medical surveillance under subsection (l)(1)(A).
(B) The record shall include at least the following information about the employee:
1. Name, social security number, and description of the duties;
2. A copy of the physician's written opinions and an explanation sheet for biological monitoring results;
3. A copy of the medical history, and the results of any physical examination and all test results that are required to be provided by this section, including biological tests, X-rays, pulmonary function tests, etc., or that have been obtained to further evaluate any condition that might be related to cadmium exposure;
4. The employee's medical symptoms that might be related to exposure to cadmium; and
5. A copy of the information provided to the physician as required by subsection (l)(9)(B)-(E).
(C) The employer shall assure that this record is maintained for the duration of employment plus thirty (30) years, in accordance with section 3204.
(4) Training.
The employer shall certify that employees have been trained by preparing a certification record which includes the identity of the person trained, the signature of the employer or the person who conducted the training, and the date the training was completed. The certification records shall be prepared at the completion of training and shall be maintained on file for one (1) year beyond the date of training of that employee.
(5) Availability.
(A) Except as otherwise provided for in this section, access to all records required to be maintained by subsections (n)(1)-(4) shall be in accordance with the provisions of section 3204.
(B) Within 15 days after a request, the employer shall make an employee's medical records required to be kept by subsection (n)(3) available for examination and copying to the subject employee, to designated representatives, to anyone having the specific written consent of the subject employee, and after the employee's death or incapacitation, to the employee's family members.
(6) Transfer of Records.
Whenever an employer ceases to do business and there is no successor employer to receive and retain records for the prescribed period or the employer intends to dispose of any records required to be preserved for at least 30 years, the employer shall comply with the requirements concerning transfer of records set forth in section 3204 (h).
(o) Observation of Monitoring.
(1) Employee Observation.
The employer shall provide affected employees or their designated representatives an opportunity to observe any monitoring of employee exposure to cadmium.
(2) Observation Procedures.
When observation of monitoring requires entry into an area where the use of protective clothing or equipment is required, the employer shall provide the observer with that clothing and equipment and shall assure that the observer uses such clothing and equipment and complies with all other applicable safety and health procedures.
(p) Reporting requirements. See section 5203.
(q) Dates.

(1) Effective Date.
This section shall become effective June 14, 1993.
(2) Start-up dates.
All obligations of this section commence on the effective date except as follows:
(A) Exposure monitoring. Except for small businesses [nineteen (19) or fewer employees], initial monitoring required by subsection (d)(2) shall be completed as soon as possible and in any event no later than 60 days after the effective date of this standard. For small businesses, initial monitoring required by subsection (d)(2) shall be completed as soon as possible and in any event no later than 120 days after the effective date of this standard.
(B) Regulated areas. Except for small business, defined under subsection (q)(2)(A) above, regulated areas required to be established by subsection (e) shall be set up as soon as possible after the results of exposure monitoring are known and in any event no later than 90 days after the effective date of this section. For small businesses, regulated areas required to be established by subsection (e) shall be set up as soon as possible after the results of exposure monitoring are known and in any event no later than 150 days after the effective date of this section.
(C) Respiratory protection. Except for small businesses, defined under subsection (q)(2)(A) above, respiratory protection required by subsection (g) shall be provided as soon as possible and in any event no later than 90 days after the effective date of this section. For small businesses, respiratory protection required by subsection (g) shall be provided as soon as possible and in any event no later than 150 days after the effective date of this section.
(D) Compliance program. Written compliance programs required by subsection (f)(2) shall be completed and available for inspection and copying as soon as possible and in any event no later than 1 year after the effective date of this section.
(E) Methods of compliance. The engineering controls required by subsection (f)(1) shall be implemented as soon as possible and in any event no later than two (2) years after the effective date of this section. Work practice controls shall be implemented as soon as possible. Work practice controls that are directly related to engineering controls to be implemented in accordance with the compliance plan shall be implemented as soon as possible after such engineering controls are implemented.
(F) Hygiene and lunchroom facilities.
1. Handwashing facilities, permanent or temporary, shall be provided in accordance with Article 9 as soon as possible and in any event no later than 60 days after the effective date of this section.
2. Change rooms, showers, and lunchroom facilities shall be completed as soon as possible and in any event no later than 1 year after the effective date of this section.
(G) Employee information and training. Except for small businesses, defined under subsection (q)(2)(A) above, employee information and training required by subsection (m)(4) shall be provided as soon as possible and in any event no later than 90 days after the effective date of this standard. For small businesses, employee information and training required by subsection (m)(4) shall be provided as soon as possible and in any event no later than 180 days after the effective date of this standard.

(H) Medical surveillance. Except for small businesses, defined under subsection (q)(2)(A) above, initial medical examinations required by subsection (l) shall be provided as soon as possible and in any event no later than 90 days after the effective date of this standard. For small businesses, initial medical examinations required by subsection (l) shall be provided as soon as possible and in any event no later than 180 days after the effective date of this standard.
(r) Appendices.
(1) Appendix C to this section is incorporated as part of this section, and compliance with its contents is mandatory.
(2) Except where portions of appendices A, B, D, E, and F to this section are expressly incorporated in requirements of this section, these appendices are purely informational and are not intended to create any additional obligations not otherwise imposed or to detract from any existing obligations.


