Presentation is loading. Please wait.

Presentation is loading. Please wait.

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

Similar presentations


Presentation on theme: "The Model for Medical Surveillance Program for Caribbean Upstream Oil/Gas Producer Presented by: Bernard L. Fontaine, Jr., CIH, CSP The Windsor Consulting."— Presentation transcript:

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

2 Medical Surveillance Program Copyright 2014 © The Windsor Consulting Group, Inc.

3 Regional Control and Resources Finance and Accounting Health, Safety, and Environmental Subsurface Reservoir Development Facilities & Construction Control, Personnel, Contract, Resources Maintenance, Deck, Inspection E&P Operator Asset – TSP Production and Process Catering, Laundry, and Housekeeping Drilling and Completion Liquefied Natural Gas Production Construction Crew Diving Crew General Services People and Organization Legal Affairs Security Medical Surveillance Program Copyright 2014 © The Windsor Consulting Group, Inc.

4 Task Based Risk Register (TBRA) 1 Drill Floor Crew Vapor exposure from descaling, solvent, and food condiment No Published Information as Suspect Human Carcinogen Health threat: URT and eye irritation Personal injury (also damage to health) 163.1 Specific sector of activity at global level High Baseline and periodic air monitoring personal/area exposures, identify peak and long-term exposures, awareness training, adequate goggles, gloves, clothing, and respirators for elevated exposures. Personal injury (also damage to health) 73.1Moderate Medium There are many individual and organizational risk factors that may influence exposure. Lung function tests for at-risk workers exposed to prolonged or repeated elevated concentrations 1 Drill Operators Vapor exposure from descaling, solvent, and food condiment No Published Information as Suspect Human Carcinogen Health threat: URT and eye irritation Personal injury (also damage to health) 163.1 Specific sector of activity at global level High Baseline and periodic air monitoring personal/area exposures, identify peak and long-term exposures, awareness training, adequate goggles, gloves, clothing, and respirators for elevated exposures. Personal injury (also damage to health) 73.1Moderate Medium There are many individual and organizational risk factors that may influence exposure. Lung function tests for at-risk workers exposed to prolonged or repeated elevated concentrations 1 Drilling Engineer Vapor exposure from descaling, solvent, and food condiment No Published Information as Suspect Human Carcinogen Health threat: URT and eye irritation Personal injury (also damage to health) 73.1 Specific sector of activity at global level Moderate Baseline and periodic air monitoring personal/area exposures, identify peak and long-term exposures, awareness training, adequate goggles, gloves, clothing, and respirators for elevated exposures. Personal injury (also damage to health) 33.1Low Medium There are many individual and organizational risk factors that may influence exposure. Lung function tests for at-risk workers exposed to prolonged or repeated elevated concentrations IDACTIVITY AREAHAZARDTHREATCONSEQUENCE POTENTIAL RISK CONTROL MEASURE RESIDUAL RISK EVALUATION PARAMETERS COMMENTDUE DATE RESPONSIBLE PARTY CATEGORY CONS LIKD EXPOSURE RISK CATEGORY CONS LIKD RISK MANAG. KNOWLD Caribbean Regional Control and Resources 1 Regional Executive Director Vapor exposure from descaling, solvent, and food condiment No Published Information as Suspect Human Carcinogen Health threat: URT and eye irritation Personal injury (also damage to health) 1.70.8 Specific sector of activity at global level Low Baseline and periodic air monitoring personal/area exposures, identify peak and long-term exposures, awareness training, adequate goggles, gloves, clothing, and respirators for elevated exposures. Personal injury (also damage to health) 1.70.4Low Medium There are many individual and organizational risk factors that may influence exposure. Lung function tests for at-risk workers exposed to prolonged or repeated elevated concentrations Medical Surveillance Program Copyright 2014 © The Windsor Consulting Group, Inc.

5 Medical Surveillance Program  Pre-Placement/Initial/New Hire Examinations. These exams are done before placement in a specific job to medically assess if the worker will be able to perform the job safely and meet the requirements for immigration status  Personnel Policy Enforcement Examinations. Personnel policy enforcement examinations medically assess workers to determine if they meet established standards and conditions of employment.  Medical Certification Examinations. Medical certification examinations determine if an individual meets specific medical fitness standards, such as those promulgated for aviators and commercial drivers.  Medical Surveillance Examinations. Medical surveillance examinations, often referred to as occupational health examinations, provide baseline and periodic assessments or measurements to detect abnormalities in workers exposed to work-related health hazards. Copyright 2014 © The Windsor Consulting Group, Inc.

6 Medical Surveillance Program  Return to Work or Fitness for Duty Examinations These examinations are done for two principle reasons:  Establish whether the individual has made adequate recovery following the disability  Determination why the person may not be performing up to the standards of the position they hold or able to perform the essentials tasks of the job  Termination of Employment Examinations. These examinations are designed to assess pertinent aspects of a worker’s health when the worker leaves employment.  Termination of Exposure Examinations These examinations are performed when exposure to a specific hazard has ceased Copyright 2014 © The Windsor Consulting Group, Inc.

7 Medical Surveillance Program  Situational Examinations This examination is conducted in response to a specific incident for which a possible overexposure to a hazardous substance is suspected. Biological monitoring may be performed if validated indices are available.  Employee Health Promotion Examinations. Employee health promotion exams are non-occupational medical examinations given to workers as a benefit of improving personal health through nutrition, diet and exercise, helping reduce the risk or adverse outcomes of diabetes and high blood pressure, heart disease and stroke, smoking, alcohol use and pregnancy, etc.  Emergency Treatment Provisions for emergency treatment and acute non-emergency treatment should be made at each site. The range of hazards include chemical, physical (such as heat and/or cold stress, falls and trips), and biologic hazards (animal bites and plant poisoning as well as hazardous biological wastes). Copyright 2014 © The Windsor Consulting Group, Inc.

8 Medical Surveillance Program Occupational and Medical History Occupational and Medical History Copyright 2014 © The Windsor Consulting Group, Inc.

9 Medical Surveillance Program Occupational and Medical Questionnaire Occupational and Medical Questionnaire Make sure the worker fills out an occupational and medical history questionnaire. Review the questionnaire before seeing the worker. In the examining room, discuss the questionnaire with the worker, paying special attention to prior occupational exposures to chemical and physical hazards. Review past illnesses and chronic diseases, particularly atopic diseases such as eczema and asthma, lung diseases, and cardiovascular disease. Review symptoms, especially shortness of breath or labored breathing on exertion, other chronic respiratory symptoms, chest pain, high blood pressure, and heat intolerance. Copyright 2014 © The Windsor Consulting Group, Inc.

10 Medical Surveillance Program Occupational and Medical Questionnaire Occupational and Medical Questionnaire Identify individuals who are vulnerable to particular substances (e.g., someone with a history of severe asthmatic reaction to a specific chemical) or who may be not immunized or vaccinated for religious or other reasons. Record relevant lifestyle habits (e.g., cigarette smoking, alcohol and drug use) and hobbies. Neurological or psychological concerns which impact mental health, stability, or normal stress on the job or increase risk violent or abnormal behavior. Copyright 2014 © The Windsor Consulting Group, Inc.

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

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

13 Medical Surveillance Program Physical Exam Physical Exam Physical exam of all body organs, focusing on the pulmonary, cardiovascular, dermatology, and musculoskeletal systems. Note conditions that could increase susceptibility to heat stroke, such as obesity and lack of physical exercise. Note any cardiovascular, metabolic, or pulmonary disease, or two or more major cardiovascular disease risk factors that restricts offshore exercise physical activity Note conditions that could affect respirator use, such as missing or arthritic fingers, facial scars, dentures, poor eyesight, or perforated ear drums. Ability to work while wearing protective equipment Copyright 2014 © The Windsor Consulting Group, Inc.

14 Medical Surveillance Program Physical Exam Physical Exam Disqualify individuals who are clearly unable to perform based on the medical history and physical exam (e.g., those with severe lung disease, heart disease, neurological, psychological, or orthopedic problems). Note limitations concerning the worker's ability to use protective equipment (e.g., individuals who must wear contact lenses cannot wear full- face piece respirators). Provide additional testing (e.g., chest X-ray, pulmonary function testing, electro-cardiogram) for ability to wear protective equipment where necessary. Base the determination on the individual worker's profile (e.g., medical history and physical exam, age, previous exposures and testing). Copyright 2014 © The Windsor Consulting Group, Inc.

15 Medical Surveillance Program Physical Exam Physical Exam Implement pre-activity screening tools (e.g., physical activity readiness survey, health risk appraisal, or health history questionnaire) to provide a means for a prospective user of health fitness equipment to clearly determine their level of risk (e.g., low, moderate and high) before engaging in a program of physical activity. Make a written assessment of the worker's capacity to perform while wearing a respirator, if wearing a respirator is a job requirement. Note: No employee should be assigned to a task that requires the use of a respirator unless it has been determined that the person is physically able to perform under such conditions. Copyright 2014 © The Windsor Consulting Group, Inc.