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







Appendix A
Substance Safety Data Sheet Cadmium

I. Substance Identification
A. Substance: Cadmium.

B. 8-Hour, Time-weighted-average, Permissible Exposure Limit (TWA PEL):
1. TWA PEL: Five micrograms of cadmium per cubic meter of air 5 m g/m 3, time-weighted average (TWA) for an 8-hour workday.
C. Appearance: Cadmium metal - soft, blue-white, malleable, lustrous metal or grayish-white powder. Some cadmium compounds may also appear as a brown, yellow, or red powdery substance.
II. Health Hazard Data
A. Routes of Exposure.
Cadmium can cause local skin or eye irritation. Cadmium can affect your health if you inhale it or if you swallow it.
B. Effects of overexposure.
1. Short-term (acute) exposure: Cadmium is much more dangerous by inhalation than by ingestion. High exposures to cadmium that may be immediately dangerous to life or health occur in jobs where workers handle large quantities of cadmium dust or fume; heat cadmium-containing compounds or cadmium-coated surfaces; weld with cadmium solders or cut cadmium-containing materials such as bolts.
2. Severe exposure may occur before symptoms appear. Early symptoms may include mild irritation of the upper respiratory tract, a sensation of constriction of the throat, a metallic taste and/or a cough. A period of 1 - 10 hours may precede the onset of rapidly progressing shortness of breath, chest pain, and flu-like symptoms with weakness, fever, headache, chills, sweating and muscular pain. Acute pulmonary edema usually develops within 24 hours and reaches a maximum by three days. If death from asphyxia does not occur, symptoms may resolve within a week.
3. Long-term (chronic) exposure. Repeated or long-term exposure to cadmium, even at relatively low concentrations, may result in kidney damage and an increased risk of cancer of the lung and of the prostate.
C. Emergency First Aid Procedures
1. Eye exposure: Direct contact may cause redness or pain. Wash eyes immediately with large amounts of water, lifting the upper and lower eyelids. Get medical attention immediately.
2. Skin exposure: Direct contact may result in irritation. Remove contaminated clothing and shoes immediately. Wash affected area with soap or mild detergent and large amounts of water. Get medical attention immediately.
3. Ingestion: Ingestion may result in vomiting, abdominal pain, nausea, diarrhea, headache and sore throat. Treatment for symptoms must be administered by medical personnel. Under no circumstances should the employer allow any person whom he retains, employs, supervises or controls to engage in therapeutic chelation. Such treatment is likely to translocate cadmium from pulmonary or other tissue to renal tissue. Get medical attention immediately.
4. Inhalation: If large amounts of cadmium are inhaled, the exposed person must be moved to fresh air at once. If breathing has stopped, perform cardiopulmonary resuscitation. Administer oxygen if available. Keep the affected person warm and at rest. Get medical attention immediately.
5. Rescue: Move the affected person from the hazardous exposure. If the exposed person has been overcome, attempt rescue only after notifying at least one other person of the emergency and putting into effect established emergency procedures. Do not become a casualty yourself. Understand your emergency rescue procedures and know the location of the emergency equipment before the need arises.
III. Employee Information
A. Protective Clothing and Equipment
1. Respirators: You may be required to wear a respirator for non-routine activities; in emergencies; while your employer is in the process of reducing cadmium exposures through engineering controls; and where engineering controls are not feasible. If respirators are worn in the future, they must have a joint Mine Safety and Health Administration (MSHA) and National Institute for Occupational Safety and Health (NIOSH) label of approval. Cadmium does not have a detectable odor except at levels well above the permissible exposure limits. If you can smell cadmium while wearing a respirator, proceed immediately to fresh air. If you experience difficulty breathing while wearing a respirator, tell your employer.
2. Protective Clothing: You may be required to wear impermeable clothing, gloves, foot gear, a face shield, or other appropriate protective clothing to prevent skin contact with cadmium. Where protective clothing is required, your employer must provide clean garments to you as necessary to assure that the clothing protects you adequately. The employer must replace or repair protective clothing that has become torn or otherwise damaged.
3. Eye Protection: You may be required to wear splash-proof or dust resistant goggles to prevent eye contact with cadmium.
B. Employer Requirements
1. Medical: Ifyou are exposed to cadmium at or above the action level, your employer is required to provide a medical examination, laboratory tests and a medical history according to the medical surveillance provisions under paragraph (l) of this standard. (See summary chart and tables in this Appendix A.) These tests shall be provided without cost to you. In addition, if you are accidentally exposed to cadmium under conditions known or suspected to constitute toxic exposure to cadmium, your employer is required to make special tests available to you. (continued)