16 Medical Surveillance Program Traditional Examination Tests Traditional Examination Tests  Pulmonary function tests should be administered if the individual uses a respirator, has been or may be exposed to irritating or toxic substances, or if the individual has breathing difficulties, especially when wearing a respirator.  Audiometric tests. Annual retests are required for personnel subject to high noise exposures (an 8-hour, time-weighted average of 85 dBA or more), those required to wear hearing protection, or as otherwise indicated by reports of a temporary or permanent shift in hearing.  Vision tests. Annual retests are recommended to check for vision degradation.  Blood and urine tests when indicated. Copyright 2014 © The Windsor Consulting Group, Inc.

17 Medical Surveillance Program Traditional Biological Tests Traditional Biological Tests FunctionTestExample Liver: General, Obstruction, and Cell injury Blood tests Enzyme test Enzyme tests  Total protein, albumin, globulin, total bilirubin (direct bilirubin if total is elevated).  Alkaline phosphatase.  Gamma glutamyl transpeptidase (GGTP),  Lactic dehydrogenase (LDH),  Serum glutamic-oxaloacetic transaminase (SGOT),  Serum glutamic-pyruvic transaminase (SGPT). Kidney: General Blood tests  Blood urea nitrogen (BUN),  Creatinine,  Uric acid. Multiple Systems and Organs Urinalysis  Including color; appearance; specific gravity; pH; qualitative glucose, protein, bile, and acetone; occult blood; microscopic examination of centrifuged sediment. Blood-Forming Function Blood tests  Complete blood count (CBC) with differential and platelet evaluation, including white cell count (WBC), red blood count (RBC), hemoglobin (HGB), hematocrit or packed cell volume (HCT), and desired erythrocyte indices. Reticulocyte count may be appropriate if there is a likelihood of exposure to hemolytic chemicals. Copyright 2014 © The Windsor Consulting Group, Inc.

18 Medical Surveillance Program Observed Effects Type of Exposure Lowered Number of Sperm Abnormal Sperm Shape Altered Sperm Shape Altered Hormones/Sexual Performance Inorganic LeadXXXX DibromochloropropaneX Carbaryl (Sevin )X Toluenediamine and DinitrotolueneX Ethylene DibromideXXX Styrene and Acetone)X Ethylene Glycol Monoethyl EtherX WeldingXX PerchloroethyleneX Mercury VaporX HeatXX Microwaves from RadarX Kepone**X Bromine Vapor**XXX Radiation** (Chernobyl)XXXX Carbon DisulfideX 2,4-Dichlorophenoxy Acetic Acid (2,4-D)XX Male Reproductive Hazards

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

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

21 Mental Health History Mental Health History Copyright 2014 © The Windsor Consulting Group, Inc.

22 Severity of Psychosocial Stressors in Adulthood Severity Acute EventsEnduring Circumstances None Mild Broke up with boyfriend/girlfriendFamily arguments Started or graduated from schoolJob dissatisfaction Child left homeResidence in high-crime region Moderate MarriageMarital discord Marital separationSerious financial problems Loss of jobTrouble with boss MiscarriageBeing a single parent Severe DivorceUnemployment Birth of first childPoverty Extreme Death of spouseSerious chronic illness Serious physical illness diagnosedOngoing physical or sexual abuse Victim of rape Catastrophic Death of childCaptivity as hostage Suicide of spouseConcentration camp experience Devastating natural disaster Nakao BioPsychoSocial Medicine 2010 4:4 doi:10.1186/1751-0759-4-4 Medical Surveillance Program Copyright 2014 © The Windsor Consulting Group, Inc.

23 Process StepSub-Step DescriptionResponsibility Step 1: Industrial Hygienist (IH) or Health, Safety, and Environmental (HSE) staff performs workplace assessment to characterize major chemical, biological, radiological, human factors/ergonomic, and/or physical agent exposure(s) as part of industrial hygiene/exposure monitoring survey to validate TBRAs. 1. Using Control Banding - define Similar Exposure Groups (SEG): The IH/HSE staff will group workers having the same general exposure profile by control banding based on: a. Similarity, duration, and frequency of the tasks they perform b. Materials, operation, and processes with which they work c. Similarity of the way they perform the work tasks based on performance using Standard Operating Procedures (SOPs) Medical Director and Regional HSE Manager 2. Define Task-Based Risk Assessment Profiles for each SEG: The IH/HSE will use quantitative and qualitative data, including exposure monitoring to determine: a. The degree of personnel exposure b. Estimates of the actual exposure levels for the SEG c. Specialized biological monitoring to evaluate exposure indices 3. Make Judgments on Acceptability of the Exposure Profile for each SEG- The IH/HSE shall judge the SEG exposure profile as acceptable, uncertain, or unacceptable. The IH/HSE shall a. Determine and document the rationale for each judgment b. Evaluate and determine the adequacy of existing controls 4. Make Control Strategy Recommendations - The IH/HSE makes appropriate recommendations regarding the workplace, workforce and environmental agents based on the results of the exposure assessments by using accepted industrial hygiene practices, which also comply with appropriate regulatory requirements. a. Include hazard-based medical surveillance recommendations for SEGs determined to have moderate to high exposure profiles 5. Communication -IH/HSE communicates applicable medical surveillance recommendations to the surveyed activity (HSE Manager, P&O Manager, HSE Officer, and Medical Director (when applicable)) via the industrial hygiene survey. a. IH/HSE explains how every section of the IH survey helps contribute to the overall Occupational Safety and Health program effectiveness for their group b. IH/HSE explains hazard-based recommendations and also informs regional leadership about additional requirements to certify exams for their personnel 6. Record Keeping – IH/HSE documents exposure data in the Occupational Health Data Management System Process StepSub-Step DescriptionResponsibility Step 2: Department Head, Regional P&O Manager, and/or HSE Manager reviews outcome of most current industrial hygiene survey and TBRA results with Supervisors 1. Department Head, Regional P&O Manager, and/or HSE Manager works with supervisors to identify each specific worker (by name) recommended for hazard based surveillance, including new check-ins during check-in process from TBRA. Department Head, Regional P&O Manager, or Regional HSE Manager 2. Department Head, Regional P&O Manager, and/or HSE Manager places each worker into the company’s manual or automated tracker system 3. Schedule required medical surveillance examinations for workers with sufficient lead time to complete examinations and maintain qualifications based on the company's operational schedule Medical Surveillance Program Copyright 2014 © The Windsor Consulting Group, Inc.

24 Medical Surveillance Program Process StepSub-Step DescriptionResponsibility Step 3: Worker or Supervisor contacts Regional HSE Manager, P&O Manager or Medical Director’s office (when applicable) to schedule initial baseline, annual, or termination exam 1. Communicate worker’s required exams to Occupational Health staff and verify any paperwork that worker needs to bring to exam Individual Supervisor, Regional HSE Manager, P&O Manager and/or Company Medical Director 2. The Medical Director may perform several Occupational Health Medical Surveillance examinations. If performed by an affiliated Company MDR, the MDR should document the exam appropriately. 3. Supervisor accommodates exam in worker’s schedule Process StepSub-Step DescriptionResponsibility Step 4: Occupational Health clinic utilizes TBRA Matrix to consolidate all required exam elements into one (if possible) exam visit N/AMedical Director Process StepSub-Step DescriptionResponsibility Step 5: Worker reports to Company Medical Department for physical exam (when applicable) at appointed exam date/time N/A Individual Supervisor, Regional HSE Manager, P&O Manager Medical Director and Individual Worker Process StepSub-Step DescriptionResponsibility Step 6: Medical Director (when applicable) performs physical exam, collect appropriate specimens/samples and documents exam completion and disposition based on all of the observations and findings 1. Place hardcopy of exam completion in medical record (when applicable)Medical Director 2. Enter exam completion into electronic medical record 3. Notify P&O Manager and Supervisor of exam completion and disposition - Qualified - Not Qualified - Qualified with Work Restrictions 4. Results indicating overexposure to a health stressor should be forwarded to the worker’s Supervisor, P&O Manager, and HSE Manager 5. Complete a Medical Surveillance Exam Completion and Disposition form Process StepSub-Step DescriptionResponsibility Step 7: Worker returns to work with exam completion documentation 1. Medical Director or other Company MDR provides objective documentation of exam completion and disposition to worker - Qualified - Not Qualified - Qualified with Work Restrictions Medical Director 2. Examining physician completes a Physician's/Provider's Written Opinion form Copyright 2014 © The Windsor Consulting Group, Inc.

25 Process StepSub-Step DescriptionResponsibility Step 8: Supervisor concurs or non-concurs with exam completion and updates by Regional HSE Manager or Medical Director 1. Worker provides copy of objective documentation to Supervisor, Regional P&O Manager and/or HSE Manager Supervisor, Regional HSE Manager, P&O Manager, and/or Medical Director 2.HSE Manager or Medical Director updates occupational health tracking system Process StepSub-Step DescriptionResponsibility Step 9: Regional HSE Manager or Medical Director updates tracker system with exam date and next exam due date 1. Occupational health tracker can take any form a. Automated system b. Manual system (Excel, Access, etc.) Regional HSE Manager, P&O Manager, and/or Medical Director Process StepSub-Step DescriptionResponsibility Step 10: Regional HSE Manager and/or Medical Director checks tracker system for scheduling periodically (monthly but not longer than quarterly recommended) 1. Regional HSE Manager or Medical Director notifies Supervisors of personnel coming due for medical surveillance exam within 45 (recommended) days Regional HSE Manager, P&O Manager, and/or Medical Director 2. Supervisor alerts worker of exam due 3. Supervisor or worker contact by Regional HSE Manager, P&O Manager, and/or Medical Director for exam scheduling/appointment (Return to Process Step 3) 4. Supervisors should inform Regional HSE Manager, P&O Manager or Medical Director if worker changes job duties and may no longer need to be enrolled in program. Regional HSE Manager or P&O Manager should consult with Medical Director regarding Termination Exam prior to official disenrollment from program. Process StepSub-Step DescriptionResponsibility Step 11: Regional HSE Manager or P&O Manager calculates and reports exam/BEI completion rates for medical surveillance program based on occupational health tracker data 1. Calculate the overall exam completion rate using the following formula: Occupational Medical Exam Completion Rate (%) = # of personnel receiving required medical exams x 100 divided by the # of personnel requiring medical exams for occupational exposures Regional HSE Manager, P&O Manager, and/or Medical Director 2. Calculate the overall audiogram completion rate using the following formula: Occupational Audiogram Completion Rate (%) = # of personnel receiving required audiograms x 100 divided by the # of personnel requiring audiograms 3. Calculate the overall BEI completion rate using the following formula: Occupational BEI Completion Rate (%) = # of personnel receiving required BEIs as part of their medical exam x 100 divided by the # of personnel requiring medical exams for occupational exposure 4. Calculate the overall occupational health performance using the following formula: Overall Qualified Workforce Rate (%) = # of personal considered “qualified or qualified with restriction x 100 divided by total number of examinations 5. Report the overall Occupational Medical Exam Completion Rates to higher corporate manager via the annual HSE self-assessment process Process StepSub-Step DescriptionResponsibility Step 12 (if applicable): Medical Director notifies Supervisor via Regional P&O Manager, HSE Manager, if exam indicates “Qualified” or “Qualified With Restrictions 1. Notification should be addressed to the Supervisor, Regional HSE Manager and P&O Manager Regional HSE Manager, P&O Manager, and/or Medical Director Medical Surveillance Program Copyright 2014 © The Windsor Consulting Group, Inc.

26 Medical Surveillance Program Process StepSub-Step DescriptionResponsibility Step 13 (if applicable): If worker is deemed medically “Not Qualified”, or “Qualified with Restrictions” the Regional HSE Manager, P&O Manager, and/or Medical Director consults with Supervisor regarding findings 1. Quantitatively characterize exposure(s) Regional HSE Manager, P&O Manager, and/or Medical Director 2. Consider possible control measures 3. Re-evaluate individual work exposure, working/operating conditions, and the selection and use of personal protective equipment 4. Determine follow-up exam recommendations and further testing for confirmation Process StepSub-Step DescriptionResponsibility Step 14 (if applicable): Medical Director notifies Regional HSE and P&O Manager of reportable illness or injury from occupational exposure or mishaps 1. Utilize absenteeism, accident, injury and illness statistics, reports, email, or other notification method to ensure Regional HSE Manager, P&O Manager, Medical Director, and Supervisor are aware of all reportable occupational related illnesses and injuries Regional HSE Manager, P&O Manager, Process StepSub-Step DescriptionResponsibility Step 15 (if applicable):Regional HSE Manager reports loss time or restricted workdays related to occupational illness and injuries to Corporate HSE Manager 1. Report recordable occupational illness and injury statistics to the Corporate HSE Manager Regional HSE Manager 2. Report near-miss occupational illness and injury statistics to the Corporate HSE Manager 3. Compare regional occupational injury and illness statistics with corporate performance metrics and benchmarks Process StepSub-Step DescriptionResponsibility Step 16 (if applicable): Contract workers with possible occupationally-related health issues or injuries contact Regional HSE Manager, P&O Manager, and Contracts Department Head 1. If abnormality in lab results or medical examination is perceived to be work related based on contractor physical provided to their personnel, information should be shared and provided to Regional HSE Manage Regional HSE Manager, P&O Manager, Contracts Department Head, and Contractor Management 2. Using control banding with SEGs, HSE staff should determine if company personnel may be at risk for similar adverse outcomes from occupational exposure Process StepSub-Step DescriptionResponsibility Step 17: Regional HSE Manager and/or Medical Director periodically assesses the tracker to ensure proper updating and compliance status 1. Regional HSE Manager or Medical Director must frequently communicate with P&O Manager and Supervisors in order to maximize likelihood of proper personnel identification, enrollment, tracking, and exam completion. Regional HSE Manager, and/or Medical Director 2. Update tracking system as needed. Process StepSub-Step DescriptionResponsibility Step 18: Corporate HSE provide oversight of regional medical surveillance program implementation, assessment, and quality control/assurance Corporate HSE periodically assess regional HSE programs during annual health and safety self-assessment rollup or during required triennial Occupational Safety and Health Management Evaluations Corporate and Regional HSE Managers, and/or Medical Director Copyright 2014 © The Windsor Consulting Group, Inc.

27 ComponentRecommendedOptional Executive Physical Examination  Medical history review on reported physical/mental ailment  Comprehensive physical  Laboratory tests: o CBC (Complete Blood Count) with differential o Urinalysis o Chemistry profile including lipid profile/cholesterol screening, blood sugar, liver and kidney profile o Thyroid function tests o C reactive protein, homocysteine  Colorectal cancer screening  EKG (Electrocardiogram)  Body composition analysis  Spirometry, as needed  Audiometry, as needed  Visual acuity, as needed  Immunizations: MMR (measles, mumps,  rubella) if born after 1956, tetanus every 10 years and hepatitis, as needed  Pap smear (women)  PSA (prostate specific antigen): Annual testing typically begins at age 45 (men) Additional exam components are provided when recommended:  Baseline mammogram at age 38 (women)  Audiology evaluation  Eye examination with glaucoma screening  Dermatology evaluation  Nutrition consult  Chest X-ray  Cardiac stress test (non-imaging): Baseline at age 45 repeat every 2 years  Bone densitometry: recommended at menopause and then every two years or upon physician recommendation  Colonoscopy at age 50 and then every 5 to 7 years. Copyright 2014 © The Windsor Consulting Group, Inc. Medical Surveillance Program

28 ComponentRecommendedOptional Staff Pre-Placement Screening  Medical history review on reported physical/ mental ailment  Occupational history.  Physical examination.  Determination of fitness to work and wearing protective clothing, respirator, and equipment.  Audiometry testing, as needed  Laboratory tests: o CBC (Complete Blood Count) with differential o Urinalysis o Chemistry profile including lipid profile/cholesterol screening, blood sugar, liver and kidney profile o Specific biological indices  Immunizations: MMR (measles, mumps, rubella) if born after 1956, tetanus every 10 years and hepatitis, as needed  Pap smear (women)  PSA (prostate specific antigen): Annual testing typically begins at age 45 (men)  Chest X-ray, as needed  Colonoscopy at age 50 and then every 5 to 7 years.  Pulmonary function test (PFT) – Spirometry from respirator use.  Eye examination  Baseline mammogram at age 38 (women)  Dermatology, as needed  EKG (Electrocardiogram)  Freezing pre- employment serum specimen for later testing (limited to specific situations, Copyright 2014 © The Windsor Consulting Group, Inc.

29 ComponentRecommendedOptional Staff Periodic/Annual Medical Exam  Yearly update of medical and occupational history; yearly physical examination; testing based on (1) Initial/periodic exam results (2) Exposures, and (3) Job class and task (4) Risk rank based on hazard  More frequent testing based on specific health condition or risk of exposures.  Specific monitoring requirements of OSHA health standards  ACGIH Biological Exposure Indices (BEIs) based on chemical exposure  Audiometric exam (if applicable)  Pulmonary function test (if needed based on respirator use)  Laboratory tests: o CBC (Complete Blood Count) with differential o Urinalysis o Chemistry profile including lipid profile/cholesterol screening, blood sugar, liver and kidney profile  Yearly testing with routine medical tests, as needed Staff Termination Medical Exam  Update of medical and occupational history; final physical examination; and lab testing based on: (1) Examination results, (2) Exposure monitoring, and (3) Job class and task (4) Risk rank based on hazard  Medical tests, as needed Medical Surveillance Program Copyright 2014 © The Windsor Consulting Group, Inc.

30 ComponentRecommendedOptional Emergency Treatment  Emergency first aid on site.  Liaison with local hospital and medical specialists.  Decontamination of victims.  Telemedicine where needed  Arrange for transport of victims.  Transfer medical records; give details of incident and medical history to next care provider.  Lab tests based on hazard  Medical follow-up based on exposure potential and exam outcome  Freezing serum specimen for later testing (limited to specific situations,  Reporting medical outcome to HSE, P&O, and leadership Non-emergency Treatment  Develop mechanism for non-emergency health care.  Construct total body health, nutrition, diet, exercise, and wellness program  Counseling for physical and mental health  Progress and follow-up, as needed Return Back to Work or Fitness for Duty Exams  Physical or mental exam based on written policy to; o Determine adequate recovery, o Validate reason not performing up to the standards of the job, o Confirm diagnosis or extent of related limitations or restriction o Prognosis or anticipated length of physical/mental disability o Reasonable accommodations process to aid the impairment which may make achievement difficult or limits the capacity for work o Review and confirm/rebut opinion to treating healthcare provider  Align return back to work and fit for duty policy with family and medical leave Medical Surveillance Program Copyright 2014 © The Windsor Consulting Group, Inc.

31 Medical Surveillance Program Component RecommendedOptional Recordkeeping and Review  Maintain and provide access to medical records in accordance with internal standard.  Report and record occupational injuries and illnesses.  Review risk assessment for work task regularly to determine if additional testing is needed.  Align recordkeeping with data from exposure monitoring  Evaluate exposure monitoring data with adverse outcomes to evaluate effectiveness of control measures to reduce risk  Review and audit program periodically.  Focus on current site hazards, exposures, risk and industrial hygiene standards/guidelines  Annual report of occupational related injuries and illness  Annual report of medical intervention based on hazard  Annual report on trending medical cost for examinations, treatment, and rehabilitation therapy for return personnel back to work Copyright 2014 © The Windsor Consulting Group, Inc.

32 Medical Surveillance Program Target Organs Medical Surveillance Criteria Required Exam Required Medical History Physical Exam Elements Required Special Procedures Other Required Elements Peripheral nervous system Central nervous system Eyes Mucous membranes Respiratory Liver and kidneys Employees who are or may be exposed : - At or above 0,012 mg.m 3 AL 8-hour TWA for more than 30 days per year - At or above 0,025 mg.m 3 PEL 8-hour TWA for more than 10 days per year - At or above 0,025 mg.m 3 for 30 days or a maximum ceiling value of 0.1 mg.m 3 for more than 10 days a year - At or above BEI criterion Note: Adjust AL or PEL 8-hour TWA exposure values for extended 12- hour workshift (i.e., multiply each value by 0.67 to get correct guidance on exposure levels Initial (baseline) Annual Reassignment or termination of occupational exposure Emergency exposure collect blood/ u rine sample prior to for urinary mercury or at the end of the shift for blood mercury levels. Medical removal from work exposure when requested by nephrologist Detailed work exposure history (provided by employer) Medical history including: - Past exposure via inhalation or skin absorption to elemental or organic mercury compounds - Renal disease - Liver disease - Medication history - Exposure from dietary sources - Personal or family history of mercury exposure Examinations conducted by or under the direct supervision of a licensed physician Initial complete physical exam Detailed medical and occupational History initially, brief update annually Complete physical examination with focus on the blood, skin from absorption, CNS, and liver and kidney function Respirator medical exam if required Annual: Brief history regarding any new exposures, changes in CNS, PNS, liver and kidney function Complete blood count (CBC), urinalysis, voluntary pregnancy test, and urine/blood mercury (results reviewed by examining physician) Other tests deemed appropriate by the physician PFT (every 3 years if required to use a respirator >30 days a year) Emergency exposure: Annual exam requirements plus urinary/blood mercury test BEI: >35 ug total inorganic mercury/g creatinine prior to work shift and/or >15 ug/l total inorganic mercury in blood end of the work shift at end of workweek Physician’s written opinion to employer: - Results of medical examination and testing - Opinion whether exposure places worker at increased risk for health impairment - Recommended work limitations - Statement that employee has been informed of exam results and conditions that may require further evaluation Employer shall provide copy of written opinion to affected employee Medical Surveillance Program for Exposure to Inorganic Mercury Copyright 2014 © The Windsor Consulting Group, Inc.

33 Target Organs Medical Surveillance Criteria Required Exam Required Medical History Physical Exam Elements Required Special Procedures Other Required Elements Blood/bone marrow Central nervous system Eyes Respiratory Skin Kidneys Employees who are or may be exposed : - At or above 0.25 ppm 8-hour AL TWA more than 30 days per year - At or above 0.5 ppm PEL 8-hour TWA or peaks of 2.5 ppm for 15-min STEL for more than 10 days a year - At or above BEI criterion - At or above 1 part per million (ppm) 30 days per year prior to 1987 - Exposure to >0.1% benzene solvent or exposure from oil/gas products Note: Adjust A or PEL 8-hour TWA exposure values for extended 12- hour workshift (i.e., multiply each value by 0.67 to get correct guidance on exposure levels Initial (baseline) Annual Reassignment or termination of occupational exposure Emergency exposure collect u rine sample at the end of shift for urinary phenol test within 72 hours and urine specific gravity corrected to 1.024. If urinary phenol test is equal to or greater than 75 mg phenol/L of urine, repeat CBC monthly for three (3) months. Medical removal from work exposure when requested by hematologist/internist Detailed work exposure history (provided by employer) Medical history including: - Past exposure to benzene or other blood/bone marrow toxins - Renal disease - Liver disease - Medication history - Exposure to ionizing radiation - Exposure to bone marrow toxins outside the work environment - Personal or family history of blood dyscrasias including blood/bone marrow neoplasms, genetic hemoglobin abnormalities, bleeding disorders, or abnormal function of formed blood elements Examinations conducted by or under the direct supervision of a licensed physician Initial complete physical exam Detailed medical and occupational History initially, brief update annually Complete physical examination with focus on the blood, skin from absorption, CNS, and liver and kidney function Respirator medical exam if required Annual: Brief history regarding any new exposures, changes in any drug use, and appearance of physical signs relating to blood disorders Complete blood count (CBC) (results reviewed by examining physician) Other tests deemed appropriate by the physician PFT (every 3 years if required to use a respirator >30 days a year) Emergency exposure: Annual exam requirements plus end of-shift urinary phenol test BEI: >25 ug/l S- phenylmercapturic acid in urine at end of workshift or > 500 mg t,t-merconic acid/g creatinine in urine at end of workshift Refer to full standard for guidance on further evaluation/ordering of laboratory tests Physician’s written opinion to employer: - Results of medical examination and testing - Opinion whether exposure places worker at increased risk for health impairment - Recommended work limitations - Statement that employee has been informed of exam results and conditions that may require further evaluation Employer shall provide copy of written opinion to affected employee Medical Surveillance Program for Exposure to Benzene Medical Surveillance Program Copyright 2014 © The Windsor Consulting Group, Inc.

34 Target Organs Medical Surveillance Criteria Required Exam Required Medical History Physical Exam Elements Required Special Procedures Other Required Elements Blood/bone Marrow Central and peripheral nervous systems Gastrointestinal System Gums Kidneys Reproductive System Cardiovascular system Employees who are or may be exposed: -At or above the 0.025 mg/m 3 AL TWA for more than30 days a year -At or above the 0.05 mg/m 3 PEL TWA for more than 10 days a year Examinations must be conducted by or under the supervision of a licensed physician A multiple-physician review may be required for discrepancies in medical opinion or diagnosis. Note: Adjust AL and PEL 8- hour TWA exposure values for extended 12-hour workshift (i.e., multiply each value by 0.67 to get correct guidance on exposure levels Pre-placement (baseline) Annual (at least annually for any employee with a blood lead level (BLL) at or above 40 μg/100g in preceding 12 months) Emergency exposure When medically appropriate for each employee either removed from or otherwise limited with regard to lead exposure Upon request of employee for medical advice regarding lead exposure and reproductive health As required for respirator clearance Reassignment or termination of occupational exposure Detailed medical and work history with emphasis on: - Past lead exposure - Occupational - Non-occupational - Personal habits - Smoking - Hygiene - Past problems - Gastrointestinal - Renal - Reproductive - Neurological - Hematologic Examinations conducted by or under the direct supervision of a licensed physician Complete physical exam with particular attention to: - Teeth - Gums - Hematologic system - Gastrointestinal tract - Kidneys - Heart - Blood vessels - Blood pressure - Neurologic system - Lungs (if respirator will be required) Blood lead (at least every 6 months) CBC with indices and peripheral smear morphology Zinc protoporphyrin (ZPP) (required each time a BLL is measured) BUN Cr Urinalysis (UA) with microscopic Medical evaluation if respirator required For biological Monitoring BEI: >30 ug lead/100 ml blood. Use control banding to evaluate similar exposures for different work tasks. Employee may request additional physician evaluation (up to three physicians total) Other tests deemed appropriate by examining physician Physician’s written opinion that includes: - Whether employee has a medical condition placing the employee at increased risk from lead exposure - Any recommended protective measures or limitations for employee - Any recommendation regarding limited use of respirators - Results of blood lead determinations - Statement that employee has been informed of exam results Medical Surveillance Program for Exposure to Inorganic Lead Medical Surveillance Program Copyright 2014 © The Windsor Consulting Group, Inc.

35 Questions?


Download ppt "The Model for Medical Surveillance Program for Caribbean Upstream Oil/Gas Producer Presented by: Bernard L. Fontaine, Jr., CIH, CSP The Windsor Consulting."

Similar presentations


Ads by Google